Pediatrics

Last week I made the switch from ID to pediatrics. There are three pediatrics units at RDH on the 5th, 6th, & 7th floors. The 5th floor consists of all general pediatrics admissions. The 6th floor encompasses the well-baby nursery, the special care nursery, & NICU. The 7th floor is the isolation ward for children with potentially contagious conditions like diarrhea or respiratory infections. There's no children's ICU, rather any children who require ICU level care go to the general ICU & are managed jointly by the pediatricians & ICU doctors.

The schedule on pediatrics is similar to the medicine schedule starting every morning with an 8am handover from the overnight registrar to the day teams. Every other Tuesday, there's an ID meeting after handover to go over any interesting ID cases with the ID team. On Wednesday there's a journal club after handover. On Thursday morning there's radiology meeting. There are also teaching conferences at noon with registrar teaching on Wednesdays, psychosocial rounds on Thursdays, & Grand Rounds on Fridays.

The workload is split among three pediatrics registrars, with an RMO assisting, who are each responsible for the units during the day. Often, another registrar or two handle emergency department admissions, transfers, & outside calls. There's a scheduled evening handover every day at 4pm during which the day teams hand-off to the evening registrar & RMO. The evening team then hands-off to the night registrar who comes on at 10pm & holds down the fort managing all admissions & cross-cover until the am handover the next day.

My first week on peds, I joined the 7th floor team. As I said earlier, this unit is the isolation ward composed of patients admitted with diarrhea or respiratory issues that could potentially be contagious. The vast majority of children admitted to the ward are Aboriginal & have severe malnutrition in addition to diarrhea & dehydration. It is estimated that up to 20% of children in the NT meet the WHO criteria for malnutrition, which by WHO definition constitutes a "health crisis." Because these children are already compromised by malnutrition & poor living conditions, they are especially vulnerable to diarrheal illness. It's not uncommon for the children to be infected with multiple organisms at once: giardia, rotavirus, salmonella, & cryptosporidium being the most common as well as other parasites like strongyloides. They often come in with severe electrolyte abnormalities with dangerously low potassium, sodium, calcium, & magnesium levels & acidosis. Many of the children also have other vitamin & micronutrient deficiencies as well as iron deficiency. We have to monitor them very closely, constantly adjusting their fluid & electrolyte replacement.

In addition to my time on the 7th floor ward, I've been on another outreach trip. One of the pediatrics consultants & I flew to the town of Gove, also known by its Aboriginal name Nhulunbuy, for a one-day clinic. Gove is at the very north-east edge of the NT. Historically, the Aboriginal communities of Nhulunbuy & Yirrkala were located there. The town of Gove was primarily built up around aluminum mining & a large ALCOA aluminum plant. The clinic was held in the hospital & the vast majority of the patients were non-Aboriginal children of parents in some way affiliated with the mines & ALCOA. These children had primarily "western" complaints with the vast majority being evaluated to developmental issues. In contrast, next week I'll return to the neighboring community of Yirrkala, which is an Aboriginal community. Next week, I will also be going to another Aboriginal community in the midst of East Arnhem, the vast region of the NT between Kakadu & the eastern border of the NT. It will be my first overnight trip to a community!