Day 25-26 Last Day working in Lilongwe and Bimphi Rural Clinic

My last day working in Lilongwe was spent teaching CPR in the morning to nursing students. Which is pretty funny when you try to show American videos which include "call for help and get an AED". AED's don't exist here, and an EMS service doesn't either!!



Lucky one of the clinical officers, trying out
some chest compressions. No one really
wanted to assess A or B first lol!



Teaching CPR at Daeyang Luke

Day 25 afternoon was spent at Partners in Hope. A non-profit clinic and hospital started and run by Dr. Jansen for HIV/AIDS patients. There is a cryptococcal research project being conducted on the premise, in addition to several HIV surveillance projects.


On the evening of Day 25 (A Friday), we decided to hit the town! Dinner at Latitude 13, followed by a Christmas Cantata.



Dinner at Latitude 13, probably the nicest
place you can eat in Lilongwe! With Donna
and Roberta



Food amazing!!! Cost us a whole 15 dollars a plate, which is
insanely expensive for here! With Laci



Christmas Cantata post dinner! With Jolynn
who sang!



One of the neighbor's cooks drops by to
have his son tested for malaria!

Day 26- Last day working in Africa! Bimphi rural clinic! Located approximately 1.5 hours drive north of Lilongwe. The mobile clinic was set up by Sam of E3. We saw approximately 450 patients between 2 US EM physicians and 2 Clinical officers. Most of the complaints were general body aches, stomachaches, and cough. This is not that shocking when you work all day in a field, while carrying a baby (for the women!), sit around a fire all the time, and only eat carbohydrates. There was a lot of time spent with education to say the least. Each clinic you see a few zebras (no not the African ones, the medical ones) who throw you for a loop, and make you go home and try to re-hash STEP 1 material. It was an amazing last day to end an amazing trip! I can't wait to come back for the next adventure!


Last day working! Rural clinic in Bimphi!



Scenery on the way to Bimphi!



The shops of Bimphi!



Our Bimphi Team!



Setting up for Clinic! Maula brings her 2 month old for her first
clinic with her parents!

The patients line up to be seen in Bimphi!
 



A young Bimphi female!



A classroom in Bimphi



Three young children wait to be seen
in the clinic. Some are orphaned, and may
not have a parent to accompany them. Makes
it a bit hard to hand out Tylenol!!









Jolynn helps me to translate at my clinic
station!



A boy in Bimphi to greet us!



Rapid Malaria testing for basically any
young child with fever! Tis the Season!



My patient looks like he wants to bail!



Dr.Ivey examines a Bimphi patient

These three young girls showed up alone,
complaining of headache!

I hope the bridge holds up!
 



Goodbye Bimphi! Sad you leave you Africa!
 




















 

 

 

 

 

 

 

 

 

Day 21-24 Back at Daeyang Luke

The last week was spent at Daeyang Luke in the Casualty department.

 

The interesting cases of the week included a chronic traumatic knee

effusion, drained of course with a catheter. A older woman with a ulcerated left breast came in after 5

years! Previously diagnosed as eczema with a biopsy that was negative for Pagets, but likely very superficial. We had a post-op patient fistulotomy patient with an ileus vs. volvulus. The surgeon was quick to want to go to the OR but luckily was convinced to try to scope the patient first. On the ward the patient made a full recovery, but as per his wife was dying of hunger. The Malawians can't even go two days without their nsima!

 

Typical Solution at Daeyang, drain it with a catheter

 

Chronic traumatic knee effusion

Ileus vs. Volvulus? Post fistulotomy

Sadly we had one child this week with suspected cerebral malaria. She had be diagnosed the previous day with malaria, started on LA, but continued to have fever, and became progressively more altered. She responded only to pain on exam, and had periodic episodes where she would shake her arms and legs. It wasn't a typical seizure, and even after her fever came down, she continued to have periodic episodes of shaking, mainly with tactile stimulation. it was quite a feat to find some rectal Tylenol as it is not routinely given! I couldn't find an answer to whether PO could be used in the rectum on google! She was started on Quinine, and then treatment for suspected meningitis infection. Many children with cerebral have a very poor outcome, and live with long term seizure disorders, as well as physical and mental incapacities.  



Transferring a pediatric trauma patient,
Malawian ambulance driving is quite an
experience!



Writing admission orders, hard at work!

The other pediatric case of the week which was very disheartening was an auto vs. ped. The young boy was hearding cattle when he tried to get his cows across a street and was struck at 50kph. He had a GCS of 8 on  arrival and a large laceration on his forehead. He was taken to the CT scanner, and was not found to have a bleed, by our radiology scan. The boy was stable to be transferred to KCH, the community hospital which does have a neurosurgeon on staff. Granted, this hospital is frequently out of medications, anesthesia drugs, and even water!! The ambulance drive was a bit scary, I was hoping not to become a trauma patient myself!! 

The COGRATULATE cake! For Sister
Beak (Mission Director of Daeyang Luke)
 who earned the Florence Nightengale
award.

Thursday afternoon, was spent helping to run a seizure clinic.
Many of the children had been afflicted by malaria, meningitis, or complications during birth, and are now suffering from the sequelae. Trying to come up with combinations of carbamazepine, phenytoin, and phenobarb is definitely beyond my scope! I am not envious of neurologists!!