week two

The Internet is relatively fast today so I thought I'd use this time for a quick update.

It is raining bucket loads here. The paths around the hospital are pretty much rivers. I just returned from the medical directors house where we had a nice BBQ lunch. Her daughter (also a doctor) is over from the UK so there is a good group of us here at the moment. We took the opportunity yesterday of going on a road trip to a town a couple of hours away called Zomba. It is at the bottom of a mountain which is the second tallest peak in Malawi after Mulanje. There is a top end hotel at the top (Mum - you would have loved it, and Dad- you would have loved the beautiful gardens). It was super expensive so we only had a cup of coffee there. The five of us (Lish, Soph, Ben, Claire and I) then embarked on a bit of a hike up the mountain after going down a bit of a 4WD track. It was very nice, even though it was raining. We were walking amongst the clouds and came across a couple of small waterfalls. We made our way back to the car only to find that both tracks off the mountain were blocked by fallen trees due to the strong winds and rain. Either side of us tall pine forrests were threatening to fall on us as we attempted to pull the trees off the road with the bull bar of the Prado. After hearing one too many cracks of tree trunks we reversed out of one path to the other obstructed path- where we sent off for help from the nearby lodge. A brood of 10 Malawian men returned carrying axes and proceeded to cut the tree from our path for a small fee ($1500 kwacha- about $10, although equivalent to a weeks wages here). We made it down the mountain safely and back to Mulanje.

Sorry for all the medical parts of the blog- I mainly do this for Mum & Dad or other medical family/friends- so if you want to skip the next medical paragraph, feel free!!

This week we had a very interesting patient. A 20 year old pregnant lady came in on Monday with malaria and also she most likely had gestational diabetes. GDM is not really picked up here from what I can gather as blood sugars are not regularly monitored. Unfortunately, this lady was overloaded with fluid in hospital as it seems protocol here is to give everyone an IV line on admission and start fluids. Her baby also died while in hospital. She slipped into a coma- we are unsure why as we do not have a great deal of scope with investigations but it could have been due to high blood sugars, malaria or cerebral oedema- likely a combination. She recovered somewhat after her BSL's were brought down with insulin and labour was induced. The following day she again slipped into a coma due to hypoglycaemia (there is much to be said for diabetes management here) and started to have seizures. Claire (director's daughter who is a second year out doctor) was sent to resuscitate her, and was shortly joined by Ben, Sophie and I. We got her on oxygen, got an airway and jaw thrusted her in turns all day. She continued to have tonic seizures which were stopped with IV diazepam (she didn't have eclampsia as far as we could tell- no proteinuria or hypertension). She was febrile and was still being treated with IV quinine for malaria and IVABs. There is no way to measure electrolytes here so I personally think she was hypokalaemic- potassium was not replaced as we brought down her glucose levels as in the past people have been killed by being given IV potassium boluses instead of K in bags- so the policy is pretty much it's safer not to worry about it. Anyway- the four of us left at the end of the day after instructing her guardians on how to jaw thrust her if her breathing became noisy during the night. To our amazement she lasted the night, despite the on call clinician disregarding our advice of no more insulin (she recieced another 10 units over night and had another hypo) and was slightly more conscious. She has been transferred to a bigger hospital now- although we are not sure if she will receive any better care than the four of us here. They at least can measure her U&Es. I don't think many people understood why we were going to such lengths with her. It was a good learning experience and really highlighted some of the limitations there are over here.
This week I will be working on the female ward, which is usually filled with gynae problems and malaria (+ HIV). We are planning an aus day BBQ - and intend on forcing our British friends to speak in Aussie accents all day- as the three Australians here seemed to have some how picked up a little too much queens english from the Brits.
Hope you all have great Australia days and I'll keep you posted on ours.

Love cy