Hospital Work

I've realized that in all of our blogging, I haven't devoted a whole post to describing my work in the hospital. It would be a shame to never do so, since not only has it been my primary responsibility, but there have been a host of fun experiences that deserve to be shared.

Hospital rounds start at 7:30-8 each morning, during which time we discuss patients who have been admitted to the hospital and decide upon their course of care. Sometimes decisions are fairly straightforward, and at other times the cases are bizarre, such as a snakebite or tetanus. I find it funny, though, as to what may be considered straightforward – for example, I've seen so much pediatric malaria, that I can basically recite the care to be given in a variety of clinical situations, as well as how to deal with various complications. Something that is a novelty in the states has now become very routine, and I'll probably have more experience treating it than all of my attendings in residency (so if a case ever comes in, I'll have a chance to look like an all star). Another few crazy facts on malaria in Togo – it's so common that you have to consider it for anyone with a fever, and will often treat without running tests. Also, it can cause such severe anemia, that single digit hematocrits are common upon admission. My personal record is 8, though patients with hematocrits as low as 4.5 have survived. (For the non-medical people, this is a measure of how anemic a person is...doctors usually transfuse a patient when their hemoglobin is less than 7, which is the equivalent of a hematocrit of 21.)

Being a family medicine (almost) doctor, I've tried to spend time helping with all types of patients – OB, medicine, pediatrics, and surgical. OB cases are some of my favorite. It's been exciting to deliver babies here in Togo. I've also gotten to get a significant amount of C-section experience. A lot of this consists of assisting the surgeons here, but I've gotten to deliver several of the babies in the OR after we have opened the uterus. Additionally, there have been 3 C-sections where I have done a majority of the operation, which has been one of the medical highlights of the trip. Many family medicine residents have never done a C-section, and I've already gotten to do 3!

After rounds, I usually go up to the clinic to see patients. It's been a new experience to have to interview patients through a translator. It works for the most part, though there are many times where I've felt I'm not getting the full picture. Sometimes this is frustrating, because knowing the language really would allow me to provide better care at times. Still, we manage to consistently help people, and it's been fun to have more responsibility in treating patients.

I'll also take call every 3-4 nights, which consists of taking phone calls when there are questions about patients and going down to the hospital when someone needs to be admitted. Fortunately, most people don't come in late at night so I would usually get at least 6 hours of sleep. The responsibility of admitting patients and having to make more decisions has been invaluable, and I feel much better prepared for residency after my 6 weeks here. I don't want it to sound like my responsibilities have meant I have little oversight. I have worked with some great doctors who have watched me make decisions and taught me a wealth of knowledge. Michael Gayle is a family medicine doctor who has been a wealth of information both in clinic and treating adult medicine patients. Russ Ebersole is a pediatrician who does an incredible job of what basically amounts to running a partial peds ICU with limited resources and monitoring, yet he saves innumerable lives. He taught me much of what I know about malaria. Todd DeKryger is a surgical PA, and he was one of the main people working on my surgical skills to train me to perform C-sections. Mary Jo is our midwife, and she has walked me through deliveries. And our short term surgeons have taught me about post-op care and allowed me to assist in the OR. All of these people have served to sharpen my skills, and I think I will only realize how much they contributed to my education once I start residency.

Some other medical highlights have included:
• getting my first intubation on a pediatric patient
• giving spinal anesthesia
• seeing a child survive a severe tetanus attack (the docs here have learned that giving antibodies into the fluid around the spinal cord and brain increases survival from 15% to 85% over conventional treatment, and while a few people had recommended this before, only in the last year is it becoming recommended practice by the experts)
• getting to practice medicine alongside Lisa...and getting to hand off the first baby I delivered by C-section to her (by the way, getting the baby after a C-section is Lisa's favorite thing to do medically)
• seeing a patient with a snake bite
• pulling out a twin during a C-section

In addition to the medical aspect, it has been a blessing to also be free to address patient's spiritual needs. And God in His grace is doing a mighty work in Togo. I have seen many people pray to accept Christ in the hospital and clinic, and it is exciting to know that our love and service is playing a role in bringing these people to salvation. It is probably true that some commitments are not genuine...after all Christ tells us in the parable of the sower that many who accept the gospel initially will fall away. But He also promises that many will go onto bear fruit, so we can trust that if the true gospel is given many confessions of faith will bear great fruit. I have already seen a picture of that as many of the Togolese serving in the hospital became believers through its ministry. One chaplain shared how his mother came to the hospital, was saved, and later led him to Christ. Now he serves sharing Christ's gospel and taking part in the work of salvation God is accomplishing at HBB. One of the PA's who is also a pastor was saved after working on the construction of the hospital 25 years ago. I had the privilege of seeing a women in clinic whose chart went back to the first year in the hospital, and she shared how during her first hospitalization she accepted Christ. A quarter century later she is faithfully serving Him. To take part in caring for these patient's as full humans – body and spirit – has been the greatest blessing of this trip. Sharing the gospel or watching others share the gospel and see patients respond to Christ's mercy is and incredible thrill. Jesus told us the angels rejoice over one who is saved, so I am certain there is a large party that keeps going on for the people of Togo. Praise God that He is making Himself known and that He lets us be a part of His work.