Patients seen on a typical day on a tanzanian ward

Patients seen on a typical day on a tanzanian ward

31st August 2011: Very tired today from the events of yesterday and lack of sleep but with help of Kahawa (coffee) managed to be vaguely alive in time for the 8am meeting. Less descriptive post today and more of a list of conditions I saw or was told about on the ward round. Lots of obstetric cases because manily obsteric ward round today. Warning, probably of not of interest to those from a non medical background!

Patients

• Human bite to lip/jaw - caused by husband!

• Malaria
• Female adult with partial intestinal obstruction- gas on percussion, diminshed high pitched bowel sounds, dilated loop of ?small bowel (doctors unsure as to which bowel!)on abdominal x ray. Commonest cause bowel obstruction in adults here = volvulus (twisting of the bowel) , kids = introsusseption (the telescoping of one part of the bowel into another). Patient going to theatre soon.
• PID - pelvic inflammatory disease (caused by STI's)
• Meningitis
• Bleed from R. Inguinal area unknown cause.
• Patient recovering from Perineal tear from labour, and pph (post partum haemorrage).

• Inevitable miscarriage (due to premature labour start) which occured yesterday - stillborn breech at what then was thought to be 22weeks but based on the size of the baby the doctor thought perhaps 29 weeks (I think this is perhaps even more tragic, because possibly in the UK this baby could have been delivered by an emergency c-section and with the resources available in England would have had a good chance of surival).
• 13 year old boy with peritonitis (inflammation of one of the membranes in the abdomen)
• The patient whose baby I delivered yesterday. I think she was still in so the baby could be observed for a bit longer because they had said that normally here woman who have given birth leave within 4 hours and when we saw her on the ward round today she had already been in for about 11 hours since her daughter was born.
• Patient who had a c section a few days ago due to Cpd (cephalo pelvic disproportion, basically babies head too big for the mum)
• Patient who had a C section on 27th - indicated due to previous pregnancy scar.
• Pregnant patient with ?malaria

• Recent C section - indicated due to big baby and poor progress of labour (4.6kg!) - due to gestational diabetes.
• Patient who had a C section 6 days ago due to foetal distress where baby hard to extract, lots of blood loss - pph, resulted in subtotal hysterctomy being performed (subtotal = cervix and ovaries left behind) - very young patient, 19 and was first baby.
• A patient who was on her 8th preg but of these had only had 1 svd (spontaneous vaginal delivary) and the other pregnacies had resulted in 4 miscarriages and 2 premature labours (which I think were too early to be viable). Was admitted to investigate cause of previous failed pregnacies in order to try and prevent the recent pregnacy progressing same way. The cause was found to be due to rhesus incompatibility. This is when the maternal and foetal rhesus factors are mismatched (rhesus factor is one aspect of some ones blood group - blood groups can be A, B, AB, O and then in addition rhesus positive or negative). Rhesus incompatibility occurs when the mother is negative and the foetus is positive.The foetal blood and maternal blood mix during birth and so if the foetus is rhesus positive and the mother is negative the maternal immune system views the positive factor as foreign and so produces antibodies against it. These antibodies cross the placenta in subsequent pregnancies and so if future babies are also rhesus positive the maternal immune system attacks the babies red blood cells causing rhesus haemolytic disease of the foetus. The first baby therefore escapes this disease (which is why the patient had one svd and since has been unable to carry a baby to term). The current pregnancy was successful so presumably this baby was rhesus negative like the mother.

In England rhesus status is checked as a matter of course and if the woman is negative she is given prophlactic anti-d to prevent the formation of the antibodies in the first place.

• Next patient was 5 month pregnant, slight contractions - salbutamol given to try and prevent full labour, membranes had ruptured so antibiotics given to stop infection.
• A patient whose due date was apparently 2nd august! This is dangerously late so hopefully date mix up. Baby alive and does not seem big so date mix up likely.
• Lady admitted 6th june - 2 month amenorrhea, admitted because no babies - bad obsteteric history. 2 miscarriage at 2 and 3 months. Impression: cervical incompetence. Admitted for complete bed rest (only allowed up for toilet), also receiving salbutamol. Now 24 weeks and feeling foetal movements. Homesick but husband visits every day.
• 7month pregnant patient admitted 2 days ago because abdo pain and thought maybe labour but now abdo pain subsided.
• Patient who was 4month pregnant, low abdo pain 2/7 prior admission, no bleeding. Past ob hist: 1st = miscarriage, 2nd= baby, 3rd= miscarriage. So bed rest and awaiting proper obstetric examination. ?cervical incompetence.
• Patient whose obstetric history was: 1st preg = c section, 2nd svd but child died shortly after, non pitting oedema on hospital arrival, lmp (last menstral period unknown but fundal height suggests term. Advised to stay and await labour.
• Patient who had suffered from uterine rupture due to obstructed pregnancy. Catherterised but still wetting bed, suspected fistula formation.

I found the obstetric ward quite shocking today as its was very overfilled - not only were all tne beds filled but there were 5 other mattresses on the floor (even though there was very little space between beds as it was), 1 of which was underneath another bed so the patient couldn't even sit up and wad forced to lie down at all times. One of the patients who was on the floor was the woman who had had the stillbirth yesterday. Not very nice for the grieving mother. On the otherhand I don't know what else they could have done - overcrowding is probably better than sending away patients in desperate need and the only ambulance here is broken so its not like tney could easily transfer patients to a different hospital.