Pediatrics

On Monday I began my week at King Edward Hospital. This is a tertiary hospital in Durban that serves the entire province. It is a teaching hospital affiliated with the Nelson Mandela Medical School through Kwa-Zulu Natal University. I spent the first three days in the Pediatric Resuscitation Unit (PRU). This is where the severely sick patients receive extra attention and full work-ups until they are stable enough to go to a ward for care. Dr. Ramji was the consulting physician in PRU. He was an excellent teacher and Molly and I joined him on rounds for about three hours each morning. He was detailed, thorough, and compassionate with each patient. We saw patients afflicted by cardiac defects, HIV related complications, Gastro Enteritis, Measles, Chronic Nephritis, Epilepsy, and much more.
Two patients stand out for me. A 3-yr old boy came in who appeared to be under a year old in development. He had Marasmus due to severe malnutrition, HIV complications, and dehydration. This child needed help desperately. It was very difficult to see a child in this state. The children here are products of their environments: extreme poverty, uneducated parents, and other socio-economic factors. Another patient was a 10 year old girl suffering from stage 4 HIV infection (AIDS) complicated by cryptococcal meningitis and marasmus. Her mother carried her in wearing her hot pink sweat outfit and she was adorable and talkative with us. We checked in on her throughout the week to see how she was doing.
On Thursday we went to the nursery and mother/baby units. Babies were everywhere! They deliver about 30-40 babies a day at King Edward. They have an ICU with only three ventilators for the entire province. They also have high care, premature care, and another room for low birth weight babies with complications. I saw about 50-60 babies in the nursery. Some interesting cases I saw: melanoma, polydactyly, myconium aspiration, umbilical central line insertion, and countless lumbar punctures and blood draws. I also so a baby die because its chances of survival on ventilation were less than the three others already on ventilation. It was unbelievable to see how many babies were being cared for in these units and with so little resources. The physicians working in this environment are incredible.