My first paracentesis, for starters....
Today was for the most part, pretty 'piece-meal'. I did just a little bit of everything. While my counterpart continued to see patients in the adult outpatient clinic, I headed to the antenatal department to see if I could touch bases with the midwives regarding any imminent or looming deliveries. Unfortunately for me, there were no women in labor. Next I headed to the inpatient department, continuing my search for work, where I overheard one of the docs discussing the need to do a paracentesis on a patient with advanced liver failure. I decided to wait around a bit, following this doc on his am rounds, hoping to get in on the action. My waiting paid off because yours truly had the chance to perform the tap (African style of course and with guidance from the staff!). It was actually quite embarrassing, because after I removed a couple liters from the woman's abdomen, she began to refer to me as an angel sent from heaven (It's not like I did anything different from the National staff! however, the color of my skin makes me 'an angel sent from heaven'). For the rest of the week, the staff kept poking fun at me, calling me angel and telling me to just go touch her belly and give her Tylenol as it was bound to have the placebo effect and cure her of all of her ailments! EMBARRASSING.
Once the procedure was finished and after I laid my hands on her belly (just for good measure :)), I went to check in with the inpatient department nurses who were frantically running around, attempting to catch up with all of the Malaria cases that had come in. There I did everything from logging/recording admits and discharges, to counting empty vials and syringes so as to ensure that our stock numbers were up to date, to acting as a courier; running to and from the lab delivering Typhoid and Malaria tests and results, taking blood pressures and giving doses of IV Quinine and Artesunate for the more severe Malaria cases.
I also had the opportunity to be present during a nutrition consult, which involved a mother and her six children, who had recently arrived from the DRC. Never before had I seen such malnourished kids! From what I gathered, a community health worker (CHW) had come upon the woman during one of her home visits and instantly recognized that her child needed immediate attention. Supposedly the mother was unaware that her child was sick and proceeded to tell the CHW that she in fact had five other children that should perhaps be seen as well. The next day, the mother and all of her six children arrived at the clinic and all were found to be severely malnourished. Her oldest child was by far the worst off. At six years of age he was unable to walk and appeared to be perhaps 3 years old, his head being completely disproportionate to the rest of his body which had stopped growing early into his development. The other children did not look quite as malnourished on first glance, however all of their MUACs (Middle Upper Arm Circumferences) were found to be in the RED which is a sign of severe acute malnutrition (SAM). The worst part is that this mother told us that she felt a great need to have at least six more children! All of the children were admitted so as to be placed on a regimented feeding program for frequent monitoring and evaluation and so that education could be given to the mother.
The nutritionist requested that I take a few photos to send to UNHCR. I only had my iPhone on hand, so the photos are not of great quality, but you can get the idea.