Urgences - the 'intensive care unit'

Despite some jet lag and 3am awakenings, I've been back to the hospital this week. I'm impressed with the work my colleagues have gotten done over the last few weeks. While we are physicians - with no business or admin training, our jobs are mostly administrative... Leah has organized most of the renovation of 10 rooms of the pediatrics ward to use for our transitional clinic - getting quotes on items, liasing with architechts & building managers and the head of pediatrics. Suzanne has been spear heading getting terms of reference agreed upon by the various sides and will be liasing with the maternity care people to ensure that kids get referred. Dana has been working on getting our translated curriculum reviewed - and in between they've been helping out on the wards.

I've taken on some of the lower profile, less 'sexy' parts - lab, monitoring & evaluation, training sessions. With my informatics, ID & public health training, I'm the only one trained to do the job I'm doing right now!

The Urgences is a difficult ward. There are about 14 beds, but 2 kids / bed. The room is small, chaotic and noisy. Although since it is the critical care unit there are more staff, and its easier to get urgent things done. There are several cases of malaria, meningitis, and malnutrition. A couple kids with chronic health conditions for which there is no treatment here - one two year old child with an unknown congenital heart lesion that would have been echoed, likely surgically managed and followed carefully in resource-rich settings. The parents are doing their best for their kids but often follow sometimes harmful traditional therapies before the last-ditch hospital visit... like the kid today with coma (likely from meningitis or severe malaria with neurologic involvement - a daily occurence here) who's parents took him to a traditional healer who recommended ?sitting him in very hot water to rouse him... so now he has not only potential brain damage but 2nd degree scalds to buttocks, 'private parts' with little chance of keeping them clean, dressing them properly etc.

On a positive note, with our incessant questions / suggestions about use of vitamin A for malnutrition, the Urgences ward managed to 'borrow' some from a district health post. It appears that vitamin A is provided for free to the CSPS' but not to the hospital. The pharmacies don't carry it as it rarely sells (and they are businesses above all) - therefore, in the hospital they haven't been giving it even to kids with kwashiorkor & marasmus. So we have a temporary solution, anyhow.

So, like all weeks some ups and downs... I'm trying to write a more balanced blog with both good & bad presented... its easier to sound more negative than I really intend to be. I'm off to Ouaga again for a national level planning meeting with ESTHER, another big NGO. The "Center of Excellence" groundbreaking is scheduled for next week - hooray!