Tropical Medicine

Friday, October 18

The day started way too early.  I know this is a whiny but the power went out at 5 am and so the fan noise stopped.  The Swedish nursing students left early for their Safari and were super loud on the patio at that point.  It was really inconsiderate and a few other guest asked them to quiet down to no avail. So, at 6:15 when the rest of us surfaced from our rooms, there was more than a little grumbling.  

Morning report was the standard.  The most amusing was that a man had been admitted with a laceration and head injury.  He and his wife had gotten into a fight and she hit him with a hoe. These women are not to be messed with!

We did good thorough rounding this morning.  It seems that the clinical officers have decided to do expedited rounds on the weekend and so I wanted to have good plans in place for everyone.  Wisdom continues to hang in there but is not responsive at all. His breathing this morning made me think that the end was near but when we left for the day there was not any change.

Immanuel was able to go home this morning.  I was so excited that everyone would be doing well when Nicole came home.  I said that out loud and turned around and another of the babies, Lysin was held by a babysitter on the bench waiting to be admitted. Arghhh!  They seem to all just be passing it around.

I wrote a discharge for one little patient and he started asking the nurse something that was not being translated to me and the nurse seemed shy about it.  I pushed and he finally divulged that the patient was asking for a picture. He had not been feeling well yesterday when we took the polaroids and missed it. Of course I took his picture. Pure cuteness!!!

We had a lot of true tropical medicine cases today.  Typhoid fever, tuberculosis, malaria, meningitis, HIV, cryptosporidium, sickle cell, etc.  Not a lot of general pediatrics.

We still finished before lunch and were able to do some teaching to cover the management of malnutrition.  

In the afternoon, I headed back to the wards.  I passed a a small group of boys. A few of them attend the local public school.  I told them I had a surprise if they would wait one minute for me to return. They did.  I brought back a kickball but as we aired it up it had a hole ( I actually think I created it with the needle).  So I went back and got tape and another one. We patched the hole a little but it will need a daily inflate, so I gave them the other ball and pump as well.  They spoke a little English and I asked if they knew the word “share”. The little one said,”that means every one play with it.” I asked if they would promise to share and all heads nodded in vigorous agreement.  We also took polaroids of all of them and one of the guards came over and asked for one too. I sat there in the dirt with the boys taking pictures and inflating balls and the Malawian surgeon and head nurses emerged from a meeting to find me in that state.  They took pictures of the spectacle and laughed. The nurse confirmed that being with the kids was the most important thing of all.

I walked back into the ward.  They had just brought in a 1 ½ year old who had near drowned in a bucket of water.  They estimated that she was submerged for about 3 minutes. She appeared to have some seizure activity which is a little odd post drowning.  We gave her some rectal diazepam. We placed her on oxygen and her saturations and lung sounds were good. It is a question of did she seize and fall in the bucket or did she fall in the bucket and then seize.  She was alert and angry when we left today although still a little drowsy.

The little girl with the liver failure had very high liver enzymes and her test for Hepatitis B was negative.  It is now hard to know the cause. The family openly admittes to taking traditional meds in the past so that may have contributed.  The question of peanut butter also came up today. Evidently, some of the peanut butter factories locally have trouble with a fungus that develops if the peanuts are not dried well.  This is evidently toxic to the liver. It seems that everything is dangerous here.

We also had a new admission with HIV who has not been compliant with his medications and has almost no immune system.  He has a rash all over that appears to be yeast, cryptococcus. His x ray also looks very concerning. His mother has already died of HIV.  What an incredibly tough life he leads.

We reached the end of the workday quickly.  All the patients were settled in. The small baby in traction was playing an empty formula can like a bongo between his legs. I so wish there was more that I could offer than waves, smiles, and fist bumps as I headed out the door.  But I keep moving because often my smile turns teary if I think on the weekend some of them are facing. 

Elisa was already in the kitchen making rolls.  He even thought a few of the girls how to make them today.  The meal smells great. We had dinner all together tonight. It will probably be my last authentic Malawian meal (nsema and all) and the last with the whole Hope’s Inn crew.  See I went from smiley to teary again. That may be the trend for the next several days.

 I also got to video chat with Mom and Dad. Happy Birthday Dad!!  It is hard to be away from you on a day that is to celebrate you.  I love you more than words can express and can’t wait to hug you next week!