Not your garden variety nursery

I'm assigned to nursery this week.  What I've found is that nursery = NICU.  Most infants born here are not evaluated by a physician unless they are sick.  The admissions are from sick babies born here, referred from other facilities, or people that walked into clinic.  Most of the infants here are very sick.  Here's a few of the things I've seen in just three days:

- gastroschisis

- Esophageal atresia with TE fistula (ruling out VACTRL)

- encephalocele x2

- Unknown syndrome: interrupted aortic arch, bilateral cleft lip, smooth filtrum, ambiguous genitalia, bilateral hyperextended knees, club feet (thought about Patau b/c of overlapping 2nd and 5th digits, but not sure)

- posterior urethral valves

- urosepsis

- hyperbili (bili was 31 on admission!)

- A form of skeletal dysplasia - not likely achondroplasia

- lots of prematurity

- grade IV IVH - baby also has a large PDA and heart failure

So it's been busy. The gastroschisis baby died the first day we were here.  The interrupted aortic arch is a ductal dependent lesion, so the baby wasn't doing well this AM.  The parents are taking her home for palliation.  Unfortunately, we do not have the resources to perform cardiac surgeries.

Any of these problems would be a challenge back home, but to add, I'm considered a "consultant" and lead teaching rounds.  It is certainly stretching me as a physician.  I'm developing a new appreciation for my attendings! It's hard!  That being said, I've been happy with my training so far - some of the above listed things I've seen before, so I was able to diagnose and treat them.

Sarahbeth is having a similar experienced on wards.  I know all this sounds depressing, but the parents all appreciate what we are doing and are thankful even in bad outcomes.  There is no entitlement mentality here, which is very refreshing.  The patients often offer as much money as they can to help pay for their hospitalizations.  

We are still doing really well.  We are having a great time getting to know the missionaries and short termers.  We have been at someone's house for dinner or desert every night we've been here, so we feel very welcome!  

Thanks again for your thoughts and prayers.  Sorry the post is a bit choppy-  the Internet only works on my iPhone right now. See you all soon

- Bryan