Being thankful

Hi everyone!

Another new adventure happened yesterday.  Trish (my Irish doctor friend who started and grew this whole program) asked me to meet with Dr. Kisenge, who I guess is the Head of the Eductional Programs at Muhimbili University while I was here to discuss a few things.  So the ward administrator, Lillian, had been trying to arrange a meeting for about a week, but Dr. Kisenge had been busy because I believe there are exams or other coordination happening right now, so yesterday morning when we got to the hospital Lillian told me my meeting was in an hour.  Well, didn’t quite know what to expect but I think it all went well–at least Lillian said so, she walked me over and sat in the meeting so she could walk me back.  We discussed the current semester plan for the Master’s program, the goals for the students, some issues that one of the students has been having and how we can help with those, and then we discussed overall plans and commitment with regard to the next class of Master’s students in Pediatric Oncology.  I think there is commitment but like all good academic programs it comes down to guaranteeing funding.  Really, everyone has a goal of running 3-4 cycles of Master’s classes which will need visiting international lecturers to provide expertise and then after that enough local folks would be trained to carry the program forward sustainably.  It’s just getting there.  So everyone is working on that.

We have continued to work through topics that the doctors have requested more teaching/review of since their formal curriculum has finished.  Thus far, we’ve covered chemotherapy mechanisms, side effects and late effects (thank goodness that is my lecture for the fellow’s basic lecture series, I could just edit), Shelton has covered oncology emergencies and immunophenotyping for leukemias, today we did some cases with regard to fluids and electrolye management and tomorrow we take on palliative care (thank you Kathy Perko for some slides to get me inspired).  I’m interested to see how palliative care will go as culturally I think palliative care may be difficult for many people here.  So everyone wish us some good thoughts, cultural sensitivity and clarity as we venture into that topic.

Poor Suman, who comes next, I totally pulled a fast one and passed brain tumors on to him but in fairness I also gave him sarcomas which are in his wheelhouse!  Hopefully Kellie and Becca have provided him with some good outlines.

As you can see, this teaching thing takes a village, so thanks to everyone who has answered some sort of red exclamation point email that I’ve sent over the past week and a half.  Which brings me to my next topic for the night…..

Things I’m thankful for that we take for granted every day.

– Our wonderful team at Doernbecher/OHSU.  The team here is certainly becoming more cohesive but they lack a team of specially trained doctors and nurses and social workers, and physical therapists and nutrition people and consultants–and a PICU and pathology and radiology etc.  Just being able to walk down the hall and find a colleague who can provide insight or an ear to bounce an idea off of.

– A working flow cytometry machine and our wonderful hemepath fellows, a special shout out to Phil, who answer the call within hours of getting a sample.  The flow machine is still awaiting a technician from Nairobi so we have several children who are just sitting awaiting diagnosis.  Some who are not at all comfortable.  The ones who we feel mostly sure have ALL have started chemo.  The ones who we think have AML have not and are miserable.  Then there are a couple who we just have no idea what they have but need to rule out leukemia.  So we wait.

– A working CT scanner and the ability to get scans the same day (let alone within minutes to hours).  We have been getting exemptions done but the scanner broke.  Also, here’s the special shout out to to the radiologists again, because we take for granted the quickness with which we get reads.  Because the machine broke there seems to be an issue getting some reads.  We have one little very happy boy whom we are awaiting a CT read on to make sure he doesn’t have a brain tumor.  We are pretty sure he doesn’t and that he just had congenital rubella but we need to know so we can transfer him somewhere else.  But he is waiting almost a week now.

– Labs that result out relatively quickly, certainly thankful for the CBC machine in the clinic that spits out our CBCs on demand.  We get labs mostly back the next day here.  But sometimes the system has been down and that hasn’t worked well.  This one is a double edged sword, because the speed with which we get results really leads to our ordering labs frequently and we really don’t really need that.  Shelton has now seen how to manage tumor lysis with daily to not even daily labs.  We worked through cases today and used clinical symptoms to assess electrolytes, for example, which they do every day.  But I’m still thankful we can get labs quickly when we need them.

– The blood bank and a ready supply of blood products.  Really, the major part of the day for the interns is tracing blood.  Which means several times a day they go to the blood bank asking if there are blood and platelets available for any of the kids.  We have one little boy who we are pretty sure has new diagnosis ALL, who presented with symptoms of heart failure due to anemia who has gotten one blood transfusion but has been really in need of another for days now but we haven’t had blood.  Today we finally got blood and literally all did a cheer.  Then Erica doggedly followed nurses around until she got someone to hang it.  So we are feeling hopeful that he and this heart will feel better tomorrow.

– Which of course then makes me thankful for our blood donors–all you blood donors out there, you really cannot know how much you do for the people you donate for.

– Pharmacy, really the fact that we have pharmacists and they check and double check us.  There is no pharmacy oversight here.  We did have an incident here this week which the child has recovered from which I’m sure would never have happened if the unit had a pharmacist.  Everyone is doing the best they can but we all know that a pharmacist has special expertise that is vital to a pediatric oncology program running safely.  And I’m really sure that the nurses here would appreciate a pharmacist to mix the chemo rather than themselves.

– The HUCs.  The doctors and nurses spend a lot of time chasing things around here because that is the system but Shelton and I looked at each other this week and said, “They need a Misty.”  And again, I’m always so amazed by how far the program has come each time I’m here and just continue to wish them more efficiency so they have time to take care of their very high census.

Well, I’m sure I’m thankful for many more things but those just came to mind today and I thought I’d share.  We really are blessed to be able to practice where we do.

On that note, Happy Thursday!



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