Educational Experiences Pay Off!

As part of our month at Mbingo, we have been giving afternoon lectures to the residents on medical topics. Mine of course all have to do with peds!  When I first arrived, I noticed that we were missing signs of dehydration, sepsis and shock.  Children can die if they are not resuscitated appropriately and I witnessed this happen the first few days I was here.  Yesterday I gave a talk on recognizing and treating dehydration/hypovolemia in children.  I really emphasized the signs of a sick child - poor pulses, cool extremities, high heart and respiratory rate and the importance of ongoing assessment and fluid management so they do not deteriorate.  Today Promise, one of the Nurse Practicioners, found me because he had just admitted a "child with severe dehydration".  We went to see him together and he pointed out all the things that we had talked about that indicated the child was severely dehydrated and hypovolemic.  The anterior fontanel was depressed, the eyes sunken, the skin was dry and tented when pinched, the hands and feet were cool with rapid pulses.  He had written orders to give a 20 mL/kg bolus of NS and for ongoing fluids and had planned to switch to oral rehydration fluids when the child was resuscitated and able to drink.  I agreed completely with his assessment and plan.  His recognition of how sick this child was and how to treat will hopefully save his life.  It's hard to come in as a foreign doctor for a month.  You have to quickly build trust with your colleagues at the same time you are trying to share information and knowledge that will better the care given.  It's important not to be too aggressive or arrogant or you will destroy that trust.  I feel very thankful that I have been able to create good relationships here and was able to teach such important concepts that made a direct difference in a practicioner's and a patient's life.