Nalerigu Day 5

Hello again!

Today was another exciting day mostly filled with medical work. This morning started with am rounds. Our little girl with necrotizing enterocolitis seems to be improving. The 6 year old boy with CNS malaria and seizures continues to awaken and appears more vigorous. At this point it seems that he may have some neurologic deficit, but time will tell. Interesting disease of the day: n. meningitis. Today we saw a pregnant woman around 32 weeks gestation who had altered mental status which is likely n meningitis. I have NEVER seen a meningitic woman carry a pregnancy. We did an ultrasound (one of the radiologic modalities we do have) and the heart beat appeared normal. She's now in the hospital being treated for the disease. We will continue to hope and pray the baby does well. Interestingly, several babies even around 1.5kg have survived at this place according to the obstetrician that lives here. Incredible as we do not have any method of respiratory support other than nasal cannula for oxygenation. The African people are extremely resilient.

Surgeries of the day: many inguinal hernia repairs, major laceration repairs, typhoid perforation repair in a young child and a skin graft.

Ultrasounds of the day: MANY! Looking for all sorts of things including abscesses, masses, pregnancies, etc. Today we had a woman who is 1 week postpartum and came in with abdominal pain. I examined her and found a right sided mass. We then took her to ultrasound which showed a large right sided abdominal mass that doesn't appear to be attached to anything. If any of you have any ideas of what this could be let us know! She is having absolutely NO other symptoms.

Another interesting medical problem we see here are snake bites. There is a certain kind of snake here called the carpet vipor which is extremely venomous, usually causing people to bleed. We do have antivenom which frequently works to stop the bleeding, but not always. The local people occasionally try home methods such as black stone to stop the venom. Black stone is actually part of a cow's thigh bone which goes through some processing including boiling. The bone fragments are then placed onto the wound which is thought to create some sort of suction that pulls out the venom. Dr. Hewitt said he hasn't found it to be very successful, but many local people really believe in it. I have a picture in the next blog.

After lunch, several of us went back to the hospital for more interesting things. I saw a boy whose classmate put a stone in his ear. Unfortunately he perforated the eardrum and all you could see in the canal was blood. We put him on antibiotics and are planning to see him back on Thursday to look again. That's the best we can do here. We then had several admissions including malaria, tuberculosis and a child with a large spleen who needed some blood.

Oh! I almost forgot to mention one of the most interesting patients of the day for Jessie and myself. As a pediatrician we have seen many cases of jaundice (yellow skin). Today, however, we saw the most significant jaundice I have ever seen. Even one of our attendings who did a pediatric residency before OBGYN said he has never seen jaundice this significant. She was a 5 day old little baby with severe jaundice that has led to kernicterus (problem in the brain). Mom was breast feeding well and there was no significant liver enlargement. The problem here...we have no capability to find out what the cause is. Normally we would check bilirubin levels, maternal and fetal blood type, etc. Here there is nothing. she could have a liver problem, she could have red blood cells breaking down, an infectious disease and on and on. There is no way to know. She is eating, has some fluids running and has been prescribed a "sun bath". This is essentially the natural bili light. Mom just takes her out into the sun every once and a while to allow the bilirubin to break down. Incredible! This girl is glowing! I have a picture of this one as well.

So those are the intersting medical cases of the day. I apologize for those of you who find this stuff boring. It is SO interesting to me!!!

That brings me to this evening. I am now on the computer, have been on "skype" with Joe and plan to return home, wash clothes and sleep. Tomorrow is a big day of clinic where hundreds of people come to be seen and only two attendings are available. Should be VERY interesting!!

Best wishes to you all. Please find thankfulness in your day today.

Jill