An Average Day for a Medical Missionary at Kudjip

For those that are interested, I decided to write up what a typical day at Kudjip looks like for a medical missionary. I picked a random day (November 22), wrote down the cases I saw, and took a couple extra pictures.

8:00am – 9:00am – Ward Rounds

This week I am on Pediatric Ward (A Ward). I am responsible for half the ward (18 beds). On this day, I took care of kids between the ages of 5 days and 10 years. Illnesses include…

Neonatal Sepsis, Pigbel, Severe Acute Malnutrition, Meningitis, Osteomyelitis, Pyomyositis, Diarrhea, and Pneumonia.

Several of the children would require intensive care either in the NICU or Pediatric ICU if they were in the U.S. Most would also require specialist or sub-specialist consultants. Here at Kudjip though, while I have surgical backup and other doctors to get a second opinion from, I am the main physician responsible for the health of these little ones (this week).

Peds ward can be a lot of fun, but also heart-breaking. Fun- because kids get better quickly and are typically a lot more pleasant than adults. Heart-breaking- because it is tough to watch kids suffer from illnesses that could be easily treated with more advanced medicine.

On this particular day, most of the kids are getting better and doing great. However, I learned that overnight two patients on my side died. The first was a 9-year-old with severe TB meningitis that was unconscious and in cardiac arrest when he first arrived at Kudjip the day before. We resuscitated him, however he remained unconscious and died during the night. The second was the last-surviving twin that was born premature at home at about 29 weeks. This first-time mom came in to get her tiny twin babies immunized only to have them both die within 24 hours.

My little buddy with Malnutrition who really turned a corner and is now eating and growing great!

9:00am – 4pm – Outpatients/ER

I attempt to finish ward rounds in 60-90 minutes to make sure there is plenty of time for the multitude of patients that will come into the ER and Outpatient Department today.

Some interesting ER patients I saw on this day include…

  • A patient with HIV and possible multi-drug resistant tuberculosis
  • A young mother of 3 with metastatic breast cancer that is incurable
  • A 9-year-old girl with severe heart failure
  • A young man with multiple large “bush knife” (machete) chops he received because of a dispute over pigs requiring some suturing by our nurses
  • An 8-year-old boy with a large abscess in his thigh which I drained (pyomyositis)
  • A patient with an open elbow fracture after getting hit with a metal rod which I reduced
  • About 5 additional ER patients
Chest X-Ray with metastatic cancer
Elbow fracture/dislocation

Some interesting outpatients I saw on this day include….

  • A patient with a suspected pituitary mass causing gigantism (acromegaly)
  • A 3-year-old with a bone infection around his eye
  • A middle-aged man that had an 80kg bag of kaukau (sweet potatoes) fall on him
  • A patient I diagnosed with tuberculosis and drained about 1.5 liters of fluid out of her chest
  • A baby with probable meningitis for which I performed a lumbar puncture
  • A man I had been following for some time that completed 6 months of TB treatment for TB in his lymph nodes and is doing great
  • Another patient with an elbow fracture and dislocation which I reduced
  • A young mom with post-partum sepsis
  • A young lady from a long way away I have been following for pericardial TB (TB inside the sac surrounding the heart)
  • About 20 additional outpatients
Little guy with orbital osteomyelitis
Lymph Node TB healing well.
Another common thing: Gifting of homegrown garden food. I got about 2 dozen cucumbers from my patient with pericardial TB.

4pm – 8am – On Call

The frequency of our nights on call depend on how many doctors are here. Right now, it is about every 4th night.

Some of the patients I took care of this afternoon and evening include…

  • A young woman with a molar pregnancy with continuous bleeding needing a blood transfusion and a D & C
  • A first-time mom in labor that wasn’t progressing well and the fetal heart rate was getting too high so I did a C-section with our on-call OR team
  • Another mom with severe preeclampsia at only 26 weeks of pregnancy, and the baby is also breech
  • A patient with miliary tuberculosis

I got to sleep around 11:30pm and I was awoken about 4am with several patients in the ER…

  • A young man with a complex penile laceration from an attempted circumcision in the bush which I repaired
  • A man with multiple small caliber gunshot wounds to his right arm
  • A teenager with a seizure, fever, and abscess in his lower leg which I drained

8am – 11am (November 23) – Ward rounds and OPD

We usually get a “half day” one day a week following call. Today my half day was at 11am and after seeing a few more patients and doing the D & C from the night before, I went home, got lunch, and took a nap in preparation for Thanksgiving!

While each day brings very different pathology at Kudjip, this was a pretty typical day. A mentor of mine here will frequently say, “There is hardly a day when I wonder why I am here.”

I can literally see lives changed and saved on a daily basis here at Kudjip. Even something simple such as a C-section for the mom in labor that was not going to deliver on her own, likely saved one, if not two, lives. I really did not think this day was anything special, but looking back at the list of patients from this past Thursday reminds me of how rewarding it is to be here and the privilege it is to serve alongside so many great doctors and nurses at Kudjip Hospital.

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