Big Sky

We drove to Kumbali village this morning where there is a nice restaurant and farmer's/craft market.  Here are some shots from along the way.  I leave Tuesday morning and am trying to soak up as much of Malawi as possible.  This is going to be a big week!

Times in the Burn Unit

Burns are a terrible and prevalent injury in sub-Saharan Africa.  Most homes still use an open flame hearth for cooking or warmth and burn injuries are most often related to this.  Patients suffering burns here are more likely to be pediatric patients and thus the peds burn ward is often full (especially in the colder months which are approaching).  Jenny and her husband bought some trinkets to give out to the kids here before she left for her trip.  We took them to the burn ward this morning.  The kazoos were a big hit.

 

For an older UNC MSI paper regarding burn injury data, see the link below:

http://imr.sagepub.com/content/39/3/873.full.pdf+html

Hospital Week 2

Hello all,

Internet has been problematic here for the past few days but seems to be working now so I'm taking advantage of the opportunity to update.

We've been busy in the hospital this week- our groups has spent time in the operating theatre, on ward rounds and in clinic, and Dr. Charles has also been holding some teaching sessions with the residents to prep them for their boards- apparently they take some variant of oral boards after their 1st, 2nd, and 5th years of General Surgery Residency.

prep for oral boards.

A couple stories from this week:
Laura, Jared's wife, has been involved with an orphanage in Malawi at least peripherally for the past several years.  There was a boy there with a large congenital (since birth) ventral hernia that had gone unrepaired his entire life.  Healthcare in Malawi is free but it can be difficult to get posted for an elective operative given the huge volume of emergency cases that come into the hospital.  I'm happy to report that thanks to some maneuvering from Laura we were able to bring the child into the hospital. He underwent an operation earlier this week and is doing well.

 

 

 

Jared, Dr. Charles, a patient who received surgery this week, and his family.

There was a really strange and terrible smell in my and Jenny's bedroom earlier this week.  We searched and searched for a dead mouse and couldn't find anything.  The smell was very strong close to our door, which is where my bed is located in our room.  The smell went away in about a day and we didnt think anything more of it.  Fast forward to last night when I came in and sat on my bed, noticed a pile of white dust, and attempted to brush it off the bed.  Then, I noticed the dust was in fact moving and looked like larvae.  I was immediately terrified it was mango fly larvae (African cousin of the botfly) and started a terrifying google image search which I don't recommend to others.  Mango flies are relatively common here.  They lay eggs on wet things like clothing line drying outside and thus everyone irons all laundry after bringing it inside to kill the larvae.  If they're not killed, the larvae can hatch and burrow into skin, which causes a painful blister which a semi mature larvae will then hatch from.  Anyway, our too kind housekeeper stripped my bed and washed everything including my large mosquito net.  When we returned from dinner there were more of the tiny larvae on the bed so I moved to one of the other beds in our room (there are 4 full sized beds in our room, feels like summer camp).

Jenny's dad has been rounding with the medicine services and attending in Cardiology clinical this week.  He received a call from the OB/GYN service here requesting a Cardiology consult for a woman 5 days post-partum with likely peri-partum cardiomyopathy.  Jenny is going into OB/GYN so she and her dad went to see the consult together.  Watching them tag-team examining the woman and coming up with a management plan (mental picture: the two of them, sitting together, dueling iPads in hand with reference materials- Jenny on LactMed looking for lactation safe drugs and her dad on UpToDate) was great.

lit review time

discussing the consult

reviewing the imaging

Very neat experience watching a father and daughter work together in a medical capacity.

More pictures of us at the front gates of the hospital...

happily nerdy about our forthcoming careers...

a great mentor.

 Thanks, all!

AH

Around Kumuzu Central

We started today off at morning report.  Interestingly, there was a gun shot wound victim who was brought to the operating theater for exploration last night.  Gun shot wounds are incredibly rare in Malawi and according to staff at the hospital they are usually the result of interactions of criminals and police officers.

We started off the day in the operating room with two cases that are rare in the US and not uncommon in Malawi- a mastectomy for a young (30s) woman with very advanced breast cancer and an emergent exploratory laparotomy for an older gentleman with a sigmoid volvulus (last part of colon twists around itself like a balloon animal and can squeeze off its own blood supply for the non-medical crowd reading this).  I was talking to a visiting resident who is working on breast cancer screening with UNC project tonight and she was telling me that there is absolutely no formal breast cancer screening program or guidelines in Malawi.  Additionally, there are only two mammography machines in Malawi as a whole and it costs about 100 USD to get a mammogram, clearly out of reach for the majority of people who live on something like 1.50 USD per day here. 

We picked up Jenny's dad from the airport this afternoon- he's a cardiologist in the states and will be working in the hospital for the week.  We toured him around the hospital and then went to the market over by Bwaila hospital to pick up some veggies for dinner as well as some Chitenge fabric. Chitenge is a patterned fabric very common in East Africa that's worn as a sarong by most women, but is also used as a sling to carry babies as well as to wrap baskets carrying food or supplies.  I hope to get some scrub hats made from some of the fabric I purchased today.

 

Morning report, presenting an orthopedic case...

Future docs. Match day is 3/20!

Vanessa, surgery resident, and Dr. Charles.

endless Malawi sky-Lilongwe is in the distance

Need directions?

We have an endoscopy suite

Main hall of the hospital

en route to the burn unit

Renal cheat sheet on the wall in dialysis.

Families prepare food and new clothing and bring it to the hospital each day in these large plastic bins.

burn unit

outside corridor of the burn unit

Waiting with her babies. The youngest is carried in a chitenge.

KCH grounds.

another great sign

Home sweet Lilongwe.