Kristen Kenny’s Blog

Dr. Kristen???? Let me introduce you to malaria.

9/4/08

This week seems to be flying by. I was scheduled to be in the OPD (out pt department) all this week. Monday I mostly just shadowed one of the doctors. He would see patients, they would talk in Twi. I would try to follow along and ask questions. Lots of children with malaria, adults with malaria, elderly persons with malaria. Headache, stomach ache, dizziness, fever, chills, bitter taste in the mouth (I had never heard that one before), decreased appetite, any one of these symptoms or combos meant malaria. I kept trying to think of other diagnoses but finally gave up and now think malaria first. The clinic was decently busy. My doctor was finished early in the afternoon so I decided to go back to the eye clinic. They perform surgery on Mondays. There was only one case that day and it was a quick one but I had never seen eye surgery before. The doctor removed a pterigium from a woman’s eye that was bothering her. Such tiny instruments. The staff in the eye clinic are very welcoming and funny. One of the women always calls me Dr. Kristen. It makes me laugh because I certainly don’t feel like a doctor especially in the eye clinic.

Tuesday was very busy. It was my first day with my own consulting room and my very own line of patients waiting outside. The experience was challenging but I finally felt like I was doing what I came to do. Seeing the patients was all about the history and physical. In the US we do so many labs and imaging studies. Here we rarely do at least at Manna Mission, at bigger hospitals it might be different. Most patients are treated empirically. Some patients are sent to do a hemoglobin or a blood film for malaria and a fair amount for urinalysis or urine pregnancy test. But even if the blood film comes back negative you often still treat for malaria anyway. A lot of the patients I saw we treated for malaria. I saw a decent amount of skin issues as well, chicken pox, random kid rashes, allergic reactions. One kid had a sore neck for the past three days. I checked for meningeal signs but he didn’t have any. We ended up treating him for malaria. I still think of him though and hope he isn’t sicker than he seemed. One of the hardest things about seeing patients for me was the drug choices and dosages. I have a drug book but many of the drugs are either not in it or go by a different name. And there were so many children for whom you have to calculate the dosages. Luckily my attending was very helpful and patient. He would help me with the treatment plan and dosages on patient after patient. Hopefully I will learn them by the end.

My Tuesday experience had pumped me up for the rest of the week. Unfortunately Wed was a bit slow. It was rainy and the busiest days are Mon, Tues, and Thurs. I sat in my room waiting for patients but only saw one, you guessed it with malaria. I ended up hanging out with one of the new doctors who recently finished his training. You can tell he is young because he takes more time with the patients and tries to build a little repoire. It was kind of a sad afternoon patient wise. We had one woman hearing voices but who didn’t want to go to the psychiatrist. Another patient had been sexually assaulted and was having chest pains and abdominal pains. I didn’t get the whole story but she seemed in desperate need for some counseling. One woman was from the Northern Region and she and the doctor were having trouble understanding each other. She mostly spoke a language from the North but understood some Twi. It was an example of what I had been feeling/experiencing for the past 2 weeks. Lastly a woman who had given birth to her baby at home with no prenatal care came in and the baby died. Sort of a depressing way to end the day but there was a good lecture on diabetes before I left for the day to cheer me up.

After my time in the clinic I have been coming home tired, ready to rest for the next day. One of the days though I did go into town to see the National Museum. One of the lab techs at the hospital has wanted to show me around Accra so we went. The museum is a little cheesy but I am glad I went. There were exhibits on culture and history and archeology. I saw some cool drums, clothes, masks, pots, etc. I will try to put up some of the pictures. The most exciting parts was the journey into and out of Accra. On the way back it was getting dark and picked up a tro tro at the station. The station was so crowded with people coming home from work. It was dark and there were buses and people everywhere. Finally we found the right bus but it went a way I had never gone before on a dark and very bumpy street. I kept praying that the tro tro wouldn’t break down going over all those huge holes in the dirt road. We made it back safe and sound, an overall enjoyable outing.