One of the biggest roadblocks on this trip has been the language barrier with patients. The thing about this hospital is that it is government run as I've mentioned before, diagnostic tests are subsidized and so are at a much more affordable cost for the patients, and there are no admission costs or any additional costs for surgeries etc. For this reason patients are coming from villages outside of Dhaka, making long trips to be seen by a physician here. This poses a challenge for me because although the basis of the language is the same all over, there are different dialects spoken. Certain words are pronounced differently or certain objects have an entirely different name. Furthermore, although I am fluent there are certain phrases or idioms that I do not know. For example...the word for urine is "peshap", well I had a patient who kept saying "poyshap" and I was a bit confused at first but was able to use context clues to figure out what she meant. Usually an intern is with me in order to help translate but when things are busy I'm on my own, but the best way to learn something is through your own experience which includes being confused and making mistakes and then making sense of things after. In another case, also related to urinary output..the mother of the baby told me that the patient wasn't really making any "peshap", in my head i'm starting to wonder, ok, this could be obstructive, there could be a posterior urethral valve as we've seen in so many patients already..let me ask a little more, I asked her to elaborate and she said "amar bachar peshap top top kore ashe"....ok..well in my head the translation went like this: My baby's urine comes out.."Something". I had no idea what the heck "top top" meant...so I asked her "Top Top mane ki?" (what does "top top" mean?) she looked at me, I looked at her...we both had the same exact confused face--like many other circumstances I was saved by an intern who was literally on the floor laughing, she told me that top top meant dribbling. the baby's urinary flow was dribbling! I started to feel the frustration I'm sure foreign medical grads feel when they come to practice in the U.S. as we have a lot of slang terms as well!
THe patient with the Wilms Tumor from an earlier post-with the inoperable tumor-has been on our ward since the operation. There is absolutely nothing we can do for him, and even worse there is some confusion regarding whether palliative care for children even exists in the hospital. The patient wants to go home, we clearly cannot send him home with hopsice care on board..so we had to figure out what we could do to make the dying process a little bit more bearable--injectable opiods are not an option, the shear cost and maintenance are not within reason for this family. The only option really are oral opioids....but the availability is not great according to our attending. Watching the family carry their son out of the ward was so heartbreaking-he probably lost another 5 pounds while here, I could easily count his ribs and see the contours on them, his face was so incredibly sunken in, his limbs were frail and he could barely keep his eyes open. His parents would turn their heads to wipe their tears and plaster a smile on their face everytime they looked back at him. I cannot imagine the pain of losing your own child.
New Admissions:
1. 4 mos female, watery stool for 4 days, baby is lethargic, presents with signs of obstruction and hx of not passing urine or stool for the last two days after having had the diarrhea.
2. acute abdominal pain, possible appendicitis
3. suspected Hirschsprungs
4. suspected septic arthritis, with possible septicemia, p/w respiratory tract infection
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