When it rains it pours...

   Last week was a bit rough...

   Before I get to that, I should say that things have generally been going very well in the hospital.  We have seen some very sick children that our Lao and expat volunteer doctors have managed brilliantly.  There were a few patients in heart failure from infantile beriberi who probably wouldn't have lived if they had been just a few hours slower in getting to the hospital.  But, they arrived in time...  Our nurses triaged them quickly, our doctors identified the problem and gave the proper treatment, and within hours they brought the patients from heart failure with low oxygen levels and respiratory distress to nearly normal.  Such cases are extremely rewarding.  Beriberi has now replaced diabetic ketoacidosis as my favorite condition to treat.  In both cases, you can guide a patient from critically ill to stable over the course of hours, all while seeing the physiology respond to treatment in front of your eyes.

   The staff are also doing a great job of managing traumas.  Under the guidance of our new executive director, Simon, they have re-aligned some displaced fractures (a little ketamine, a little tension, a little pressure, and a cast).  Our new director of medical education, Christine, is moving forward with the neonatal training we need to open our newborn unit.  And, our nursing director, Becky, is preparing the nurses for neonatal and surgical nursing - not to mention experimenting in the kitchen to prepare "plumpy nut" (ready to eat therapeutic food) in a way that Lao kids won't spit it out.  There is a lot of progress being made.

   Despite the successes, we sadly had 2 children die last week.  Considering how sick many of our patients are, it is surprisingly not that common that one of our patients dies in the hospital.  Two deaths in one week has been hard on all of us.

   I have to be careful discussing details out of respect and privacy, but I can share some information.  One of the cases was a toddler who came to us after having seizures continuously for nearly 24 hours.  The child arrived with dangerously low oxygen levels (for who knows how long at that point).  He also had very elevated blood acid levels, undetectably low blood sugar, and was in acute kidney failure when he arrived.  We were able to stop the seizures using three anti seizure medicines, quickly correct the blood sugar, and slowly resolve the acidosis, but the damage to brain and other organs was too much at that point, and he succumbed to his illness.

   It was heart-breaking to see the family suffer through this loss, especially since they had recently lost another child.  On the other hand, it was  inspiring to see the support of their extended family who, within an hour, had already sewn a beautiful little black funerary outfit for the child.  Family and community are especially powerful at times like these.  One of our Lao staff sat with the family, comforting them and simply being there.  She did an amazing job, but was pretty shaken.  A few hours later, I asked how she was doing.  "Not good, Dr. Greg. I cried. I am not strong enough yet."  I told her that every one of us in that room cried.  Crying is not weakness; it showed the family that she cared.  If there ever comes a day that I stop feeling grief at the loss of any child, then I should stop being a pediatrician.

   On top of all of this, one of our staff had to leave urgently because a family member suffered a severe accident with uncertain prognosis...

   As I said, it was a rough week.

   Fortunately the weekend has been therapeutic.  Many of the staff got together for a little fun at a karaoke club on Friday night - there was a private room with a few microphones, a few disco globes, a few cases of BeerLao (sweet iced tea for the abstainers), a big screen TV,  an eclectic selection of English, Lao, and Thai songs, and mercifully some VERY powerful air conditioning.  There were some great singers, and there were a few who sang like me...  Nobody cared, and nobody was particularly self-conscious.  It was all innocent fun and a well-deserved release of tension.

Bad picture, good fun.

   Yesterday the medical leadership team met with Amy Gray, an Australian pediatrician who has been working in Laos for years.  She also traveled with a few pediatric fellows who are working with her in Vientiane.  They were able to share insights about the past, current, and potential future state of pediatrics in the country... and the best part is no conference rooms were involved!  We talked over breakfast at a Le Banneton, an open-air French bakery/cafe', soaked away the afternoon in the swimming pool at La Pistoche (which is filled with Lao kids by day, and foreign tourists by night), and enjoyed a delicious dinner at Kaiphaen, a "social enterprise" restaurant that reinvests all profits into training programs for its student-employees.  The food was outstanding. all. day. long.  So good that I even passed on dessert.

Swimming at La Pistoche

   Overnight and into the morning on Sunday, we had the kind of house-shaking thunderstorm I remember fondly from childhood storms in the Midwestern US.  The rain mercifully brought the temperature down a few notches so I did a little walking around town, and the day left plenty of free time (and functioning internet!) to do a little websurfing, a little work via e-mail, FaceTime with the family, and Skype with a prospective volunteer.

   I finished the weekend with even more great food and conversation.  First came dinner at a newly opened Chinese restaurant with perhaps my favorite Szechuan dish 酸菜鱼 - spicy pickled veggies with fresh fish.  The owner gave me dinner for free after I helped him post his business to google maps.  I also chatted with his sister-in-law at length about educating kids while living abroad.  She sent her 6 year old back to China to live with the grandparents so he could learn Chinese characters and not fall behind in the demanding Chinese school system.  She is still struggling over that decision.

So delicious.

   Finally, I wandered back to the guesthouse where I exchanged Lao and English language tips and cultural insights with some of the young staff over a plate of sliced mangoes and rambutans.  I think I am ready for another week.

Novice monk resting, with frangipani in the foreground.