(no subject)
The consultant who is on call this week looks a little bit like Michael Palin. Like the ugly brother of.
So we 'clerked' another patient in HDU this morning. This time we were helped by one of the nurses in translating some questions to the mother. This little girl came in with convulsions, drowsiness, and high temperature, and after some blood films and a lumbar pucture, was found to have cerebral malaria. Happily she doesn't have bacterial meningitis on top of that.
I thought our presentation went much better this time round. Today's consultant ward round was in essence similar to yesterday's in spirit and content, but we were better prepared to receive it and were more vocal.
Everything's different. Back home we'd never dream - or I wouldn't anyway, and I can't imagine Pap would - of interrupting a presentation of an SHO to a consultant on a consultant ward round in order to ask even the most burning question. But it seems perfectly ok and even constructive to ask in the middle of a ..'presentation' here. The dynamics are different.
Not much documentation goes on here, either. In the UK every exchange with a member of the patient's family, and any conclusions from a discussion of the patient's case with other staff members (especially consultants) is written down in the patient's notes - almost always as it happens. But yesterday's consultant ward round wasn't written up either during the round or later on.
I mean, I guess the potential for litigation is higher in the UK and so that explains the emphasis on documenting everything - but.
The kid we clerked yesterday has a set of problems that the consultant doesn't know what to do with. One of the other consultants here is a neurologist - he's going to be called on to have a look. I hope he knows what's wrong with him.
The boy with ?rabies may not have it. Apparently there is no clear-cut way that we can say "definitely rabies" - and the only other thing that could explain his symptoms is TB-meningitis, so he's going to be started on treatment for it. I really hope that he has TB-meningitis, because having rabies basically means waiting to die in a horrible and undignified way. There's actually nothing that can be done to stop the rabies virus once symptoms start to appear (I've been reading some Tropical Medicine textbooks in the library..).
Yesterday it was revealed on the ward round (but not documented) that the parents apparently had taken the boy to a clinic after his dog bite and were offered the post-exposure vaccine. They declined because they'd have to pay 910 shillings for it, which is (based on what the HIV tutorial doctor was saying about average earning) is 23 weeks' wages. It is also the equivalent of 7 pounds.
7 pounds. It's just impossible to relate the consequences of rabies infection to that amount of money and what it translates to in the UK. It seems the most blatantly WRONG thing I've ever come across.
Another thing here is that in the consultant ward round, there's never been any attempt so far to reach a consensus on what to tell the parents of a patient. I don't know what the ?rabid child's mother thinks is going on. Ward rounds are done in English and most of the patients' mums, even though they're always sat next to them, speak only versions of Swahili.
So we 'clerked' another patient in HDU this morning. This time we were helped by one of the nurses in translating some questions to the mother. This little girl came in with convulsions, drowsiness, and high temperature, and after some blood films and a lumbar pucture, was found to have cerebral malaria. Happily she doesn't have bacterial meningitis on top of that.
I thought our presentation went much better this time round. Today's consultant ward round was in essence similar to yesterday's in spirit and content, but we were better prepared to receive it and were more vocal.
Everything's different. Back home we'd never dream - or I wouldn't anyway, and I can't imagine Pap would - of interrupting a presentation of an SHO to a consultant on a consultant ward round in order to ask even the most burning question. But it seems perfectly ok and even constructive to ask in the middle of a ..'presentation' here. The dynamics are different.
Not much documentation goes on here, either. In the UK every exchange with a member of the patient's family, and any conclusions from a discussion of the patient's case with other staff members (especially consultants) is written down in the patient's notes - almost always as it happens. But yesterday's consultant ward round wasn't written up either during the round or later on.
I mean, I guess the potential for litigation is higher in the UK and so that explains the emphasis on documenting everything - but.
The kid we clerked yesterday has a set of problems that the consultant doesn't know what to do with. One of the other consultants here is a neurologist - he's going to be called on to have a look. I hope he knows what's wrong with him.
The boy with ?rabies may not have it. Apparently there is no clear-cut way that we can say "definitely rabies" - and the only other thing that could explain his symptoms is TB-meningitis, so he's going to be started on treatment for it. I really hope that he has TB-meningitis, because having rabies basically means waiting to die in a horrible and undignified way. There's actually nothing that can be done to stop the rabies virus once symptoms start to appear (I've been reading some Tropical Medicine textbooks in the library..).
Yesterday it was revealed on the ward round (but not documented) that the parents apparently had taken the boy to a clinic after his dog bite and were offered the post-exposure vaccine. They declined because they'd have to pay 910 shillings for it, which is (based on what the HIV tutorial doctor was saying about average earning) is 23 weeks' wages. It is also the equivalent of 7 pounds.
7 pounds. It's just impossible to relate the consequences of rabies infection to that amount of money and what it translates to in the UK. It seems the most blatantly WRONG thing I've ever come across.
Another thing here is that in the consultant ward round, there's never been any attempt so far to reach a consensus on what to tell the parents of a patient. I don't know what the ?rabid child's mother thinks is going on. Ward rounds are done in English and most of the patients' mums, even though they're always sat next to them, speak only versions of Swahili.