Week 2: Princess Marie Louise Children’s Hospital

Exterior of PML Children's Hospital

Ramps at PML

This has been a great week full of learning in the Princess Marie Louise (PML) Children’s Hospital. I want to give a little background about the hospital where I have been working. It is the only children’s hospital in Ghana and has a unique history. Dr. Cecily Williams, a female physician originally from Jamaica, discovered and recognized Kwashiorkor at PML as a separate condition, innovating treatments targeting this common malady that still persists today in Ghana. It is such a unique experience to be able to work at the very hospital where the condition kwashiorkor, a name that means the sickness the baby gets when the new baby comes in Ga, one of the local languages here.

There are two types of malnutrition with distinct pathophysiologies, called marasmus and Kwashiorkor. Marasmus is total calorie malnutrition and presents with severe wasting, a child with thin limbs and a bloated abdomen. Kwashiorkor, on the other hand, causes edema, enlarged liver, and dermatosis. Kwashiorkor is also called severe acute malnutrition with edema and largely is known for afflicting children who are spaced too close together in age, resulting in the second child experiencing malnutrition from being weaned too early and getting a mostly carbohydrate-based diet deficient in protein sources. Last week, I mentioned how I worked in the inpatient nutrition ward, where I saw cases of both marasmus and kwashiorkor. One of the most striking things for me was the gradual turnaround when you start rehabilitating a child nutritionally. I was lucky enough to catch children at the tail end of their inpatient stay to be able to follow up with them this last week in the outpatient nutritional rehabilitation clinic, which allows women to learn how to prepare balanced meals at the center for themselves and their children.

A case of marasmus

They are taught how to use local foods to create meals that have a balance of fats, carbohydrates, and proteins to ensure adequate nutrition for growing children. The women let me help the grind onions, peppers and cut up okra for a stew they were making. I had a great time learning about them and being able to practice the Twi I have been learning.

I'm in the outpatient nutritional rehab program helping prepare food with the local women
I’m in the outpatient nutritional rehab program helping prepare food with the local women

Since last Saturday, I bought fabric from Woodin for me to have two dresses made. I ended up picking out a combo pack with a pink fabric and a green pattern. The two dresses look great!! I am so happy about how they turned out. On Sunday, I slept in and ate with Dr. Charles at a lady’s house where she prepares, omutsuu (rice balls) with red fish and tuna. I later went to Labadi beach with Nora, where we went horseback riding along the beach. It wa so nice to just people watch and enjoy the ocean.

My dress!
My dress!

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Omutsuu with ground nut soup
Omutsuu with ground nut soup

On Monday, I worked in the outpatient department (OPD), where all the children pass through for vitals and triage. I worked with the nurses by getting names, ages, and chief complaints while also taking each patients’ axillary (armpit) temperature. In total, I must have helped check in 80-90 patients in two hours, demonstrating the high patient load at the children’s hospital. Earlier in the morning, I reviewed patient charts in the High Dependency Unit and saw a case of marasmus complicated by probable sepsis and bronchopneumonia. Being culturally sensitive, it is crucial to be respectful to each and every patient and their family. I thought this patient was an interesting learning case, so I asked the child’s mother if I could take a photo of the child, but was refused. I actually can totally understand her reasoning of being protective of her child. This actually bring up important ethics of participating in trips abroad, where it is crucial to air on the side of caution and never assume it is okay to take a picture of someone or something unless permission is explicitly ask for and given.

I later went upstairs to review the infant ward, where I saw an interesting case of a left posterior neck mass that was fluctuant, likely an abscess. The patient will be referred to surgery for evaluation and drainage. I saw a few more cases on Monday, where one patient, an infant 2 weeks old, had been hospitalized for jaundice being treated with phototherapy. When we were placing a new intravenous line, the mother of the child began to cry, explaining that she feels she has been k the hospital too long and that she is anxious to get home because they haven’t even been able to set up the naming ceremony. In Ghana, when a child is born, it can take up to 2 to 4 weeks for a name to be selected. The rationale is to not name a child when they may pass away shortly after birth. This ceremony would be similar to a baptism in the US. This custom is similar to Mexico, where it was not uncommon to wait a while before deciding upon a name for a new infant.

I will write again in Cape Coast! I leave tomorrow morning with Dr. Charles 🙂

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