Posted on behalf of Patricia Hickey (PL3) and Junaid Niazi (MP3)
Sabaidee from Laos!
Junaid and I are halfway through our rotation working with local
Pediatric residents. Our role is to discuss patients with the residents and
teach, as well as learn. These residents are completing 3-year residency
programs developed by Health Frontiers, a group based out of the US. The
residents are supervised on the wards by excellent Lao “teachers,”
as they call attendings, and are also supported in their education by the
Health Frontiers coordinator, currently a congenial Australian pediatrician.
Visitors like us come from countries all over the world to contribute and
learn. The Lao teachers are more patient with random foreigners coming to teach
than I think we might be in the US. They trained at a time when resources were
even more limited and the country was much more isolated from the rest of the
global medical community but they are very competent and experienced. The mob
of white coats on rounds is even more impressive here than at St. Paul Children’s
as there are more trainees per team here. So there is plenty of teaching to go
around...for the most part. This week it turns out most of the residents are
attending seminars given by German Neonatologists so there is less for us to
do. We can’t participate in patient care directly because we don’t
speak Lao and don’t have Lao medical licenses.
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| Rounding |
We arrive at the hospital in the morning after the residents have
completed their morning report (in Lao) and most of their rounding. They are
usually busy filling out fairly extensive paper charts and writing paper
orders, which parents take to the pharmacy/radiology/etc to pay for each item
of care ahead of time, be it an X-ray or antibiotic. The residents take turns
presenting “interesting cases” to us - which as far as we are concerned
is all of the cases. Even if it’s something we've typically seen,
such as gastroenteritis, there are always discussions to be had about
different management in areas with different epidemiology and different
resources. Many of the cases have been especially interesting because they
represent very late manifestations and advanced disease. There tends to be an
additional element of mystery because of the frequent lack of diagnostic tools
available. I think sometimes we have had the benefit of correlating history and
physical more closely with diagnoses because of the extensive workups our
patients have in the US. For example, here they may never know that a patient
has Tetrology of Fallot because there is no Pediatric Cardiologist in the
hospital and if the patient is too sick to be transported to radiology she won’t
get an echo. There is a 6 month old baby here who I suspect has TOF but his
last echocardiogram (performed by an adult Radiologist) months ago was read as
large ASD which would not explain why he is in heart failure and has a palpable
thrill.
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| The hospital |
Resources here are changing frequently as Laos is a country in
the midst of change. Construction surrounds us at every corner, from before
dawn to well past sunset. We eat croissants for breakfast, walk to work dodging
streams of shiny cars, and blend in with crowds of backpackers on our way to
the hospital where there is minimal air-conditioning. Where you can be
intubated but cannot obtain blood gases or portable chest X-rays. Where you can
get a head CT but not an albuterol inhaler. Where we found a brand new
ultrasound machine in the PICU untouched because no one was taught to use it.
We have discussed the basics of bedside ultrasound with some of the residents and
are working on a developing a “how to” guide, as well as planning several practice
sessions. I am sure adoption of this technique will require much more
reinforcement by people more qualified and more consistently present than we
are but hopefully we have at least introduced the idea. This has the potential to
be an incredibly valuable tool where portable imaging is not available and
imaging in the Radiology department is not always affordable or attainable. We
are grateful that we literally stumbled across this project and excited that
several residents seem eager to learn bedside ultrasound. Before we leave Laos,
we want to ensure that a procurement system is in place for ultrasound supplies—the
gel, photo paper for printing images, etc. If we can accomplish this, then we
will have given back a tiny fraction of what we have gained from this
experience. Until next time!
Patricia & Junaid
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| Junaid Niazi, MP3 & Patrica Hickey, PL3 |
