DeAnna Friedman Arrives at Chiang Mai University

The following was submitted by DeAnna Friedman, 3rd-year pediatric resident:

Hi everyone!

Made it to Chiang Mai safe and sound. I'm staying in a hostel right now, but I have more permanent accommodations starting on Saturday. Everything is new and different, and I've been finding my way around. I've never been in a place where so few people speak English before - wait, that's not true - I've never been ALONE in a place where so few people speak English before (I've traveled through Central America plenty, but I usually have a Spanish-speaking friend with me). I'm getting by with some pantomiming and brand names and such, though.

I've already had the chance to take lots of great pictures, which I'm posting on a public gallery. There are all kinds of old beautiful buildings here in Chiang Mai. I'm still trying to learn what everything is (again with the not-a-lot-of-English thing, I can't just ask people). I hope I haven't made any missteps as of yet with my picture taking - again, still learning.

I started work at the hospital today. Everyone here is very nice and very accommodating. They helped me find a place to stay from Saturday on, and showed me around the campus. I attended wards rounds, and they were nice enough to do them in English for me for today. I am to be paired with an ID fellow starting on Monday, but he's out of town right now, so they paired me with a neurology fellow doing general pediatrics wards rounds with one of the resident teams that speaks English well. The residents were a little nervous about doing rounds in English, I think, but it all worked well.

Photo of the outside of the Faculty of Medicine at Chiang Mai

Outside another of the Faculty of Medicine buildings at Chiang Mai University

I saw several children with issues similar to what we have back in the U.S.: a 15 month old with medulloblastoma with an infected extraventricular device, on meropenem and colistin and still spiking fevers; a 7 month old, ex-28 week premie who came in with hematemesis and was found to have esophageal varices and portal vein thrombosis, likely from his UVC at birth; a 15 y/o with a suspected brain abscess, although it seems to not be improving well on cefotaxime.

We ended with a girl with high-risk ALL who's relapsing while on her induction therapy. This child would have been on the BMT consult list back home.

Overall, things here are similar to the setup back home. CTs, CSF studies and cultures, phenotyping for the ALL, and meropenem are available. We have morning report or other conference first thing (8:30-9:30), then wards rounds until noonish, then an afternoon conference for teaching. It should be an interesting 2 weeks!

DeAnna

John Heimerl Completes His Elective In Zambia

Wow, I am now down to my last few days in Zambia. It is amazing how fast time goes!

This past weekend the farm hosted a Tiny Tim and Friends social and graduation. Each month, children newly enrolled in the program gather to celebrate those who have been in the group already for six months.

The day is filled with education and activity and culminates with a graduation ceremony.

Over 80 children attended. I had the opportunity to take some good pictures during the event, and as soon as a camera was noticed I was surrounded by children asking to have their picture taken.

The farm also started building for the animal enclosures that are being planned for the farm.

This is the future site of the chicken house. The farm also plans to keep goats and ducks in the future.

Also on Saturday we visited Our Lady's Hospice.

Dr. Tim rounds there each week and sees the more complicated patients they are having difficulties with.

We saw three adult patients. One had suffered an acute intracranial hemorrhage following an eclamptic seizure, another was suffering from dementia, and the last was also suffering the devastating effects of a stroke. There were 28 patients at the hospice.

Our Lady's Hospice will be the site of the first pediatric palliative care center in Zambia.

TTF will start with 4 rooms at the hospice and then expand in time.

The project will allow for proper palliation and access to opioids when needed. Currently, terminally ill children in Zambia are either sent the University Teaching Hospital or are sent home with minimal pain relief.

The new palliative care center will be staffed with a specifically pediatric- trained nurse on site to care for the terminal children.

The training is intense and will take two months in Uganda.

There are big things on the horizon for TTF and the children of Zambia.

I will be traveling back to Minnesota on April 5, so this will conclude my blog updates from Zambia. Thanks to all of you for viewing my photos and posts while I've been here.

Cheers,
John

John Heimerl's 3rd Week In Zambia

This blog posting was authored by John Heimerl, M.D., 2nd year Pediatrics resident at the University of Minnesota.

We had another busy week at TTF.

Clinic days are full of patients to see. Here are two pictures from clinic.

Here is the TTF clinical team, along with a patient and his mother in the center.







Here I am with the pharmacist, Thomas.

I also had the chance to visit the large University Teaching Hospital
(UTH), which is the referral center for Zambia.

A nurse named Clements (the only male nurse I saw during my visit) give me a tour, which I limited to three hours. He showed me each section of the pediatric wards.

The pediatric department is spread out over a number of buildings, each housing a different ward.

I saw the emergency ward, then Admitting. From Admitting, patients are sent to one of the five remaining wards--Malnutrition, Heme/Onc, PICU, General Pediatrics (x2) and Endocrine.

I wasn't able to take any pictures of the inside of the hospital, but here is what the grounds and building look like.

Also last week I was able to do something I failed to do on my last trip to
Zambia--I took a bus 400km south to Victoria Falls, which borders
Zimbabwe (I hear we made good time; it only took us 6 hours, and I've heard it can take up to 10).

As you can see, the waterfalls were spectacular. In a couple of sections, you are drenched by the spray from the water falling, and it was entertaining to watch visitors get drenched.

Well, I have to get back to clinic to see the rest of the patients. Hope to send more pictures soon.

Cheers,
John

Residents Abroad

Every year, the University of Minnesota's Pediatric Global Health Track sends about 12 residents abroad. Check this site for actual updates from their experiences.