The Luke Commission and Pediatrics thus far

I didn't realize it had been a week since my last post! I kind of neglected my blog a little bit, sorry everyone! I apologize in advance for the length of this post. Anyway, it has been a very busy week for us. Sunday, Stephanie arrived safely after a minor mishap at Johannesburg airport that caused her to miss her flight to Swaziland, but was bumped to another flight leaving just a few hours after her original one. Otherwise, the day was pretty low key. We took her to eat traditional Swazi food (variety of cooked meat and pap) and then spent the rest of the day letting her get settled in.

Monday we went out to a rural clinic with The Luke Commission. They picked us up at the hospital at 7am and took us to their base camp while the crew packed up the trailers with supplies. When we got there, their dog greeted us timidly but immediately became super friendly when she realized we were animal lovers. She was so sweet, and LOVED her belly rubbed. Those of you that know me well know it brought me great joy to pet her, I've missed loving on animals! She was pretty dirty, but I really didn't care about that. Soon we were on the road to the first clinic of the year for The Luke Commission (TLC). This group is headed by Harry and Echo VanderWal, a husband and wife who are a doctor and PA respectively. I think they are originally from Ohio; they both graduated from Cedarville University. They have 4 boys (one set of triplets!), and one little girl "in the oven." There are two nurses from America with them for the long term as well. Rebekah is from Corbin, KY and Melody from a small town in Iowa. They both graduated from Cedarville as well. They are assisted by a large group of Swazi staff that do everything from translation, set up, clean up, triaging, counseling and more. Its really a great set up, and these clinics are much needed in the rural areas of Swaziland.

We drove about 30 minutes out to the site, which was a primary school. So many adorable kids! I'm sorry I do not have pictures from this day, I forgot to put my memory card back in my camera after uploading my last set of pictures! Once things got set up and ready to go, we started out helping Harry quickly look over all of the school children for Tinea Capitus (ringworm on the scalp), scabies, and any other skin abnormalities we could treat. We also had a translator with us so if any had additional complaints, such as ear pain. There were many kids that needed treatment and they were prescribed free medication from the pharmacy for their problem, as well as free vitamins and more. After we finished seeing the children, we went to our stations to start the clinic officially. Emily, Stephanie and I were placed in Triage where we took blood pressure, blood sugar, and performed free HIV testing for those that requested it. The test was a bit tricky to do at first, but we got the hang of it. There were alot of people that came through as well, with over 100 that we tested for HIV.

Around 2pm, Echo sent for one of us to join her in the Surgery department, where they were performing Male Circumcisions. Male Circumcision for all ages is being heavily encouraged right now because it decreases the chances of contracting and spreading HIV. This year, TLC decided to offer circumcision to males who attend the clinics, as long as the cases were uncomplicated. It is very difficult for people in the rural area to make it all the way into town for a surgical procedure, on top of the costs of getting there, so they often have not had the procedure done for that reason. I took the opportunity to join her and I'm very glad I did. I got to first assist in two of the surgeries! (both were pre-adolescent boys around the age of 12) I had also never seen a male circumcision on anyone over a week old, so it was a good learning experience. Due to resources, the patients only receive local anesthesia and a dose of Tylenol with codeine, meaning they are awake for the entire procedure. There also was no screen to shield the patient from looking at the process taking place. Some of them get really scared and upset, even though they are completely numb (like the first one I assisted in). But others handle it well as long as they don't look. The second case I assisted in even fell asleep during the procedure! Echo said he got the award for easiest surgical patient of the day!

After the last case was finished, the crew started packing up and getting ready to go home. There was alot more to it than I ever would have realized without attending. Some of it gets pretty complicated, such as disposal of sharps and biohazard waste. But they do a great job of managing it all. When we finally returned from the clinic to the hospital, it was around 8pm. And that was a short clinic day for them! They work so hard to provide for the people of Swaziland and I admire their dedication. Exhausted we went to bed fairly early to prepare for our first day on a new rotation. I met Dr Pawelos in the morning and started off doing rounds in the Children's Ward. The children are so precious, and several have just broke my heart. I have learned alot about malnutrition this week. In the afternoon, I went to the Pediatric out patient department where I learned alot as well. In the notes my family sent with me for the trip, my Mom had included some smiley face stickers. I decided to bring some with me to give out to the kids to help them warm up to us and not be so afraid. They were a big hit! Their sweet smiles after receiving them were the greatest. Most of them understood what to do with them, but a couple ate them! It cracked me up.

Wednesday we joined TLC again for another rural clinic. This time it was about an hour and a half drive to the location, which was another primary school. I remembered to put my memory card back in my camera so I got some pictures this time! The morning went the same as Monday, first set up, next checking all the school children and then we went to triage. There were many more people seen at this clinic and the day was longer. The people of the village brought us food for dinner as a thank you for visiting them. It was chicken and rice as usual, but it was much better than the hospital's. Thinking back, I probably shouldn't have eaten it though. Oh well. They gave Emily and I an extra bowl each for some reason. We didn't want to waste it so we started to eat it too and noticed about 5 children standing at the window looking in at us. We looked at each other and immediately had the same thought, so we gave it to them. The way children accept things here are very respectful and sweet. They cup their hands and somewhat curtsy or bow when they are given something. Very different from American children! It warmed my heart to share with these kids. I love seeing them smile (side note - most have surprising nice and naturally straight teeth!)

The school kids lined up in the school yard before we quickly check them.

Just as the clinic was wrapping up and starting to pack things in the dark, a man in his 70s was brought from the village complaining of sores. He had severe HIV, neuropathy, and seemed to be bed-ridden. When we took him out of the wheelchair (having to lay him on the concrete with nothing more than his own blanket) we undressed the wounds to examine him. He had the worst decubitus ulcers (aka bed sores) I have ever seen in my life, and will probably ever see. There were several on both heels, legs, and ankles revealing tendons. They were also severely infected. The largest ulcer was on his buttocks, over the sacral region. It was as large as my whole hand, and so deep you could see differentiation in the muscles where they attach to the spine. It was horrendous. After tending to the man as best as we could, we sent him home with medications, extra dressing and instructions. There wasn't really anything else we could do for him there. Shortly after, the crew packed the rest of the things up and we were back on our way home. This time we got back to our room around 11pm. We were very tired but still had a great day.

Thursday and Friday I was back to working Pediatrics at the hospital. So far I really like it. This rotation has a very different dynamic than my last one! They actually do physical exams on the patients, which was very rare in Internal Medicine here. I know part of it is because the children can't always tell you whats wrong and you will find more on exam, but still. I've actually got to start seeing patients myself now, which is a big step up from the last rotation. My preceptor is really pushing me to start seeing patients on my own in the out patient department! I'm excited, but there's ALOT I need to learn before then. It doesn't help that the drug formulary here is different from that in the states. I really need to get the hang of Pediatric dosing as well.

I'm going to end this post here since it is getting pretty lengthy. I'll make a new one soon about what we've been up to this weekend.