Orthopedics, the carpentry of medicine!

It has been a busy couple of weeks at Kalene as an orthopedic surgeon, Dr. Gill, arrived (we now have 7 doctors!) and with him came an onslought of patients with various fractures and osteomyelitis.  At the same time, we had a 48 hour blitz from an ortho team in Lusaka that flew in to deal with the obscure ortho cases. This team, headed up by Prof. Jellis, visits Kalene several times a year. Each visit last less than 48 hours and involves a clinic on the first day, weeding through all of the referals of ortho patients that we've saved for him over the past few months, seeing who is appropriate for surgery. The second day was spent in the OR, going though an intense list of patients with operations from setting fractures, grafting old compound fractures and even correcting a fused ankle from septic arthritis! Needless to say, the wards are busy too, as these patients need to be prep-ed for the OR, then monitored as they return to ward, semi-conscious on Ketamine anasthetic.
Along side the ortho patients are 5 babies with measles....in 4 beds. We have very few semi-private rooms (6 in total, only 2 on Men's ward). This has created a problem, as the first case of the the recent outbreak of measles was on the pediatric mal-nutrition ward. As you can imagine, these babies and toddlers have very little reserve and are therefore quite sick with measles. We've been isolating them as fast as we can once the symptoms appear, but seeing as the incubation period for the virus is 2 weeks...we're looking ahead to an outbreak every 2 weeks for a while. Thankfully, I have been vaccinated against measles, because one day last week, I walked into the isolation room to see a 1 year old baby, completely naked sitting by himself on the bed bawling his little eyes out. I turned to the man in the room, and he indicated that it wasn't his child and was he absolutely unprepared to care for him as he was watching the other child in the room. The baby's name is Gift. I sat down beside Gift and when he didn't cry any harder, I picked him up in my arms. The poor baby was freezing! All he needed was a blanket and a cuddle! He went right to sleep. It's amazing how easy some nursing is and how much suffering can be cured by a simple hug!
While all of this is going on on Men's Ward...chaos ensues elsewhere in the hospital. Last Monday, I was walking by Women's ward an noticed a commotion. Commotions tend to happen during visiting hours, so I didn't think much of it as I went to investigate. In the bed, lay a 14 year old girl in a full-blown seizure. This was the first seizure I'd ever seen. Emma was already there, so I ran to get the doctors and the diazepam. At this point, we believe that the diagnosis is neurosyphilis. The girl seized for nearly half an hour, even with diazepam and phenylbarital infusion. She de-saturated and basically stoped breathing on her own. As we are fairly ill-equiped when it comes to ventilatiors and ICU...we manually ventilated her for 6 hours. My shift went from 1800h-1900h....it was uneventful, until she seized again, 45 minutes into my shift, at the same time as an unconscious, hemorraging admission arrived an needed to be taken directly to the OR. It made for a crazy evening with doctors, nurses and monitoring equipment flying in all directions, but there's nothing like an emergency to pull everyone together.

I'm looking forward to a busy month ahead. Becs comes back to run Men's ward at the end of April and I am leaving then for Lunda lessons for a week or two, after which I head to Lusaka for the Safari and then the dreaded Zambian RN exam...
Well, it's a short note, but I'll try to write more later!