3rd Yr MP Resident Bomberg Tours the Menominee Reservation

Posted on behalf of Eric Bomberg, 3rd year MedPeds Resident

Yesterday, I had a tour of the Menominee Reservation. The reservation is beautiful and is covered with trees. There is a powwow site and twice a year they have 3 day powwow events where the Menominee come from all over the country to attend. The Menominee people used to own over 9,000,000 acres covering much of the state of Wisconsin, from up here all the way down to Milwaukee. Due to repeated treaties, the land size has been cut down to around 265,000 acres. Each time a treaty was signed, they were given a smaller area of land in exchange for such supplies as food and money. However, with each newly-signed treaty, what was promised from the previous treaty was made null and void, and as such the Menominee people each time did not get what they were promised from the government. This has lead to a land size much smaller than they originally owned, as well as a general mistrust of the government. On one such occasion, the government passed a treaty in which only 5% of the Menominee people agreed to, many of whom did not understand the English language. This has all leads to a concept called "historical trauma," which I will talk about more in a later post and which underlies a lot of the challenges faced within the community. Overall, Menominee County is the 13th poorest county in the nation.  The main industries on the reservation are the logging company, which employs about 200 people (most of whom are native), and the casino, which also employs a large amount of workers as well.

I had the day off on Sunday and went up to Door County, which was
incredible. It is located right on the peninsula in Wisconsin. Up
there, they have multiple state parks, wineries, restaurants, and shopping. I
went for a 7 mile hike right on the shores of Lake Michigan!

 

MP Resident Bomberg brushes up on OB and NRP Skills

Posted on behalf of MP3 Resident, Eric Bomberg

This has definitely been a crazy week. I drove back to the Cities for graduation events, which was great!  However, on the way back, about 20 miles outside of Shawano, my car hit a deer on the freeway.  Apparently, this happens to almost everyone at some point in Shawano.  In fact, car insurance rates in the county are about $400 dollars a year higher than surrounding areas due to the extensive deer population and the fact this happens so much. Had to get the car towed to Green Bay, where it will be for the next 2 weeks as they fix the extensive damage.

This continues to be a fantastic experience. I am on call tonight, and there was a young mother with type I diabetes who presented with preterm labor at 30 weeks gestation. The heart tones were not fully reassuring. 

My heart was racing a bit as I thought about the possibility of having to resuscitate this 30 week child that would be born to a diabetic mother. There is no NICU here, and no neonatalogist in the near vicinity.

I quickly read up on my neonatal resuscitation and got ready to go. Fortunately, the heart tones stabilized, and we were able to transfer the mother to an acute care hospital with NICU capabilities, as we do not have this here.  The alternative would be to have stabilized the baby and transfer out when available . . . such is life in a rural setting.

Although my residency does not train me to do OB, this whole experience was definitely a great refresher, and definitely got me to read up on my NRP skills!

Plans for later in the week are going on Thursday to see patients in the jail on the reservation.  More updates coming soon!

Bomberg finishes first week at Menominee Tribal Reservation

Posted on behalf of 3rd Year MedPeds Resident Eric Bomberg

Hello all! Eric Bomberg here, just finishing up my first week in Shawano, Wisconsin at the Menominee Tribal Reservation.

The experience here has been fantastic! I work as a Medicine/Pediatric hospitalist in the morning, seeing patients from the Menominee tribe who were admitted.  In the afternoon I go to work at the Menominee Tribal Clinic, where I have my own schedule of patients.

The picture above was taken looking out from the balcony at the home where I am staying.  We're close to the river at home and at the hospital!  We have wireless internet, cable TV, a full kitchen, a laundry machine, and weekly house cleaning services.  They take good care of us here

At the hospital, all of my meals are covered and they even pack me a bag lunch to take with me when I go to clinic.  Because the hospital is small, everyone there knows who you are and they know my food preferences!

The hospital has 25 beds and we take care of everything from newborns to trauma. The patients at the hospital are not all from the Menominee tribe, and there are many other providers there as well.  We admit our own patients from clinic and almost exclusively follow tribal patients while there.

The major things I have taken away so far is what is means to practice in a rural setting (Shawano is the largest town around here with a population of approximately 9,000).  It's not uncommon to see a patient in clinic and then follow them in the hospital.  The experience of practicing medicine in a rural setting first hand is so valuable and I've already learned so much in one week. 

More to come!!! Eric

Satrom Gives a Tour of Elective Site

2nd Year Pediatric Resident, Katie Satrom, recorded a video presentation for the Annual Global Health Grand Rounds: While They Were Away: Resident Contributions Abroad 12-13 held on May 29, 2013.

