The Infant's Ward

I started my rotation at Oroto Children's Hospital on Wednesday on the infant ward - ages 1 month to 1 year. Our team consists of the attending - Dr. Tewelde, myself and two interns.

The ward occupies the second floor of the hospital, stretching north to south, divided in the middle by the landing between flights of stairs. The nurse's station is just south of this landing and therefore the more acute patients are located on this side of the ward.

There are about 10 or 12 rooms in all, each housing between 3 and 6 1950's dormitory/orphanage-style metal frame children's beds. (They remind me of the "Madeline" books I read as a kid.).The beds are all pushed up against the walls, leaving a space in the middle of the room for us to round.

Each bed has one or two children in it and at least one adult planted in a chair adjacent to it - to vigilantly swat away the flies, comfort the children and administer medication. In just about all cases this adult is the child's mother. But one mother is poignantly missing. Her father is attending to the infant instead, as the mother herself is hospitalized, presumably with tuberculosis.

The first room past the nurse's station holds the wards most critical children - most of whom require some form of respiratory support. Unfortunately the hospital only has the ability to provide supplemental oxygen via nasal cannula - there is not even high flow oxygen, let alone any form of mechanical ventilation. In fact, all of the children who require support are hooked up, via an impressive maze of plastic tubing, to the same, lone oxygen tank.

As I step into the room I instinctively begin breathing through my mouth - an attempt to blunt the effect of the odor emanating from the room, a combination of body odor, diarrhea and food. The lone window at the far end of the room is as wide open as possible, to little effect. The air refuses to circulate.

Some of the children in this first room, those who are the most accutely ill, are relatively straightforward. They have bronchiolitis or pneumonia - diseases I can almost manage with my hands tied behind my back (that is, when I have the appropriate support available). But the lack of proper suction and oxygen support are by no means my biggest hurdles. Almost all of these children are also severely malnourished. And the questions continue to linger - who among these kids has HIV? Who has TB? Who simply needs more time and who needs more/different medications?

The more challenging children in this room are the ones with congenital heart disease. (No Brian, I am not drooling.) Unfortunately, the physician who performs and reads the echocardiograms is on vacation for the next couple of weeks. So we are left with a chest x-ray and physical exam to make the diagnosis. Not that it really matters. There are no fellowship-trained cardiologists here - interventional or otherwise. And no pediatric heart surgeons. I clearly have my work cut out for me.

As one progresses down the hallway, away from the nurse's station, the cases become less acute. At the very end of the ward is a room for the chronic patients - the ones we cannot improve enough to send home in a week or two's time. The first child in this room presented in a coma, with decerebrate posturing and a fever. After completing a treatment for presumptive bacterial meningitis she has minimally improved. She no long postures, though she only reacts non-focally to pain. The next child has spastic quadriplegic cerebral palsy, a seizure disorder, and is severely malnourished. As for the last child in this room - I can't remember anything about her. This is the twenty-somethingth child of the morning and I need a break. I need to sit down. I need some water. I need some fresh air.