In the NICU, the Ethiopian calendar is also used for birthdays and there is some confusion about the time as well. We are the ones confused of course. Right now it is 1:30 in the afternoon and 7:30pm on our watches. The driver is planning to pick us up at 1:15 in the morning which means the sun will have been up for 1 hour and fifteen minutes. This works well here because we are close to the equator and the days and nights are about equal length.
Today was our fourth day making rounds. The residents came a bit late. There were several sick babies. One premie I briefly saw on Friday with a bit of abdominal distention looks like she has necrotizing enterocolitis today. Another x-ray was ordered but not done yet when we came back from lunch later. The little baby with Down's Syndrome was having some oxygen desaturation. It's not clear how well the oxygen delivery system is working. We did switch to using one of our pulse oximeter probes and that worked better so we discovered the actual oxygen sat levels on several babies. One little new one was quite cold and we connected the servo probe to his skin and that seemed to help.
There are four warmers on the one side of the room that were donated from the U.S. Unfortunately, they have 110 voltage power cords and can't be plugged into the 220 power. Like me, they need converters! In the afternoon, we went out on another search for those. One of the interns went with us. Two taxi rides and a bit of walking brought us to Electric World. There we thought we had found them and bought three. Only they are adaptors and not converters!! So the hunt goes on. If we can find them, we plan to buy enough to be able to use the warmers as well as charge my various devices.
There was no water in the NICU again. Plenty of alcohol lotions though so that was good. Rounds was difficult again. Adane, who is a pediatrician with some neonatal training kept interrupting the residents with questions. He has strong opinions and of course expresses them. Some are good but some are not that helpful. There does not appear to be an attending physician and he is not there making rounds everyday or teaching the residents. Cindy and I are also trying to advise the residents who are the responsible ones.
Over the weekend, there were two deaths. One baby who was delivered at some sort of ambulatory center by vacuum and then sent home in six hours. He was admitted with a severe subgaleal hemorrhage, shock, and a hematocrit of 10. His mother brought him because she noticed his scalp swelling. He was resuscitated with volume and blood, but then died because of hypoxic/ischemic encephalopathy related seizures and apnea. Probably for the best. The other was the second of twins born about eight weeks early. Also from respiratory failure and apnea. There are no ventilators here, only ineffective CPAP and bag and mask support.
The first twin was the one Cindy and I warmed up. She is on cpap. Mother has hepatitis B also and the baby didn't get the vaccine. There is no immune globulin either, so there is possibility of chronic hepatitis and liver failure later.
Also, another 2 year old was presented at morning report who had missed diagnosis of congenital hip dislocation.
So quite a sad day for these babies and families.
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