Third week: Neonatology

We are downtown for the night in our new favorite cafe to use the wifi again. Supposedly the wifi at our apartment will be fixed Monday or Tuesday…we will see! This week Judithe and I were back at Hospital del Niño in the NICU. I did a NICU rotation back in the fall at Dayton Children’s and really enjoyed seeing their unit here. There were 6 main patients for the week, and a few others that were in and out for less acute things like hyperbilirubinia (jaundice). Some of the more interesting cases were:

1. Suspected Tetralogy of Fallot (a heart condition that some babies are born with) as well as sepsis (bacteria in the blood) that was being treated with antibiotics. They were waiting to do surgery on her heart because she was too unstable due to the infection. We got to witness several talks with the baby’s aunts about how grave her situation is and how the prognosis is unknown. Her mom is 19 years old and home sick so wasn’t able to visit. The doctor told us that teenage pregnancies are common here (guess that is a universal thing!). He also reminded us how very important it is to have several talks with families about the medical condition on different occasions so they can fully understand.

2. Our favorite baby, who had a surgery done for a diaphragmatic hernia. The diaphragm is a big muscle that helps you breathe and separates your chest cavity from your abdominal cavity. This baby’s intestines were up in his chest due to the hernia. He recovered really well from the surgery and is just waiting for his older brother to recover from a case of pneumonia before he can go home. Judithe and I visited him every day and talked to him, sang to him, and even got to hold him/help feed him on our last day 🙂

3. A case of ileal atresia (where your intestine doesn’t develop right and it is not open so food can’t pass through). This little guy had already had surgery and was just in the unit as he recovered.

4. A case of intestinal volvolus with obstruction (where the intestine twists on itself). This is a surgical emergency because the blood supply can be cut off and cause that part of the intestine to die.

We worked with a nice doctor again, a neonatologist whose last name is complicated to spell so I will just call him Dr. P haha. He took time each day to ask us of we were understanding everything on rounds ok. He also asked several questions about the United States and how things work in hospitals at home. For example, he was telling us one day that it is very common here for babies to be abandoned (sadly one of the little guys in the unit was in that situation, from what I could gather from rounds) and left to go to orphanages, especially if the parents are young or already have many children and can’t afford another. He was surprised to hear that we have many problems with social situations in the U.S., as well. I asked about his training and it seems to be the same here as at home for neonatology- pediatric residency followed by a neonatology fellowship.

Neonatology unit

Neonatology unit

Part of the unit.

Part of the unit.

Resident workstation, complete with paper charts and typewriters.

Resident workstation, complete with paper charts and typewriters.

There was another strike on Thursday and Friday, but it didn’t affect our work in the NICU at all. We did manage to get a picture of the sign on the front door this time!

This sign (more or less) says "The lack of human resources, infrastructure, and teams within the hospital...is this not negligence?"

This sign (more or less) says “The lack of human resources, infrastructure, and teams within the hospital…is this not negligence?”

We also got to go to Down Syndrome clinic again with Dra. Salete on Wednesday as there were only 6 patients in the NICU at that time and rounds were over by 10:30. I love love love working with Dra. Salete! Always a breath of fresh air, how passionate she is about helping her patients. This week she even paid for a patient’s x-ray with her own money since his family couldn’t afford it.

We got a double lecture on Tuesday evening from Dra. Uribe since she had a sore throat last week and couldn’t lecture- one on surgical emergencies and one on Chagas disease (a parasitic infection). Chagas is not endemic in La Paz because of the colder temperatures but is a big problem in the more southern, tropical areas. Very interesting talks! And pretty easy to follow even in Spanish because there were accompanying powerpoints. Plus a lot of the medical words are similar, so that helps.

This morning, we got up bright and early to travel to Hospital de Los Andes, a maternal infant hospital located about an hour away in El Alto, the highest part of the city (the rim of the “bowl”). This is where Dra. Uribe works and she picked us up this morning at 7:30 to drive us there. Judithe, Amina and I each got to work with different groups of residents. Judithe was in the OR and got to observe a C-section, Amina was in the neonatology unit, and I was in the post-partum section. Compared to this hospital, Hospital del Niño is pretty high tech. El Alto had around 1 million residents and is well known as one of the poorest sections of La Paz. I got to see about 10 babies with the resident, and do physical exams on them. I also saw the OB rounding on the moms but didn’t get to work with him personally. The residents’ notes were all hand written here (no type writers that I saw). I feel like I am a little spoiled with our electronic medical records at home. It takes impressive stamina to write all those notes so quickly without your hand falling off! Skin to skin contact between the baby and mom right after birth is the practice here, as well. They also put an emphasis on teaching moms’ the importance of breast feeding. In the postpartum unit, there were 30 beds. Each big room had 6-8 beds- no private rooms. The baby stayed in the same bed as the mom.

I was also excited to work more closely with the residents because I got to talk to them a lot. They of course asked me a lot of questions about medicine back home, and I in turn asked them lots of questions 😉 There doesn’t seem to be work hour restrictions here during residency, as opposed to home (80 hours per week). I asked one resident how many hours she worked every week and she told me this is much more than work because it feels like she lives at the hospital. So not much changes between cultures… That is how I feel some months, and I am sure how I will feel for the next 3 years 🙂 We also got to attend didactics this morning on neonatal sepsis, which was interesting. One of the residents presented. I am glad I went and was able to see the hospital! A very eye-opening experience for sure.

Tomorrow we plan on visiting the zoo and maybe going to see a movie in Spanish (super cheap here compared to home!!). There is a new PA student coming tomorrow so there will be 4 of us this week 🙂

Judithe and I will be doing nephrology Monday, Wednesday and Friday this week, and going to an adolescent medicine clinic on Tuesday and Thursday. Should be a great end to a great rotation! I will update again as soon as we are back in wifi-land. Hope you all enjoy the rest of your weekend!

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