Belau National Hospital

On Monday, Justin and I begrudgingly started work at the hospital...we've definitely been enjoying ourselves learning to scuba dive (more on that later) and taking advantage of the beach at the Palau Pacific Resort. We got to the hospital around 7:30am after a quick bike ride in the rain (during which I got very wet and dirty from splashed mud and, thus, annoyed) and met up with Dr. Dever a bit later. He gave us a quick tour of the hospital before his slew of morning meetings and assigned us to either the medicine or pediatric service.
In terms of layout, the hospital has more than I would have expected, but I think it is lacking in other critical aspects (like meds). It has a small ER which is manned by an ER physician and nurse from Taiwan (they have some kind of arrangement that I don't quite understand), a hemodialysis unit, a physical therapy unit, a small ICU, an L&D ward with a small nursery (Dr. Dever said they have about 300 deliveries annually), a surgical unit, an inpatient ward for both adults and children, a radiology department with X-ray and CT capability, a lab for basic tests, a woefully poorly stocked pharmacy, and a section of the hospital for outpatient clinics. It also has a small medical library with computers and internet but I can't access the blog from those computers, unfortunately. Most people on the islands get their medical care at the hospital, but there are a few private clinics around town as well. Not surprisingly, I believe that the cost of care is higher at these private clinics.
I have been assigned to the pediatric service for the week (from what I understand, we'll probably be switching to different services each week). There are two pediatricians that work in this department: Dr. Becheserrak and Dr. Mungal. There aren't that many patients in-house, but they have a lot of scheduled clinic time throughout the week. They have specified clinic days for scheduled well-baby check ups (ages 0-5), for postpartum 2 and 6 week follow-ups, for high-risk children, and then a day for unscheduled outpatient visits. The high risk clinic days are usually filled with children who are anemic, asthmatic, or obese. Working on this service is definitely giving me a refresher course in pediatrics and well-baby care. I haven't really done any of that since my pediatric rotation over a year ago, and it's nice to refresh my memory before starting residency. However, I haven't really gotten to do much hands-on work yet. It looks like I'll have to be more assertive about it.
The most interesting case so far is in the new-born nursery. The baby was born into a toilet. Yes....a toilet. The mother presented to the hospital earlier that day with signs of preterm labor. She was treated, observed, and released later that afternoon. After being home for a while, she started to feel pain in her abdomen and tried to go to the restroom. Apparently, she didn't have to use the restroom, but she did end up delivering her baby at 32 weeks in the toilet. The mom and grandmother brought the baby in the next day due to eye discharge. She is still in the nursery on antibiotics but is doing quite well. She'll probably be released in a couple of days when she reaches the goal weight of 5lbs.
Ok...well, I'm almost out of time. So until next post....