First day at the hospital

Here's the impression I got when I first signed up for this whole adventure. I'd be working in a rural health clinic that was being run by an American pediatrician. I'd have alot of autonomy, but the other doctor would be there to help supervise me and give me advice when needed. I've been slowly coming to terms with the fact that this is my last year of residency and I'd be on my own next year, so this plan sounded like a great idea. I learned a little over a month ago that the clinic would not be open yet, and that I'd be working primarily in a hospital. The final word I got was that I'd mostly be shadowing for the first week, then supervised by the Rwandan "attendings" as I got more familiar with the system. I was still pretty ok with that plan, so I was excited to start today.

However, here's the reality of what happened. I walked up to the hospital at around 8:00 where I was told that there was a department meeting. I saw some people in white coats who I initially thought were doctors, but turned out to be nurses. Once they saw me and realized I was a pediatrician, they led me into the pediatric ward and to a patient's bed. I was pretty sure rounds weren't starting until 9:00 and that I was just shadowing today, but everyone seemed to be looking at me to do something. Finally, one of the nurses handed me a chart, which was only about 50% in English (which is one of the higher percentages as far as the charts went). I looked through it and could only figure out that the kid had come in with fevers that had since stopped. The nurse then looked at me and said, "He has malaria, but his blood test is negative, what do you want to do?" I tried to stall a little bit by examining the kid and asking a few questions, but then I finally ran out of filler material and asked where the other doctors were. They all got a confused look on their faces and said, "You are the doctor, there are no others." I almost passed out.

It turns out, the doctors, who are a mix of Rwandan and Chinese, usually blow through rounds in the morning and rarely coordinate care between the two groups. I guess everyone thought I was adding my bit of American style to the mix. Luckily, my interpreter showed up at that moment and I was able to convey to everyone that I was only observing today. We eventually met up with one of the Chinese doctors, who only speaks Chinese and very bad French, and I followed her around the NICU and pediatric wards. I only gleamed about 10% of what was going on, and while my interpreter is great, she doesn't have a large medical knowledge, so clarifying methods of treatment and the reasoning for diagnoses was difficult.

I also stopped by the public health clinic today with Tom, our housemate and Peace Corps worker. The clinic has no doctors and is run by 4 nurses, at least I think they're nurses. Nobody speaks English there, and they seem to think that I'm going to show up and run the clinic and give advice to the nurses. While I may have more medical knowledge than they do, they have a much better understanding of how things work here and the specific diseases that the people here suffer from. Plus, the administrator initially told us they didn't need a doctor, and if I wanted to work there, I needed written permission from the hospital administrator.

Basically, I feel a little bit like a beginning 3rd year medical student. I have alot of experience and knowledge, but I'm not quite sure how to get past the language, cultural, and systemic barriers. I have this bad feeling that the people at the hospital, the clinic, and even Tom and Malea have these high expectations from me that I'm not quite sure how to meet yet. I want to be helpful and make a difference in these kids lives, but I think the most I can accomplish this month is to learn about malaria, typhoid, and the other conditions that we don't have back in Tucson, and figure out how to navigate the system here. These goals are in line with what I set out to do, as I really am interested in how medicine is practiced in other areas of the world, but I'm not quite sure how to convey to everyone here that I'm not some expert on these things and they shouldn't expect me to come in and solve riddles that their own doctors haven't been able to solve. That would be hard enough if I could communicate with anyone, but it's going to be incredibly difficult here.

I guess I'm having the mandatory "freak out" moment that Dr. Berg, the head of Humanity for Children, said I'd have. I also assured me that things will get better the longer I'm here. I'm confident they will too, I just need to figure out a few things first. For example, how to simply order IV fluids on a kid, or more importantly, how not to seem like a dufus before I figure out what's going on. I'll keep everyone posted. I'm not even sure what time or where I'm supposed to show up tomorrow, but at least everyone knows my face.