I have been trying to sum up my experience working in the Peds unit for the last few days. It’s been a whirlwind where I have been able to take on substantial patient responsibility and learn a ton. I was quickly oriented to the EMR they use here and have been able to work at basically an intern level. I have been making my own plans, putting in orders and prescribing meds as needed. This might not sound like a lot, but it takes us a while before we are fully given this much responsibility in the US system.
What is hard to put to words is my experience. Obviously, access to care is more limited here so the entire practice of medicine is different. Each test has a very tangible cost to patients that we try to be aware of. When you order labs, the price of each one is totaled below. In fact, I think they should try this in the US and see if it makes physicians think before ordering unnecessary tests. In addition, meds and other resources are limited. The other major difference, especially when the majority of my Pediatric experience was in a rather small setting, is the cases. The disease profiles are totally different. I have not seen a single kid coming in for a cold or a flu, which generally makes up a majority of ER and hospital visits.
What I have seen is kids with devastating infections raging through their body, kids with parasitic infections unheard of in the developed world, kids who crawled into fires, tiny 28 week preemies I am amazed are still alive, and even a boy who likely has rabies. All of this was beyond my scope of knowledge in many ways, and I am learning how to approach these cases both in general and with the limitations of Tenwek in mind. But the one thing that still strikes me is how resilient kids are. The baby in the NICU who was born at 28 weeks – against all odds and without the capabilities of advanced care is still fighting, every day growing gram by gram. Kids with horrible infections or burns on their entire faces are still running around and playing outside in the sun. This very fact is what has always drawn me to Peds – kids are the toughest creatures. It is sad when we can’t help one and a little kid dies, but things that adults would never survive or would send them spiraling into depression, children fight on. While I refrain from photographing patients for obvious privacy reasons, the smiles I have seen on kids faces remind me of why I love this area of medicine.
I have definitely loved getting to do a week of Peds during my very limited time here. I know that I have solidified some knowledge (like dosing medications, the doctors here don’t use fancy EMR calculators to do it for them) and gained invaluable experience. I do hope the faces of some of these patients will stick with me through training.
Plus – all the time in the NICU here should help as I start NICU at Toledo just a week from Monday.