Working Hard

I have tried to keep track, and estimate I have already done over 70 echos in the past 2.5 weeks with the Vscan, plus over 30 echos using the larger ultrasound machine that Queen Elizabeth Central Hospital (QECH) has in their radiology department! I have been seeing anywhere from 10-20 per ½ day clinic. At QECH I have been helping in the hypertension, chest, diabetes, and pediatric cardiology clinics.

There is a once-weekly pediatric cardiology clinic where one of the pediatricians with an interest in cardiology follows > 200 kids with heart disease. Both times I have attended this clinic, we saw > 30 children for the ½-day clinic! There is a committee in Malawi to which all cases requiring care outside the country are petitioned. So some of the children with congenital heart disease do get referred to that committee for consideration. I hear that they are limited to sending about 100 cases per year out of country (including all the non-cardiac surgery and the adult cases too) and there is a rumor that it can take about 18 months to get through he process and get the surgery done (usually in South Africa).  There are very few families who can afford to skip the committee and pay out of pocket for these surgeries elsewhere.  Yesterday we saw 2 children with Patent Ductus Arteriosis (which would be likely be fixed percutaneously-using catheters inserted from a blood vessel in the leg-at most any Children’s Hospital in the US) but we also saw 2 children with tetrology of fallot (which is not so simple and would usually require open heart surgery).  If anyone reading this blog is an interventional cardiologist and wanted to come to Malawi for a week or two, please contact me!

During the day, in addition to helping with clinics here at QECH, I have also been doing consults on the in-patient wards as needed. Usually it would either be doing an echo for suspected pericardial effusion or heart failure; or as a consult for management of arrhythmia or rheumatic heart disease. And, of course, almost every day I have been called by the General Practitioner’s at Blantyre Adventist Hospital (BAH) for advice with 1 or 2 of their patients, which I usually have to do before 8am or after 4pm when the afternoon clinic finishes at Queen Elizabeth. Once my orientation period is finished at QECH, we will officially open the Cardiology & Internal Medicine clinics at BAH, as well as a weekly ½ day clinic at Malamulo.

In my spare time, I have also been trying to work on the ICU. I have been making a list of expectations and guidelines for the ICU nurses. We are now advertising for an ICU charge nurse and 6 regular ICU nurses, there is a committee to help me choose out of the applicants. I am also trying to figure out exactly what we already have available and what we still need to try to acquire before we can open the ICU.

On a more personal note, progress is being made on the repairs at the house we will be renting , so hopefully just 2 more weeks before we can move in there. And, Darryl & I celebrated out 6^th wedding anniversary last weekend.  We took the opportunity to hitch a ride with Ryan & Sharlene Hayton up to the Zomba Plateau for one night away from the patients and to-do lists, which was wonderful! We met some of the other Malamulo crowd to, which was nice. Elisa Brown and her brother Randy & family. We took some wonderful pictures (I think) but after they were downloaded onto our computer and deleted from the camera, the computer crashed and we have thus far been unable to revive it…

ADDENDUM: we have rescued some of the pictures from our trip!