Monday, June 4, 2018

A day's work

Typical queue outside the hospital in the morning

Many of my blog posts focus on a particular patient's story – one that captures and speaks to me. I hope that those stories bring a fresh perspective to those who read about them. But I recently came across the journal of another medical missionary who outlined his typical day. I want to do the same, in an effort to make “a day in the life” of Dr. Mark a little more real to those who have partnered in our journey - this amazing ministry of medical missions. Perhaps this can also help those considering a similar career for their future.

So recently I kept a log throughout my day. As a general outline, we usually get up around 6:30. I make some coffee (french press if the power is off) and usually try to sit on the swing on our back porch looking out on the clearing of the fog from the misty mountains around us. The children are up at 7 and we get them fed and Anna ready for school. By 7:45 or so I am off on a walk with Anna to drop her off at school on my way to the hospital.

Lately I have had some protected times in the morning from 8-9am to study for my upcoming tests, but I usually will see patients on a ward (Medicine, Pediatrics or Obstetrics). During this particular day I saw patients on our pediatrics wards with a variety of childhood ailments ranging from heart disease to pneumonias to diarrhea and malnutrition. After ward rounds, about 9am, I go to the hospital's out-patient department (clinic) and see patients there as well as covering the emergency room or delivery ward.

On this particular day, after ward rounds, I saw cases of:
Pericardial tuberculosis, tetanus, severe asthma requiring IV aminophylline, typhoid fever, a follow-up of pneumonia in a pregnant HIV patient, an undescended testis in a 4-year-old which I confirmed with an ultrasound examination, hypertension, a follow-up of a supra-condylar fracture in a child I reduced and splinted the day prior, splenomegaly from portal hypertension caused by congenital hepatitis B infection, and a bronchitis in a patient with hypertension. 

It was then time for a meeting with the provincial malaria officer to discuss a case of artemether-resistant malaria I picked up in a young boy living in a remote part of the province. We needed to organize a community outreach to confirm any additional cases and put plans in place to deliver bed nets and alert the national malaria control program. I also met with our provincial TB officer to talk about staff from WHO that were planning to come to our province and conduct a survey of our TB patients.

I went home for lunch with Esther, Levi, Lucy and Gabriel – Anna takes her lunch at the school. Lunch breaks are great ... an hour every day that I can take just a 5-minute walk to escape the pressures of the hospital and see my family. I know that if I were practicing in the US, the odds of getting lunch with my family would be pretty slim, and I'm grateful to have that chance here.

In the afternoon I was back to the clinic to finish a busy day, including cases like:
Gastroesophageal reflux, vomitting in a newborn, a 10-month old with pneumonia, osteoarthritis in an elderly lady, and then a summons to the delivery room to assist with a severe shoulder dystocia that needed very involved maneuvers to deliver – thankfully after resuscitation efforts both mother and baby survived, then back to clinic for a forearm fracture in a 6-year old, persistent diarrhea and weight loss secondary to enteric fever, a new supra-condylar humerus fracture needing reduction and splinting, carpal tunnel syndrome, rheumatic fever, a 12-hour old foot laceration, a child with nephrotic syndrome and finally a young woman who likely had infertility from polycystic ovarian syndrome.

About 10-12 pediatric inpatients
10 clinic patients in the morning and two meetings with provincial disease control officers
12 patients in the afternoon along with a severely complicated shoulder dystocia delivery

Every day at Kudjip is different. Each one brings its own challenges and rewards. Each one is tiring. But each one holds work that needs doing and, often, a patient that needs special care and prayer.

It would be impossible to capture one day and call it typical. But for those who would like to imagine what medical ministry looks like at Kudjip hospital, perhaps this can provide a glimpse into it.

“Throw away, in the first place, all ambition beyond that of doing the day's work well.”

-Sir William Osler