15.10.17

Underqualified

(by Greg)

Since our return to Burundi, I have been slowly coming to terms with another one of my phobias.  I have a fear of children.  Not all children.  I am not afraid of my children, or really most children.  But as a child is brought into the operating room, my perspective on them changes immediately from “cute and cuddly” to “instrument of terror”.  Why is this?  

For the past 10 years, as an anesthesiologist in private practice in the U.S., I have become quite comfortable taking care of adult patients in the operating room, even very sick ones.  But my time spent taking care of children in the OR has grown more and more sparse.  There is a growing movement in the US to stop taking care of pediatric surgical needs at community hospitals and instead to transfer them to a children’s hospital, where they can be taken care of by a pediatric surgeon, a pediatric anesthesiologist, nurses and techs who take care of children every day.  In fact, research has now demonstrated that children, especially those under the age of 2, have better outcomes at hospitals that specialize in pediatric care.  The result has been that in the US, I rarely anesthetize children, and almost NEVER children under the age of 2.  

It turns out there are a lot of ways you can damage or even kill a very small child during surgery and anesthesia.  These include medication errors, dosing errors, airway mismanagement, even temperature management.  And so you can imagine my, let's just say discomfort upon my return to Kibuye, where I am presented almost daily with children who need to be anesthetized.  There is no pediatric hospital in Burundi.  My suggestion on day one to transfer a sick child to a “tertiary care center” (specialty hospital) was met with stares of confusion and awkward silence.

On Monday this week, I entered the OR to find that we had scheduled a 2 day old, followed by a 3 day old, followed by a 21 day old, all needing emergent bowel surgery under general anesthesia.  Pretty much a full on nightmare from my point of view.  

Some people with whom I have spoken over the past several years have suggested that if you are not qualified to do something in Africa, you should not do it.  I understand their perspective from a theoretical standpoint.  However, from a practical standpoint, if we do not offer surgery to these children at Kibuye, they will most certainly die.  So, when does one go from being “underqualified” to “disqualified”?  Is it simply a numbers game?  If half of your patients are surviving, should you keep going?  I can tell you that this week has led me to seriously consider going back to the US to do a year long fellowship in pediatric anesthesia.  But even that would likely mean hundreds of kids left without an anesthesiologist for a year.  

Thankfully, all three of our tiny patients on Monday survived surgery.  I am not sure they will all recover completely, but for now, they are alive and awake.  Their anesthesia was not perfect, but they survived.  I prayed for each of them.  I can only thank God for the fact that they survived.  For ultimately it is God who holds their lives in His hands, and uses those of us who are far too underqualified.  



8 comments:

Rebekah said...

This sounds terrifying! Praise God for giving you the courage to do what needed done & that all of your patients are on the road to recovery!

Unknown said...

Greg, praying for you. Love you lots. Hang in there bud.

onewhostrives said...

All I can say is "wow," "thank you," and "God cares for these patients." You are His instrument of grace to them, even if you feel a little out of tune at the start of the concert.

Verena Teko said...

Greg, I understand your"fears". God knows them much better. I pray HE will guide you as to which path to walk. I will pray specifically for wisdom and knowledge that will qualify you for whatever is God's will for you. Blessings.

Aaron Gonter said...

Greg,
Amazing story. Can't imagine how uncomfortable those cases must have felt. Have you explored the idea of having pediatric anesthesiologists/fellows rotate at your hospital? Not sure if that's paractical or not. Keep up the good work, and do the best you can,given the circumstances.

DrsMyhre said...

Greg we thank you. This is our daily life, stretched to give what we can in places of need. These are Gods loves babies first and foremost. You won’t always be perfect, but thanks for jumping into an arena no one else is trying to enter.

Bluebuckeye07 said...

Greg,
I have never met you, but follow this blog and know Jason & Heather Fader from their time in Ann Arbor. I am a pediatric anesthesiologist currently working at Mott Children's Hospital (Univ of Michigan). If I can ever be of help from afar, please feel free to contact me at bluebuckeye07@gmail.com. If you would find it helpful, I am also happy to give my phone number to you via email as well. My family will keep you and all the little ones you are tasked to care for in our prayers.
Sincerely,
Rebecca Hong
ps sometimes the tiniest ones still scare me ;)

Sara Davies said...

When I left high school I worked in a Special Baby Care unit as an orderly for three months. I fed, changed and cuddled many tiny babies.
In my training in UK I did three months paediatric anaesthesia in Edinburgh and again in Manchester at their children's hospitals. Because of this I was never afraid of looking after children, since they were always larger than the babies I had looked after originally.
Greg you will be fine, you are rightly concerned about careful dosing and temperature management. I'm sure your patients aren't as healthy as their US counterparts but they will usually not have the adult diseases that you often have to deal with. With practice you will become more comfortable, and it looks like you are going to get a lot of practice. At Lahey I prepared cheat sheets for children weighing 5kg, 10 kg, 15kg....with tube sizes, fluid requirements, drug doses, especially emergency drugs which hopefully you will never need. Just preparing them helps to review and remind and they are invaluable in a real emergency. With God as your copilot you will succeed. I send my love, prayers and healing thoughts. Sara Davies.