Pediatrics at Maua Hospital

It is hard to adequately describe the pediatric ward here.  The closest picture I can come up with is that of a battle-field.  The immediate enemy is disease, but we’re also fighting malnutrition, fear, and lack of education, and always, always poverty.  We don’t have adequate weapons to win all of the battles, only the skirmishes.  There are 8 beds to a room. The place becomes even more crowded because the mothers or caretakers have to stay with the children at all times, feed them and give them their cares.  The ward is dilapidated, at times not too clean, and many things don’t work any more.  The nurses are critically short-handed, and the hospital is critically short on finances.  

Given all these constraints, what the hospital accomplishes here is nothing short of a miracle. The intern that I have been working with is exceptional.  He is bright, conscientious, and deals with mothers very well.  My hope is that he will decide to go into pediatrics.  Right now we have 20 acutely ill patients on the ward, including some patients that would tax the ability of a tertiary hospital to care for them.  There are 8 patients in the sick nursery, including 5 premature infants.  We have lost a couple of the preemies because we exceeded the capacity of the hospital staff to care for them.  At times I have felt that I was in over my head, both with the numbers of patients, their emergent needs, the unfamiliar diseases, the difficulties with language, (Most of the patients do not speak English) and huge cultural differences.  On the other hand I am having one of the best clinical experiences of my life.  

The challenges are stimulating, the teaching is going well, and I have learned to repeat the Serenity Prayer often. “ Lord, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”