Tuesday, June 23: Day 2

(Katherine) 

Tuesday at St. Peter’s Hospital is the day for Family Planning and the Under Fives Clinic, all while the urgent care outpatient center is operating.

When I arrived, a little before morning prayer, I visited baby Jacob and his family. We enjoyed laughing together and talking about the trip the family would make later in the day back to the village—a 2km walk. After a brief morning prayer, I attended the report meeting to be briefed about the patients that stayed or were admitted to the hospital overnight. On Monday, the meeting had been quick, maybe 5 minutes, to just list what patients we had. Today though, our meeting lasted almost an hour! Since Family Planning and Under Fives Clinic consisted mostly of giving vaccines and immunizations, I will talk mostly about the meeting.

Before I continue explaining the meeting, let me tell you about some other visitors working in St. Peter’s right now. Four fourth year medical students, all men, from the UK have been working on Likoma for a week, running the urgent care Monday through Friday at St. Peter’s Hospital. The guys are staying in the Bishop’s guest house, right next to our house, and are sharing our kitchen, so we are getting to know them well. Unlike us however, the guys are not working for the Diocese, but only for the hospital. They have told us that they are not particularly religious, but chose to come to Likoma and work at St. Peter’s for the semester of medical school they must spend abroad. Due to this, they have not attended the morning prayer services or the church services. Unfortunately, I think they have not even been inside beautiful St. Peter’s Cathedral!!!

Now, back to the morning report: Mr. Tableou, the nurse matron, described that the hospital had 5 patients in the general ward, 1 in the pediatric ward, and 2 in maternity overnight. Though some patients were stable and had little change, a few were of particular interest. One patient in the general ward had been admitted on the previous day for acute type one diabetes. He had been misdiagnosed the previous week, prescribed the incorrect medication, and had blood sugar levels that were so high they could not be read by the typical glucometer upon his return to the urgent care. He was quickly admitted and given insulin. After an all-night battle to reduce his blood sugar, it proved still very high. The UK students, Mr. Tableou and the Clinical Officer who oversees the urgent care had differing opinions on how to treat this teenager. The guys from the UK offered a plan based on UK standards of care for a diabetic patient: to provide saline drip, insulin, and withhold food intake until blood sugar levels are stable. The Malawians offered a different plan based on Malawian standards of care: to provide ringer’s lactate drip (because no saline is available in the hospital), insulin, and give healthy, natural foods because Malawi does not withhold food from a patient for any reason. Even with this conflict, as I watched the discussion, I admired the diplomacy and respect among all involved. Tension did exist between the UK students and the Malawians, but the ultimate goal seemed to always be the wellbeing of the patient. Ultimately, a compromise formed to check the patient, reevaluate, provide ringer’s lactate, insulin, and wait to give food. So far, the patient has stabilized, due to the team work shown by his care providers.

The pediatric patient also has an interesting story. After being admitted for acute malaria yesterday and being prescribed quinine, he developed pneumonia during the night. Mr. Tableou happened to be on night duty, so he decided it would be best to start the child on oxygen to assist his breathing along with some antibiotics. When he explained the treatment plan to the child’s mother, she accepted the antibiotics but refused the oxygen. Mr. Tableou told me that her reason for refusing the oxygen therapy for her wheezing three year old son was because she had heard that being on oxygen kills people. He said that unfortunately this is a common traditional belief in this area.