Gratitude, Part II

To expand on our post earlier this week, we would like to mention a few more things we're thankful for back in the States:

1. Pediatricians. Real, residency-trained, board-certified pediatricians.
2. Effective social workers who visit more than once a week. We have children who have been here for weeks now waiting for their social issues to be addressed.
3. WIC. If we could just feed the children who don't have food here, imagine how different it would be! No more malnutrition. Healthy bodies that can more effectively fight off infection. Enough food to nourish developing brains.
4. Readily-available medications. Some of our patients live so far from clinics and pharmacies that their parents can not or will not fill their child's prescription on a regular basis. Even if they are within a reasonable distance from a pharmacy, the medications they require are often not stocked.
5. Child Life. These kids need someone to explain in a child-friendly manner about procedures and provide them with some sort of stimulation so that they can engage in imaginitive or educational play. These kids are hanging out in hospial wards with no toys to arouse their interest.
6. Sedation. Can you imagine trying to convince a 9 year-old that he wants a spinal needle placed in his back?
7. MRN's. The identification number here is the child's birthdate, backwards. There could never be overlap, right? These numbers are rarely used and when you're sending labs or following up on labs, you're stuck trying to spell out a name that is hand-written in chicken-scratch. There are often discrepencies between the true spelling of the patient's name and what is down in the lab, making it very difficult to locate results.
8. Full work days. Yes, that's right. When you finish the hospital day at 11 am, it leaves little time to do any sort of follow up, whether it be on labs, radiologic studies, or the status of your patient. It also makes it very difficult to arrange consults or diagnostic studies or to perform procedures. "We'll do that tomorrow" is a running theme.
9. Formal rounding on every patient every day. That's right. We'll often breeze over patients without discussing them, writing a note, or formulating a plan for the day. It sometimes takes days to begin a true investigation into the source a patient's illness, and even then, we tend to address one small part of the picture rather than looking at the entire illness.
10. Antibiotic approval requirements. We send you many, many thanks, Dr. Ravin! The running theme here is to use antibiotics "just in case". We've already experienced the consequences of this form of practice. Sara has a patient with an E. coli infection that the lab has reported is resistent to everything except imipenem. This includes only intermediate sensitivity to amikacin!