Written by Hongyu Zhao, MD, PGY-2 and Qing Meng Zhang, MD, PGY-2 at Kaiser Permanente…
Posted by Kevin Quinn, MD (a second year resident from Kaiser Permanente Oakland Pediatrics serving a global health elective at University Teaching Hospital in Lusaka, Zambia)
If you like procedures, this is the place. The residents here are absolute rock stars at getting IV access, as every call night is filled with 50-80 admits needing cannulation, the vast majority of them in some degree of severe dehydration or malnourishment. Turns out you don’t need a fancy kit (maybe with one of the new drills I’m waiting to play with back at Kaiser) to do an intraosseous line- a good old 20-gauge needle will get the job done when everything else failed and we needed access pronto. I did an LP the other day (LOTS of meningitis here) where I saw thick yellow, chunky fluid coming out the needle and thought “oh god, I just stuck the gallbladder”…only to realize that it was thick pus from the intrathecal space. I needled an infant’s chest for a pneumothorax yesterday morning (based on physical exam- same x-ray transport problem and it turns out the aforementioned ultrasound machine didn’t turn on). I’ve done an average of probably 3-5 resuscitations a day, complicated by only having a handful of potential code drugs (luckily one of them is epinephrine). Remember back when we thought it was a good idea to use digoxin to convert SVT? It starts to sound like a good idea again when there’s no cardioversion, no amiodarone, no verapamil, no adenosine, no procainamide, not even a bag of ice to have a shot at a vagal maneuver.
The residents and attendings here have been very gracious in hosting me and helping me through the sticking points in the hospital (anyone know how to get the euro-version of Epocrates with all the different drug names??). We’ve been talking with one of the senior residents on my team who is very committed to preventing/prosecuting child sexual abuse which seems to be on a disturbing rise here of late. We’re hoping to get him over to Oakland so he can work with Jim Crawford and Child Protective Services and share strategies. Historically there have been many residents like myself who have rotated through UTH, but the relationship has never been reciprocal.
Having essentially no internet access and with Nelson’s oftentimes being behind locked doors in didactic buildings far from patients, my sidekick on this trip has been my Palm TX with Epocrates and Up-To-Date installed. I’m not really one to fawn over technology, but that combination (along with the growth-BP app, Harriet Lane, and to my surprise, Surgery Recall from back in my med school days) has been a true lifesaver. I highly recommend dusting it off if you’re headed anywhere remote- even the boondocks tend to have cars and so a car charger is probably enough to give you and your patients a fighting chance when it’s the middle of the night and you’re trying to remember the acute care algorithms for stroke (which we unfortunately see a lot with all the sicklers here). If there’s some value I’ve been able to bring to the residents here other than another able body to absorb admits, it’s probably been my Boy Scout/OCD aversion to being anywhere in the hospital without my awesomely cool go-go-gadget utility belt/fanny pack filled with diagnostic equipment and didactic references- most of the residents do have the equipment/handbooks at home from medical school but not readily available. Several have told me that they’re going to start carrying theirs around again after noting the utility of having the tools and references near at hand.
Well, time to get some sleep before doing it all again tomorrow- there are no days off here!
Take care everyone,