Hospital First Impressions

It may seem a bit odd that I’m doing a “First Impressions” post 3 weeks into my stay in Botswana. I think it’s taken me this much time to actually develop first impressions. I will be having a few different roles while working here and each has led to different impressions and insights.

For the first three weeks, I have been focusing most of my attention on a gastroenteritis (vomiting and diarrhea) study. It was my plan before coming here to be involved with this research, but it has worked out ever better since we are currently in the middle of a gastroenteritis outbreak. In Canada, when children get gastroenteritis, most of them are managed at home or in the emergency department and sent home. In developing countries, gastroenteritis can be a very serious illness accounting for a great deal of mortality and morbidity.

I’ve been spending quite a bit of time helping to recruit new patients to the study and testing stool samples looking for viruses that are known to cause vomiting and diarrhea. It is a good opportunity to meet some of the families whose children will be included in the study as well as to get a feel for the work and resources that are required to do research in a setting where resources are at a minimum.

In addition to helping with the study, I have also had a chance to work in the pediatric HIV clinic. Botswana has one of the highest prevalence of HIV infection in the world, so it is a great opportunity to learn more about this illness since the number of children that come through clinic here is on a totally different scale than what we see in Canada. Throughout my stay, I will continue to be involved with the HIV program and will be doing a block of 3-4 weeks where I will be in HIV clinic each day.

Today was the start of my pediatric ward rotation for the next month. The research I have been doing has involved recruiting patients from the ward, so I knew a little bit about what to expect. At CHEO in Ottawa, each child either has their own room or will usually share with just one other child as long as neither child has a contagious condition. It is very different at the hospital here. The ward is divided up into different cubicles all within one large room. Each cubicle officially contains approximately 8 “beds”, but when the wards are busy, it can go well above this. I put beds in quotes above, since many of the children and their families stay on a foam mattress covered with a sheet on the floor. These are often between the official beds when more room is needed. The children are not divided based on their illness, so a child with diarrhea may be next to a child with pneumonia, and they are often seen playing together! (The infection control team at CHEO would not be happy!)

The most eye-opening experience for me came at a meeting they have here once a month where all the admissions for the month are summarized. At this meeting, it was shared that approximately 9-10% of all children admitted to the ward that month died in hospital. I have been told that this number is quite typical for a given month and is not actually that high for African countries. Still, it definitely hit me hard. At CHEO, we have very few deaths in hospital, so few in fact that most people working in the hospital will hear about children who die since it is still a relatively rare event. Some of the kids here are dying of serious illnesses or complications of HIV infection, but it is hardest to hear about deaths that would be considered completely preventable in countries like Canada with a much greater access to medical resources. I think it is safe to say that it is the goal of each doctor working at the hospital to prevent these cases despite the fact that there often isn’t much to work with.

Sorry for the long post. I know lots of people have been asking me about my work and research and I hope this provides a glimpse of my day to day activities. After all, while it is fun to post pictures of safaris and the other “fun stuff”, it’s also important to remember that first and foremost, I am here to hopefully lend a helping hand and learn about the difficulties of health care in resource limited settings. Feel free to ask questions and I’ll do my best to answer!