A nice birthday

Today I rounded on the general pediatric service. There are many separate large rooms that are nearly spotless, with no odor, and each patient has their own twin bed. There are usually 3-8 patients per room and there is no sense of overcrowding.

We started in the pediatric intensive care unit. There were three children, two who were recovering from severe diarrhea and one six month-old who was very ill with pneumonia. His work of breathing was so intense that he could not take any food or liquid by mouth.

We then progressed to the ward for malnutrition. The children were sickly, thin and weak, but they did not have the absolute emaciated appearance of the patients from the DR Congo. These children in East Timor were malnourished simply due to lack of calories, not secondary to HIV/AIDS or tuberculosis.

Our next stop was the “Malaria ward”. Surprisingly there were no patients with malaria but the unit acted as the overflow ward. One child was admitted for abdominal pain and nausea. An astute clinician heard signs consistent with pneumonia and made the correct diagnosis. While I was examining the patient, I noticed a heart murmur (diastolic at the apex). Hopefully we can find someone on the island who can do a cardiac ultrasound. I would guess he has mitral stenosis.

The next room was the tuberculosis room. There are no definitive tests for tuberculosis and the diagnosis is made clinically. Basically, if the patient has a pneumonia that does not improve with the usual antibiotics, treatment for tuberculosis begins. There were six patients in various stages of their illness.

The final room was for gastrointestinal diseases. Most of the children presented with diarrhea, usually bloody, and abdominal pain. There are no stool tests and the standard treatment is a trial of one antibiotic (ampicillin). If there is no improvement, a second medication is started (metronidazole).

Today was fun. The pediatrician, Dr. Edna, led rounds and seems to be a competent and confident doctor. She taught me about the treatment of malnutrition and I taught her about the cardiac exam and cardiac lesions. We also were lucky to have a group of fourth-year medical students. They are very intelligent and eager to learn more.

Tonight, Lisa and I will have my birthday dinner at a small hotel. I have heard the food is fairly tasty.

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