Passover

So this was Passover in Botswana (yes I know it was three weeks ago, sorry I'm a bit behind on the blogging...)  Given that there is really no Jewish community in Botswana, (no synagogues, no chabads, very few Jews), I was not really expecting to get a chance to celebrate the holiday.  Luckily Matt had other plans.  He managed to find a Haggadah online (again what did we do before internet?), printed many copies, and invited all of our friends to his and Premal's house for a seder.  There were 20 people at the seder, only 4 were Jewish, and most everyone else was at their first seder.  To our surprise, there was even matzah in the local supermarket and the visiting cardiologist's wife made matzah ball soup (after a trip to South Africa to get the matzah ball mix).  We had a proper seder with everyone taking turns reading from the Haggadah and much discussion relating history with the present.  We even had two children to find the Afikoman at the end! 

It was a wonderful way to celebrate the holiday, and though I missed being with my family, I was thrilled to have so many people to share Passover with.

I know the last few blogs have been all about fun trips and celebrations, but don't worry, I have also been working ;) The last week of March and first week of April, (in addition to being Passover), were two more weeks on the inpatient wards.  I find the inpatient wards to be the most challenging part of the job here.  I have always been a person more aligned with outpatient medicine and the children on the wards here are often extremely sick (the opposite of outpatients).  I often find myself managing children who belong in an ICU and often the outcome is not good.  

In two weeks there were three deaths on our team, all children less than one year old who came in severely ill.  One had been given traditional medicine and had gone into renal failure and had severe respiratory distress by the time he came to the hospital.  One had severe meningitis, and the other had severe respiratory distress and a VSD (hole in her heart).  All three would probably have benefited from an ICU, where they could have been intubated, given ventilator support, dialysis, etc.  However, that is not really available here, as we only have an adult ICU and they rarely accept pediatric patients.  So we did our best for them on the wards, but unfortunately it was not enough.  It never gets easier to tell a parent there is nothing more you can do for their child (nor should it ever get easier).  Doctors are supposed to be able to make things better and it is hard not to feel defeated when you can't. 

However, for each of the defeats there were a lot more battles which we won.  During those two weeks there were also a number of children with gastroenteritis and bronchiolitis, (both things that I had a lot of experience managing back in the states), who just needed some supportive therapy (IV hydration, oxygen, etc) and TLC and managed to be discharged in a day or two.  Watching the dehydrated and lethargic children become animated and playful and the child with croup who finally improves with nebulized adrenalin and steroids; makes it possible to continue the fight.  

As we say on Passover: "Next year may we all be free." To me this is not just free from slavery, but free from persecution, poverty, unnecessary deaths, war, inadequate health care, etc.  A lofty goal for a year, but I hope with each passing year we will be one step closer!