Kamuzu Central Hospital

Last week I spent Tuesday and Wednesday in the Pediatrics ward of Kamuzu Central Hospital. The hospital is right next door to the UNC Project guesthouse and the Tidziwe Center, but because Tidziwe is where the HIV research goes on, I hadn't seen much of the hospital until today!

Malawi does have a national health program that provides free care to children under 16 - to the extent that care is available. Every baby born is issued a "Health Passport" - which is a passport-sized notebook that both adult and pediatric patients are expected to bring to any doctor's visit. The HP contains all their immunization documentation, the patient's medical history and all doctors' notes, including HIV testing and results, and all prescriptions. Its not EMR - but I think the HP is pretty ingenious - its a great way to flip through and get a detailed picture of the patient's health throughout life. If you can read the handwriting, that is.

Unfortunately this really isn't the place to ask to take pictures of people...so I had to snap these when no one was around.

This one's for you, Dad...notice lack of red Radiation trefoil logo...
but at least they're welcoming!

I started my day at 8am, sitting in on the weekend hand-off meeting between the weekend staff and attending pediatricians. The clinical officers and a couple of newlY-minted Malawian pediatricians (very sleepy ones) each gave a run-down of what happened in the ward each day of the weekend - admissions, transfers, complications, and deaths. For each day they would pick a couple of the most complicated or interesting cases, and discuss that patient's course of treatment. The chair of the pediatrics department, "Dr. M" ran this meeting, and was grilling these students and young doctors pretty hard, interrogating them about why they made the treatment choices they did, and telling them what could have been done better. Gotta love that Socratic method.

After the meeting I followed Dr. Portia Kanthunzi on rounds. We started with a 12-year-old girl with bacterial meningitis in the High Dependency Unit (a.k.a. Peds ICU), saw a baby with malaria and a 5-year-old with diabetes - a particularly rough diagnosis in a country where the staple food is finely-milled cornmeal. A visiting physician from China, Dr. Chen, was observing for the week: he LOVED to ask me questions and his English was only somewhat better than my Chichewa. So the three of us saw patients pretty slowly - with Dr. Kanthunzi paraphrasing into English what the kids' parents would say in Chichewa, and me translating Malawian-accented English into American English for Dr. Chen's very tiny Chinese interpreter, and she translating into Chinese.

I was pretty relieved to get to spend the rest of the morning with Dr. Patty - a HUGE Congolese internist who came to KCH through UNICEF. We spent most of our time working up A 7-year-old girl who appeared to have acute kidney failure, possibly hemolytic uremic syndrome, secondary to malaria. Around lunchtime he sent me with the poor girl's urine and blood samples in hand, to take them to the UNC lab at Tidziwe. Although designed for the HIV clinical trials and research studies, the UNC Project gets a lot of use from KCH and they're so grateful to have it. Without it, they couldn't do liver function tests or really anything other than a full blood count.

I think I mentioned this before, but most Malawian hospitals don't provide food our laundry service for the patients. So all kids admitted to the hospital come with a guardian, usually a mother or grandmother (who usually has one or more other children to take care of, so they come too.) The guardians prepare meals and wash linens for their children, and mostly just live and wait outside the hospital. This is a shot I took from the Peds hallway, of one of the yards right outside.