Monthly Dinner Discussion

Date & Time: Monday, May 6 — 6:30 p.m.—8:30 p.m.

Location: Dr. Howard's house

Topic: Tanzania Talk  - For those Going to (Or Thinking About Going to) Tanzania for a Global Health Elective

Presenter: Dr. Steve Swanson & visiting Pediatric Registrar - Doreen Mapunda

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Global Health Research Lunch

Date & Time: Monday, May 13 — 12:00 p.m.—1:00 p.m.

Location: Wilf Conference Room 1

Topic: Showcasing Faculty Research and Expertise

Presenter: Bradley Robideau, National Media Relations Consultant, University Relations

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Grand Rounds

Date & Time: Wednesday, June 5—7:30 a.m.—8:30 a.m.

Location: Wilf Auditorium

Topic: Pediatric Global Health Track Presenters

Presenters: Amr El-Bolk, CJ Koozer, Alice Lehman, Nasreen Quadri, Mike Pitt and Sharmila Raghunandan

Amr El-Bolk - Egypt 2/12/19-3/11/19

Having grown up in Cairo for most of my childhood, it was rather nostalgic to navigate through the much familiar streets on my way to the hospital on the first day. As the biggest tertiary care center in the country, the University of Cairo Hospital campus was enormous with roots dating back to the 1800s. It serves as the safety net hospital providing free care for the Cairo metro and the surrounding area. Some patients, I recently found out, travel days to get here. I ponder on this as I approach the hospital and merge into the coalescing mass of individuals going through the gates. I pass an elderly man in traditional grey garb and a colorful scarf making his way through the crowd with a noticeable limp and a hoarse cough. A mother of four rushes in front of me with her baby cuddled in her arms and three little figures in tow. Amidst all this there are medical students and residents, identifiable by scrubs and their familiar efficient rushed pace no doubt hastening through to make their way to team rounds. 

 After arriving to the pediatric hospital and when I am past the initial introductions and exchanging pleasantries with faculty, I make my way to the unit. As I enter the NICU, the familiar sounds of telemetry beeps shower over me and surprisingly provide me with a calm that eases my stranger anxiety and sprouts a feeling of belonging. This is further magnified when I witness the residents busy at sign out and preparing for rounds. As, I wandered around and observed, it struck me all the beds were full. This was one of two main NICU units in the hospital with around 40 beds each. I would later learn that the hospital had about 100 deliveries a day most of which have very limited prenatal care. This is in addition to all the transfers they get from the community hospitals and emergency rooms. A few days of rounds had me noticing an interesting trend. While most residents are pre-rounding, there is seemingly always one resident who is constantly on the phone apologizing. “I’m sorry, we are full. There is nothing we can do.” This sentence would resonate with me for the rest of the rotation as we are forced to triage our services. It wouldn’t truly sink in though until later that week. 

 On a Wednesday afternoon as one of the interns was showing me the resuscitation room for the first time, the nurses wheel in a hypoxic term infant with minimal respiratory effort at around 2-3 minutes of life. It quickly became apparent that no amount of stimulation, or suction will turn this around so we start positive pressure ventilation and eventually intubate. As I am bagging the infant, I notice the father and grandparents standing in the back of the room visibly fidgeting with worry so I usher the father over and explain to him what we need to do. Eventually I say “Now we’ll take him back to the NICU, place him on a ventilator, and get a few labs and a picture of his chest.” At this moment the nurse desperately forces eye contact with me and shakes his head. He leans over and whispers “but there are no ventilators available upstairs. There is nowhere to take him.” My heart starts pounding vigorously and my hands become sweaty. I send a nurse on the impossible task on procure a ventilator from a different unit as I look down between my sweaty gloved hands at the rhythmic tiny chest rise of a life yet to be named. Between myself and the intern, we bagged that infant for two and a half hours. Eventually I look over at father and explain the situation all the while remembering the grave look on the triaging resident’s face every morning as he said “I’m sorry, we are full. There is nothing we can do.”

 As I am reflecting back on this experience today, I remember the frustrations of an inadequately funded and overwhelmed medical care system, from delayed lab work to absence of advanced imaging to the limited number of essential lifesaving equipment, medications, and medical personnel. That being said, as a resident, I have never felt as powerful and direct consequences of the application of my skills and training as I had in Egypt. From teaching to quality improvement to just being an extra set of hands to bag an infant on the verge of death and be part of the team effort that would eventually see him discharged with his parents.