Twin B

1 month ago premature twins were born, weighing 3 and 4 pounds respectively.  The smaller one was the second twin which is normally the case.  Big brother also took most of the blood from the placenta as Twin B was noticeably paler.  Both babies did well for a few days then they both developed fevers.  The nurses felt it was just the incubators overheating but I placed both babies on antibiotics.  The next morning we surprised to find that the larger baby had died during the night.  Little Twin B was slow to gain weight but has continued to look good.  He just finished a second 10 day course of antibiotics after developing fever again last week.  This morning he topped the scales at 3 and 3/4 pounds.  His mother mourns for the loss of his brother but is overjoyed with his steady growth.  We are cautiously optimistic that he will continue to do well.

Zidan

6 year old Zidan arrived at the hospital 10 days ago.  He had pneumonia and he looked like he was 3 years old instead of 6.  He had classic signs of Kwashiorkor(protein malnutrition) with a big belly, swollen hands and feet with sparse, fine hair.  We were not surprised that his HIV test was positive.  It was clear by looking at him that he did not feel well.  The presence of a white doctor who did not speak his language was not a comfort to him.  After a few days of increased protein intake and treating his pneumonia his fear of me gradually diminished.  A few days ago I was finally able to get a small smile from him.  Zidan was discharged today and while I likely will never see him again I will always remember the reluctant goodbye wave he gave me with a small smile.

Jubilee

Saturday St Martin de Porres Hospital celebrated it’s 50th Anniversary with a huge Jubilee celebration.  The Hospital has been preparing for this the last year.  Most of the buildings received a face lift with new paint inside and out.  Much of the cement work throughout the hospital was replaced and the grounds were manicured.  The Celebration began with a Mass concelebrated by 4 Bishops and 46 Priests.  Numerous civic and government officials were in attendance.  Portable pavilions were erected and over 1200 people attended.  The weather was beautiful and the normal daily rains threated but never materialized.  It was a joyous occasion and Terry and I feel blessed that we were here to witness it.

Sandrine

14 year Sandrine is one of the many HIV orphan here.  Unfortunately medication was not available to reduce the transmission of the virus from mother to child at that time.  Sandrine lives with her grandmother who is taking care of several grandchildren, a common occurrence.  Sandrine started on HIV medication 5 years ago and has had ongoing problems taking her medications on a regular basis.  Her CD4 count rose from 39 to 519 after her first year of treatment and since then it has been on a steady decline with it now being 9.  Failure to take her medication on a daily basis resulted in the development of resistance of the HIV virus in her body, i.e. the medication is no longer effective.  Rather than growing Sandrine has lost 16 pounds and literally is mostly skin and bones.

We discussed placing her on our second line of medication last year but it was felt she needed to become better at her medication compliance before starting her last chance medication.  In Cameroon we have only 2 medication combinations unlike in Western Countries where over 50 are available.  Sandrine starts her new medications today and we all will do our best to encourage her compliance.  In addition we hope that additional medications will become available in the future.

Sam

Terry and I first met 32 year old Sam about a year and one half ago when he was admitted to the hospital with HIV, TB and Cryptococcal Meningitis.  Initially he was very wasted and mentally obtunded.  As he slowly recovered we met the real Sam, a pleasant man with with a huge smile.  He spent nearly 2 months in the hospital so we got to know Sam and his mother quite well.  Our donors paid his hospital bills and he eventually made it home.  Unfortunately Sam and his family could not afford Fluconazole, a medication to prevent return of his Cryptococcal Meningitis.  Sam did well for a few months then his condition deteriorated.  He was too weak to come in for his HIV medications so one of the counselors would deliver his medications to him and update us on his progress.

Last October Sam’s mother could no longer care for him and brought him back to the hospital.  He had been lying in bed so long that he had the worst bed sores that I have ever seen.  Both hip bones were exposed with sores involving more than 1/2 of each buttocks.  Sam was barely conscious and was obviously septic from his wounds.  I seriously thought about not treating his infection thinking there was no possible way Sam could recover.  As I pondered what to do Sam whispered, “help me Doctor”.  Sam made the decision for me and we started antibiotics and daily cleansing of his wounds.  Dr Laura Dooley had just brought us a large supply of Fluconazole so we started Sam back on it.  Slowly Sam showed improvement and his smile returned.

Around Christmas Terry and I realized Sam was just not going to give up.  We also realized his
wounds were never going to heal on his primarily carbohydrate diet.  We began supplying Sam with sardines, peanuts and eggs to increase his protein intake.  I also tried to see Sam during his dressing changes at least once a week and cauterize his wounds with silver nitrate.  Gradually Sam started gaining some weight and his wounds became smaller.  With determination Sam got out of bed and began walking with the aid of a walker.  His mobility slowly increased and Terry and I had to walk through out the Hospital to find Sam for his protein deliveries.  Sam’s smile was never bigger than yesterday when he was finally discharged.  He will be staying near the hospital so he can continue with dressing changes until the last of his wounds are completely healed.  Terry and I feel blessed to be a witness to one man’s determination and a real miracle!

Elizabeth

6 months ago we first met 25 year old Elizabeth.  She was being treated for recurrent Tuberculosis.  Unfortunately she developed Hepatitis from INH, one of the five medications in her treatment regimen.  We withheld her medication for a week and then restarted the medication at a low dose and then gradually increased the dose.  At home we would have come up with a replacement drug for the INH but here there are no alternative drugs.  Elizabeth was doing well and sputum tests in January showed no sign of TB.  Last week Elizabeth returned to OPD very sick.  She was jaundiced and her liver was extremely enlarged.  She also was retaining fluid and was in heart failure.  She likely had damage to her heart valves from Rheumatic Fever when she was younger.  Her problems were triggered by the INH medication again.

Elizabeth had a difficult weekend being extremely short of breath.  We prayed all weekend that there would be no power outages as she desperately needed supplemental Oxygen from an oxygen concentrator that requires electricity to run.  We fortunately had fewer outages than normal and we were all encouraged Monday morning when she looked slightly better.  I figured everyday she could manage gave here liver a chance to recover from the INH insult.  Yesterday morning Elizabeth lost her fight and left a grieving family trying to understand why someone so young was no longer with them.  Elizabeth, like so many people here, endured a terrible illness with great dignity.  She and her family remain in our prayers today.

Praises

19 month old Praises was brought to the hospital by her mother 10 days ago.  She had been ill for the prior one week with fever and diarrhea.  She spent several days in a small Health Center and they reported that she had vomited up a tapeworm but despite their treatments she showed no improvement.  She was very ill and lethargic on arrival.  All of her tests failed to reveal what was wrong with her.  She passed blood in her stool for several days last week  and she remained as limp as a doll.  Over the last couple of days Praises has become more responsive and even called for her mother for the first time this morning.  Our limited diagnostics can be frustrating with cases like this.  We keep her in our daily prayers and are hopeful that we will see see more shine in her eyes each day.