I realized that based on my posting you might not know that I am actually working. Work is going well. I am slowly getting more comfortable. I am having to find people to ask questions less and less often. I am also learning a whole area of medicine that has nothing to do with HIV. I have sharpened my blood drawing skills. I have learned how to set up IVs although still not great at starting them. I even learned how to mix Ceftriaxone (an antibiotic) yesterday and push it all by myself. Definately a skill set that I had never really considered before. Who knew there were all these steps between writing an order and it getting completed.
Since I have been here I have seen a lot of deaths, but I learned last week of the first one where something I had done directly contributed to the death. Nothing I did was wrong, but that does not necesarrily make it any easier. This was a 4 1/2 yo little boy who had just left the hospital for malnutrition. He was doing better and came in for initiation. He unfortunately developed the rare, but serious side effect called Stephens-Johnson syndrome. This is a severe blistering rash that effects the skin as well as mucous membranes (mouth, gi tract). He also started to have vomiting and diarrhea and was unable to keep anything down. He returned to clinic and was admitted. Unfortunately, he passed away the next day. This all happened while I was in Uganda so I did not get to talk with the mother. Mom was also initiated on ARVs the same day because she was 36 weeks pregnant. Hopefully, she has continued her ARVs and this baby will be born HIV free.
Participated in my first training yesterday. This training included about 22 nurses from all over the country. Baylor does these formal trainings every couple of months. I spoke on the prevention of mother to child transmission and the swaziland protocal for early infant diagnosis using DNA PCR from a dried blood spot. This is completed in a similar manner to the newborn screens in the US and detect the actual virus. This is important because the routine test used here detects antibody. However, children less than 18 months can still have antibody from the mother and not actually have the virus. The DNA PCR allows us to diagnose the wee ones before they get sick. This has become even more important because the World Health Organization just changed their recommendation to say that every infant less than 12 months old who is found to be HIV positive should start on antiretroviral therapy ASAP regardless of how they are doing clinically and their Cd4 count (measure of their immune system that HIV attacks) . This is because 35% of these infants die in the first year and 50% by their second birthday.
3 comments:
Do you feel like being surrounded by such a high mortality rate is changing you in any way?
I just sat down and read your entire blog. I'm going to keep reading. This sounds like an amazing (and at times sad) experience. -Jessica B.
That is a hard question and I am not really sure of the answer. Each death I have even been peripherally involved in has still affected me. I have still tried to think about why they died and what could have been done differently. I suppose in a way though that I probably do not dwell on them for quite as long as pediatric deaths in the US. Each pediatric death in the US was a big deal that would often have multiple meetings, discussions and sometimes even grief sessions for those involved because they are so infrequent. Here we do seem to talk about a lot of the cases either formally in our doctors meetings or informally with the other doctors involved, but not to the same extent. Don't know if that answered your question or not. It definately got me thinking though.
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