Satrom Enjoys Some R&R Away From the Wards In Cameroon

The following post was contributed by second year Pediatric Resident, Katie Satrom, on international elective.

Mbingo offers great opportunities for beautiful hikes. Since the hospital compound is about 45 minutes from the nearest town, many of the hospital staff go hiking on the weekend for entertainment and exercise. Here are a few photos from our recent adventure!


Walking in some tall grass


One of the many beautiful waterfalls


Cows being herded by the Fulani people, a nomadic cattle herding group across West Africa


Paying homage to the coffee bean at a nearby coffee plantation


View of the hospital compound

Case Study From Cameroon

These cases were submitted by 2nd year pediatrics resident, Katie Satrom on international elective in Cameroon. Photographs were used with the permission of the family.

CASE 1. Differential Diagnosis of Acute Jaw Swelling

6 year-old previously healthy male presents with 3 days of painful left jaw swelling. The pain is worse with eating and is associated with bleeding from the mouth.

After IV therapy

Outcome: Given extremely poor dental hygiene and initial improvement with antibiotics, the child was continued on IV antibiotics for the treatment of a dental abscess and associated cellulitis.

CASE 2. Fine needle aspiration consistent with Burkitt's Lymphoma

5 year-old previously healthy female presents with 2 weeks of painless right jaw swelling. She was seen by an outside facility where she was treated with antibiotics for a presumed dental abscess without improvement.

After 1 cycle of chemotherapy

Satrom Arrives In Cameroon

The following post was submitted by Katie Satrom, MD, second-year resident in the University of Minnesota Pediatric Global Health Track:

The view from my room

Greetings from Cameroon!

Dr. Tina Slusher and I arrived safely in Cameroon last week. We're working at Mbingo Baptist Hospital, which is a 250+ bed mission hospital in the Northwest Province. There are 45 physicians who work here, 600+ staff, and over 100 volunteers annually.

The pediatric ward consists for 20 general beds and another 6 oncology beds. There are also some children who are boarding in the surgical and ortho wards. In addition, there is a newborn nursery associated with the maternity ward and a very small NICU.

Currently 3 American pediatricians are working at the hospital. They are all recent grads who have committed to working here for 2 years. The hospital has surgical residents through the Pan African Academy of Christian Surgeons (PAACS) program and also a med-peds residency (although they only do 25% pediatrics).

The hospital entrance

Our daily routine consists of morning report from 7am-8am, followed by either rounding in the nursery or seeing some clinic patients. Inpatient rounds begin at 9:30.

The local residents do all of the pre-rounding, documentation, and most of the orders. Later in the afternoon, we will follow-up with any loose ends, see new admits, or spend more time in clinic or nursery.

Our role is more for supervision and teaching, as the local residents do not have much pediatric experience. I am learning a lot from the residents as well, especially about specific endemic diseases and also how to best use limited medical resources.

Drs. Satrom and Slusher with two nursery nurses and another resident, Erin Young

There are a lot of volunteers who are coming and going. Currently there is an American adult nephrologist who is here to help set up peritoneal dialysis. We have had two interesting cases of nephrotic syndrome on the wards, so he has been a helpful consult.

This week, Dr. Peter Hesseling, a pediatric oncologist from South Africa, and his team are here. They have a Burkitt lymphoma protocol to deliver simple, low-cost treatment for children that can be used in rural hospitals. Their team has treated more than 900 cases of Burkitt's in this region of Africa so far.

There is also a 2nd-year pathology resident from Mayo here for 6 weeks, so it's been fun to hang out with her. My husband comes next week to help with some engineering projects, so I'm looking forward to that!

Drs. Slusher and Satrom on rounds on the wards

My first day on the wards, I saw a new diagnosis of Burkitt's lymphoma, intussusception, cerebral malaria x3, acute bilirubin encephalopathy, TB peritonitis, H. flu meningitis, and bilateral retinoblastoma, just to name a few

This 26-week preemie was born here and was stabilized on bubble CPAP, and is actually doing quite well. Dr. Slusher and I check in on her a few times a day and have had to be creative when the power goes out for extended periods of time.

I've also been able to observe and help Dr. Slusher teach the Helping Babies Breathe protocol to the local nurses. One of these nurses is visiting from another city and will bring back what she has learned to teach others. It's pretty neat to watch them learn about simple neonatal care and to know how big a difference that can make in infant mortality if done well!

I'll try to write additional posts with interesting cases and pictures. The internet connection isn't great, so sometimes it's hard get online and especially to upload photos.

Katie