There are four "sections" in the pediatric ward. The first is "Intensive care" which consists of three beds separated from the rest in a large room by screens. There are no special machines there; they are just located closer to the table where the doctor and interns sit to write their notes. This area is for the children who are the sickest. The rest of the beds in that large room are the section called "P1" This is for the kid's who are a little better than the ones in Intensive Care. The most common diagnosis is malaria and pneumonia. Dr. Lace told us that malaria is the number one killer of children under age 5 in Tanzania. It presents as fever, vomiting, diarrhea, as well as other symptoms. That, of course, could be other things, but they have very few diagnostic tools and malaria is so common that they just generally treat for it. There were also cases of kidney disease in which protien is shed in the urine, a mystery case of headache and dizziness, and a probable skull fracture that was a week old. It was very interesting to watch Dr. Lace interact with the interns, both of whom are Tanzanian medical students. Because there is so little in the way of technology, Dr. Lace emphasizes listening the patient's story, the physical exam, and informed reasoning about what is likely going on. He has shared with us earlier the challenges of bringing in technology that is appropriate to the setting, and his finding over the years that the most helpful thing is conversations with the doctors about specific cases, sharing information and expanding their knowledge base. We had one case of an umbilical hernia with a granuloma (a part of the umbilical cord that had not died) in a month old baby. The intern had thought it was an infection, because she had never seen this before. But Dr. Lace recognized it immediately -- and now the intern will know about this possibility for the future as well.
A third section is "P2" where the kids from "P1" go when they are a bit better but not yet ready to go home. The fourth section is the "Malnutrition Room" There were three patients in there today. One is an HIV positive baby who was left with his grandparents for 10 months while his mother looked for work. While there the grandparents stopped giving him his medicine and he stopped eating. He is responding to the care at the hospital and the intern was considering releasing him, but Dr. Lace said keep him here for at least a week, "We need to fatten him up!" Another was a baby who is 12 months old, but is the same size as a newborn. He has been vomiting all his life, can't keep any food down. It is a mystery how he has survived! Dr. Lace is hoping that they can get some more "investigations" (tests) done to discover the why of his ailment.
From there we went to the actual hospital. We were able to tour the renovations which will be quite an improvement. Instead of open windows, there will be sliding windows with screens. Instead of concrete slab floors there will be tile floors. There are lovely rooms with glass doors and walls. We went to the nursery for the newborns and preemies. There were some amazing sights there. A few babies look healthy and responsive and will go home today probably. There was a set of twins with Cerebral Palsy, and some tiny ones who need oxygen. Many have nasal gastric feeding tubes because they can't suck, and some can't swallow. There was one baby I kept watching closely to see if he was going to get that next breath. It came seldom and was the only sign that he was still alive. But they said he was better than the day before! The cribs have 2-3 babies in them. There is no bedding, so each baby is wrapped in or resting on a cotton cloth, called kanga here.
We also saw the women in the breast feeding class. That is good!
We met the only local pediatrician (for an area of 1 1/2 million people). She said to us "This is how it is here. It is hard to be born in Africa. But if you survive your birth, you will be strong!"