Week 3 Rotation - Pediatric Nephrology

This week I am at Hospital de Los Niños in the Nephrology unit.  We started on Tuesday because Monday, July 16, 2012 was La Paz day.  This week, Jodi and I were paired up with Dra. Bocangel. 

Day 1: Consultorio day - kidney-ing it up.

Twins came in, they are healthy (sanos) and all matchy matchy!

This patient was hyperactive (diagnosed with ADHD), which was very apparent the moment she walked in, but when she opened her candy bag (which I have no idea why her mother would do such a thing), she made a happy face :-)

 Day 2 - Case Study and Nephrology Unit

Every Wednesday, Hospital de Los Niños holds a case study lecture in the Auditorium.  This week, Silvia (Infectologia Resident, 1st year) discussed an abandoned 3 month old who was diagnosed with H1N1.

 Day 3-4 - Nephrology Unit

Dra. Bocangel dictating to Resident Roxana about Samuel (diagnosed with Otitis).

In La Paz (and I guess in Bolivia), parents have to buy the instuments needed to do certain surgeries.  Fabian, 8 years old, need a central catheter placed because his fistula in his arm died and he very much needs his dialysis treatments. Mom and dad paid $800.00 Bolivianos for their son's pediatric central cath (hard to come by in Bolivia).  Turns out they were over charged $600.00 Bolivianos.  When Dra. Bocangel found out, she called the company and called them monstruous - def had to hold back the tears when listening in on that phone call.  But I saw Advocacy of the patient at its finest.

Sonia, 14 years, Kidney Failure, until she gets a transplant, she'll be on dialysis treatments for life.  Here, she is showing us a card trick.  Just about all the docs and med students and residents know her...she's somewhat of a celebrity!

Fabian's x-ray showing his catheter placement. (Left subclavian).

BINGO and COLORING

So, the nurses asked me to get Sonia a "Rompe Cabeza" because she wanted one - it's a puzzle.  So, on the hunt for her puzzle, I saw other great toys that we (Jodi and I) could utilize in the unit (one big room) - Bingo and paper and markers - it was VERY successful AND the nurses loved us and thought that it was a great therapeutic outlet for the kids.

Gabriel, 4 years, spinning the wheel to see what number will be called next for BINGO.

Jodi calling out the numbers in Spanish (she was awesome!)

Gabriel drawing at the table with his mom.

Samuel drawing the cartoon characters from his bedspread.  He LOVED drawing!!!

Jodi taping the drawing (Gabriel's) to his bed.

 Hemodialysis - this is in the Nephrology Unit in this hospital; consists of two machines (pretty much one is dedicated to Sonia, who has been in the hospital since I've been in Bolivia).  Watching the process is interesting.  The amount of supplies reused is questionable, but obviously is necessary here with the limited supplies.

Pediatric Hemodialysis machine.

Both machines running (one for Sonia, on right, and one for Fabian, on left).  Both are watching TV (Gato en las Botas).

Both the nurse and Dra. Bocangel trying to find Sonia's fistula - they couldn't get it, but I could def hear the swooshing sound when auscultating her arm.

Fabian getting his hemodialysis treatment - he was so FULL OF SMILES... I loved it :-)

Great 3rd week! Definitely loved interacting with the kids and good experiences with what this unit had to offer.  Going to donate the little supplies that I do have to the Hemodialysis unit.  I definitely feel like they need my gloves and alcohol swabs.  Can't believe I only have 1 week left, time has definitely flown by.