This is Michelle today, giving Andy a break from blogging. He asked me to write about work, so here goes....

My day starts at 8 am when I go into the pediatric ward at the hospital. Right now we are in the slow season, so we get about 50 admissions per day. When the rains come and malaria season starts, it can go up to 150/day. This will be around February and last for a few months.

At home, if kids are acutely ill, they go to the ER for any emergency, whether a medical illness or trauma. Here it works a bit differently. The ER is called the "Casualty" department, so it receives trauma cases, burns, broken bones, but not the medical emergencies. All sick kids, regardless of how sick, come the outpatient clinic and are then triaged and seen. So it happens that several times a day, a mother comes to the clinic with her very ill child, who is then rushed from clinic down the hall to the pediatric ward and they are resuscitated or treated on the ward. The main room where this is done is  a large open room with about 20 beds, most of which have 2-4 kids on each bed and a guardian/mom with each. The other day I looked over and saw a baby on the floor underneath the bed. It turns out it was the twin of the patient and the mom didn't have anywhere else to put the well child. Needless to say, this room, which we call the "emergency zone," isn't a popular place to be with the families, as they are constantly watching crazy stuff go down in the front of the room, its always noisy and crowded. We try to keep all the sickest kids there so that they can be monitored as well as possible.

The very sick children tend to have one of a few stories. Malaria is a big player. Among other things, malaria can cause very severe anemia requiring an emergent transfusion as well as seizures and altered mental status. My own kids probably have a hemoglobin (red blood cell) level around 13 or so. The average healthy kid here is probably at around 8-10, and malaria can take it down to 3 or 4. For these kids, securing a rapid blood transfusion is critical, so we spend a lot of time chasing down blood at the blood bank. They can also have seizures, and this is where access to care becomes an issue. There is no EMS service, so you have to get yourself to the nearest health facility in whatever way possible. That usually involves tying your baby on your back and walking. Unfortunately some of the kids don't make it, and that is always a really sad event, especially if the child looks healthy. We have plenty of kids who have illnesses that can't be cured, but when you lose a child who was probably playing the day before, it seems to hit a little closer to home. It brings to the forefront all of the other determinants of health outside of the things which happen in the hospital.

As sad as it is sometimes, things have really improved here since I first came in 2011. Despite the challenges of working in this setting, doing some simple things well makes a big difference, and that is being done here more often then not. It is really a lot of fun to work with the medical students, clinicians and nurses. The chaos is wonderful for developing a zen approach to life - getting flustered is completely counterproductive and culturally is not well received, so it's best to try and find some humor in things and stay calm. I'm working on it.

I guess I should use this opportunity to appeal for help as well. We rely quite a bit on donations for equipment and supplies. If anyone is compelled to donate, I can assure you that your money will go directly to buying needed supplies. Two things come to mind. A big ticket item is an oxygen concentrator - this machine condenses oxygen from room air and frees us from the need to drag oxygen cylinders around and from me having the call the oxygen delivery guy if I find we're out of cylinders going into a call night or weekend. We can also use the machine to provide CPAP, which is a higher level of respiratory support and has been hugely helpful since it was introduced here a few years ago, truly lifesaving. We have several of these machines already but we would love to get at least 4-6 more. We have a supplier for these concentrators and the cost is about $1500 USD. For smaller donations, we have a small machine that checks hemoglobin levels. This helps us to be more accurate in our assessment of whether a kids needs a transfusion and use the blood judiciously. The machine requires plastic cartridges to check each kid which are fairly expensive - about $40 for a container of 50. We always love to buy extras of these and they are extremely handy and can be lifesaving.

Anyway, this is the nature of working here that after telling a sad story, there is an "ask" that comes shortly after. I figured I'd better do it now in case Andy doesn't give me another opportunity on the blog. Otherwise, all is well and we are enjoying our time here, but miss everyone at home a lot. We aren't wanting for much (except hot yoga) and the kids are doing great, so I don't think we can ask of much more. We'll be cooking Thanksgiving dinner Thursday for some friends, so we'll let you know what a Malawian turkey tastes like. Enjoy the holiday this week!!