7 June 2012

Universitas Hospital

Summary

Today followed the pattern of the previous days at the hospital.  We began with surgical ICU rounds followed by paediatric rounds.  I then screened patients and observed a diabetic consultation.  Overall it was a very nice day; the dieticians are fantastic at what they do!

Detailed Account

1.        I began with rounds in the surgical ICU reassessing some of the patient’s I first observed earlier in the week.  As expected some are doing better while others have taken a turn for the worse.  Their feeding protocols were revised and when continued on.

2.       I was then fortunate enough to go on rounds in the paediatric ward.  Over the course of the week this is where I have found myself most excited about the learning and more engaged with the patients.  I really do enjoy being around children and helping them recover and strive. 

One particular child had a type of trisomy and was extremely small and unhealthy.  He would always be chronically ill and they had done everything they could for him at the hospital for the time being.  A discussion arose on the next step, sending him home on oxygen.  The problem was that both of his parents smoked and he could not be around smoking in his compromised condition.  It was a difficult case to watch, like most in the paediatric area, but I wish the best for the little one.

The most interesting and severe case I saw was a 14 month old child whose characteristics remained baby-like.  The child was 4 kg at birth and is currently only 4.5 kg, gaining a mere 0.5 kg in over a year.  The child appears extremely malnourished and has blotchy, peeling, discoursed skin.  He was born HIV positive, has eczema, failure to thrive, and dermatitis due to severe allergies.  The majority of his problems are due to the allergies (besides HIV).  His blood is being tested to determine how allergic he is to certain food groups.  They have found that he is severely allergic to maize (the staple food of most people), soy, wheat, and dairy.  His family is extremely poor, coming from Lesotho, so they will try to feed him rice porridge, spinach, pear, pumpkin, chicken, and potato because they are usually considered safe foods.  The cause of his severe allergies are unknown but it could be due to what the mother consumed when she was breastfeeding or pregnant.

3.       I sifted (screened) patients after the rounds.  In order to “sift” a patient I filled out information and took measurements.  From the patient’s chart I obtained the category of admittance (Cancer, Surgery, GIT/Liver/Pancreas, Immunocompromised, CVD/HT/DVT, Pulmonary/TB/Pneumonia, DM/Hypoglycaemia, Renal, Other), patient number, name, date of admittance, gender, age, date of birth, and ethnicity.  Following I met with the patient and measured their height, weight, knee height, demi-span, ulna length, mid upper-arm circumference, and handgrip strength.  I also noted if the patient had lost weight since their admittance to the hospital, etc.  It seemed very much like an exercise science lab so I felt confident in my abilities to take the measurements.

4.       Lastly I observed a diabetic counselling session.  The patient was diagnosed 10 years ago and had never seen a dietician but will eager to learn what was going on in his body.  The dietician was incredible at his job, drawing pictures and explaining everything so they patient fully understood diabetes.  Side effects were discussed followed by a food recall.  The dietician then made recommendations of how to change the diet to improve the quality of life and gave the patient papers to assist in further learning.  It was a very educational process to observe and I will take the explanation back to the states for explanation purposes.

a.       I have noticed over the week that hand washing is not emphasized as much as it is in the states.  There are pictures all over the walls indicating when and how to properly wash your hands but I have rarely seen it done.  I find myself washing my hands more than I have seen anyone else do so but that may just be from lack of observation or the wrong timing. 

b.      My future is tentatively planned but no matter what I do I want to have hot drinks as a part of my life and career.  This may sound extremely odd and not the place to write about this but I find it to be important.  Every time I have studied abroad I have gone to a location where people cherish these hot beverages.  This enjoyment rubs off on me but seems to slowly fade away upon my arrival back to America. 

Today I was waiting for the dieticians to come back after lunch and a woman appears from her office asking if I would like a hot drink.  I told her I was fine, but honestly I would have loved one.  Moments later she appeared with a traditional South African tea latte that was almost as spectacular as her kindness and generosity.  From that moment I could not get the smile off my face.  I feel like hot drinks, when appropriate, can bring people together and build rapport.