Shock

So, though I had been warned and though I thought I knew what to expect, I had no idea. Yesterday, was our first introduction to the hospital. Let me just share a few experiences with you to give you an idea of what it's like here.

One of the first patients I saw yesterday was a 6 year-old girl who presented because her "eyes were bulging". After a CT scan of her head, it became clear that she has some sort of malignancy. She has a posterior fossa lesion with eye involvement. She also has soft tissue lesions on her head where the cancer has eroded through the bone. She is completely wasted. She has left corneal scarring and cloudiness secondary to an inability to close her eyelid. The unfortunate thing is that I'm not sure her mother understands the gravity of the situation. No one updates her on rounds, and she doesn't speak English for me to explain. The patient will be transferred to the oncology unit tomorrow for palliative care.

I've seen TB with all its varieties of complications. We have a 3 year-old who suffers from cor pulmonale with massive ascites and hepatomegaly secondary to his chronic TB. For the past two days, every time I walk by his room, he is simply standing, leaning over a chair, and never moves as he is unable to lie down or even sit comfortably. There are two other children who have both HIV and TB. One of these patients has oral thrush and has been complaining of pain with swallowing and likely has esophageal candidiasis. The other is the most wasted child I've ever seen. You could see every rib, every bone in his face, and with pants on, sitting in bed, you couldn't even make out his legs beneath the material.

The social services system is equally abysmal. We had one child who we were treating for marasmus. He had been living on a diet of cornmeal and water. When Mom conveyed that she did not have enough money for food, one of the doctors told her, "We will place a social work consult, but you need to find work. No one is going to help you here in Windhoek." That's it. End of discussion.

The kids are absolutely adorable and are starving for attention. They follow you around everywhere. Their playroom consists of a tv. They have NO toys. Anywhere. Not even a pencil to draw with. They borrow our pens during rounds and write on their bodies.

In the afternoon, we go down to clinic. My first patient was a 23 month-old whose father was an alcoholic and mother died in childbirth. Her two aunts finally took over care for her in January. However, the child is a bit withdrawn and cries out at night, and the aunt has decided this is too much for her to handle. She kept asking me to admit the child despite her lack of any obvious illness. When I pointed this out, they said that she won't eat and she vomits when she eats. I gave her some of my trailmix, and she ate it all with no emesis. Then, they told me she will only eat sweet stuff and she doesn't want good food. I explained that picky eating was a normal part of toddler behavior. They then told me she was possessed by a demon. Now, I was stuck. What do you say to that? She is very withdrawn. She just sits there, does not make eye contact, and holds her hands tightly in front of her chest. I got the very distinct impression that if I admitted the child, the aunts would not be back to pick her up. Dr. Brown says child abandonment is not uncommon. It's incredibly sad, and I'm really worried about her...