Holiday Spirit

A few weeks ago when I was in Mahalapye the chief medical officer told me about a 14 year old girl who had come in with dysfunctional uterine bleeding, (in this case a very prolonged menstrual period causing her extensive blood loss).  Her hemoglobin was 3!  Dangerously low and she need a blood transfusion.  However, there is a nationwide blood shortage and the hospital was out of blood.  He called the two bigger referral hospitals and they said they also were out of blood.  I said "well I can donate blood right now."  In the States I try to donate every 2 months, but I had not donated since I had been here.  It turns out, I even had the same blood type as the patient.  However Mahalapye does not have a blood donation system.  They have no way to collect, test, or separate blood.  The blood donation process can only be done in the two referral hospitals, so that was not an option.  Miraculously, after threatening to refer the patient to the nearest of the two referral hospitals, some blood was found and they were sending it by car which was going to take about 4 hours, but luckily the patient was stable.
So last week when I saw the signs for blood donation at the Princess Marina Hospital in Gaborone, I went to donate.  Of course, I showed up at the end of work (4:30 pm) and they were just packing up.  However they told me I could go to donate the next day at the national blood donation center about 5 mins from the main hospital.  The next day was a slow day on the wards (more about that soon), so I went to donate.  It was basically the same procedure as blood donation in the States, but with less nit picking.  They do have a questionnaire about your habits, through after hearing that I had donated numerous times in the States, my "counselor" marked "no" for all the questions. They check your hemoglobin and your weight, and then voila they are sticking a 16 gauge needle in your arm while you hold the blood bag in your lap.

A similar sticker sheet full of millions of bar codes gets put on your bag.  At the end they take two test tubes of blood, as they do screen the blood for all the things we test blood for in the States.  Then you get the choice of fanta, coke, or sprite and you proceed to the couch where you find....

An entire package of biscuits and the largest Sprite I have ever seen.  I thought the touch of the sliver platter was quite funny.  Here women can only donate every four months (as opposed to men who can donate every 2 months, in the states everyone is eligible every 2 months).  The difference is that they are worried that women will be more prone to anemia because of menstruation; more of a worry here given the poor diet of many people here.  

Last week also marked my first week as attending on the inpatient wards.  I have been consulting at various local hospitals when I was based in Serowe, but now that I am spending more time in Gaborone I also will be spending some time in Princess Marina Hospital (PMH).  PMH is one of two referral hospitals in the country, and one of the few places where pediatricians staff the inpatient unit.  However, we do not have many pediatric sub-specialists, so us general pediatricians end up managing a lot of things specialists would manage in the States.  In addition to lack of specialists, we also don't have many of the things one would find in a children's hospital in the States.  We don't have child life specialists (people who help children deal with their feelings about illness and fears about procedures), there are no private rooms (the patients are in beds lining either side of several 3 sided rooms), there is no place for parents to sleep (and yet almost every single patient has a parent with them 24/7; they sleep in chairs or on the floor next to the child, or in bed with the smaller children.)  Parents provide a lot of the care in the hospital from feeding and cleaning their children, to reminding the nurse when the child's IV fluids have run out, to acting as monitors when the child is really in distress.  It can be a really dismal place.  But last week I noticed that someone had gotten the children to make wishes for the holiday.  

This Christmas tree was up on the wards with each little ornament reflecting the wish of one child.  Some were pretty unique..... 

Sorry for the poor quality photo, but it says "I wish my brothers liked (or he/she may have meant tickled since the first letter looks like a t) me every second"

 

While others seemed liked things kids in the States would write.  "I want to be a pop star," " I want an X Box 360," or the one above "I wish I had a TV in my room."  Unfortunately I don't think that Santa brought these children exactly what they wished for, but at least a local radio station did visit the hospital with some gifts around Christmas.

More stories about the wards in upcoming blogs, but I wanted to share one final photo. 

 He is one of the children I met in Serowe.  He did not want to be put down so he sat on my lap as I wrote notes and finally fell asleep in my arms as I read through one of the other patient's charts.  He was so excited to see his picture on the camera, that he could not wait for the photo to actually be taken!

Happy 2010 everyone!  I hope this year brings some health, happiness, hope, peace, equality, and the ability to experience small joys through the eyes of a child to all corners of the world!