Life on the Ward

            It has been a while since I’ve updated this blog.  Life here is draining, and often the only thing I want to do with my free time is sleep, or read about other people’s lives on Facebook.  Getting together the drive to post a new entry is simply beyond me.  But there are so many people who have kindly expressed interest in my life, and I wouldn’t be here without your support, so now let me share some of my life here with all of you.

A young girl works by the side of the road.  Note the minaret of a mosque in the background.  That is one of the most common sights in Hargeisa.  Another common sight: plastic bags and other waste carpeting the brush on the roadside.

            I have mostly settled into a routine on the Medical Ward.  I care for anywhere from 2-5 patients, depending on the wildly fluctuating hospital census.  We care for a range of conditions here, from babies with pneumonia to adults with uncontrolled diabetes, to strokes and heart attacks.   

Much of what we see is difficult to process, as someone trained in a part of the world where no one suffers because we simply don’t have what we need.  Insurance may refuse to pay for things, but everything is available back home.  Here I have seem multiple cases of children, some as young as 3 months old, brought into Edna’s because the staff at another facility administered a drug called Plasil to stop vomiting.  In truth, the children would be better served with IV fluids and monitoring, but that’s hard for an anxious parent to accept.  Plasil is metoclopramide, known back home as Reglan.  It is not indicated for children under any circumstances, as it causes EPS reactions with much greater frequency than it does in adults.  The hallmark reaction in the children I’ve seen is hyperextension of the neck, lasting for hours.  In short, their neck muscles stiffen, and they are forced to look skyward for hours, until they come to us and we administer Valium.  Why do other hospitals and clinics routinely give Plasil to children, given the dangers?  Well, it’s the only anti-emetic available here, and when a child has been vomiting for some time and the parents beg you to do something, anything, some health workers just give it, even though they know better, hoping the child won’t have a reaction.  This kind of problem, one cause by privation rather than ignorance, is so hard to see.  It’s fairly straightforward to fix mistakes caused by a lack of knowledge (impart knowledge!), but without resources, the knowledge can be useless.

One of the most interesting cases I’ve been dealing with has been the care of an infant with an intractable facial infection.  A foundling who was discovered by a river, in a fetid pool, with her cord still attached, and was taken in by a family with 6 children and another one the way (baby #7 has since been born), baby H had some sort of infection or skin condition from birth, and was severely burned by the concoctions of a traditional healer before being brought here by her foster mother.  The family is too poor to afford medical care, so two of the staff here have taken on the bulk of her expenses, with the rest of us contributing in small ways where we can, by paying for a blood test, or buying a pack of diapers.  The infection causes redness, swelling, weeping sores and eventually a drying and sloughing off of the outer layers of the skin.  It may be a condition called Staphylococcal Scalded Skin Syndrome, but we need a culture and a skin biopsy to confirm that diagnosis.  Baby H has been in and out of the hospital several times in her short life, but each recovery is followed by a relapse.  There is a pathologist at the hospital now, and we hope that the next few weeks will bring us confirmation of a diagnosis, with the appropriate meds being brought over from England by a visitor if they aren’t available here.  I can’t post pictures of Baby H, for privacy reasons, but trust me, she is adorable, and everyone here is rooting for her permanent recovery.

When I’m not on the ward I can sometimes be found in the classroom.  I teach English once a week to the first-year nursing students.  I spoke to Edna today, and she would also like me to begin teaching English to the Pharmacy students in the near future.  My first lecture on a medical topic will be in October—I’ll be presenting an overview of Gestational Diabetes to the BSc Midwifery students.  It should be review for them, but one thing I‘ve learned here is that I should never assume that the information landed the first time around.  As some of you know, I love teaching, and I greatly enjoy my time in the classroom. 

I thinks that’s all for now—I need to save something for the next update!  I hope you are enjoying my stories so far, I certainly enjoy sharing them with all of you. 

If you would like to support my volunteer work here at the Edna Adan Hospital, please consider making a tax-deductable donation to help me cover the cost of my room and board, as well as an eventual return ticket.  Any amount is appreciated, and checks made out to the East Sandwich Friends Meeting, and marked in the memo line for the Brown Fund, can be mailed to PO Box 198, East Sandwich MA, 02537.  Please include a request for a receipt if you would like one.  Thanks to everyone who has supported me so far!