Yesterday I had a very interesting young man present to the Out Patient Department. He had fallen off a motorcycle with no injury to his back. Histories frequently don't make sense here so you try to piece things together as best as possible. At some point he got a penicillin shot in his derriere and shortly thereafter developed pain and swelling in his lower back with weakness in his legs. He was seen several places and was told the problem was from an incorrectly given penicillin shot.
note difference below 3rd
square bone just above flash
He had with him a great digital x-ray showing major destruction of L3-L4-L5 vertebral bodies (sorry my flash messed up the picture). Exam showed an impressive midline swelling in his lower back.
Diagnosis: Pott's Disease, Tuberculosis of the spine (I have not seen this since our trip to Zimbabwe)
He is fortunate it is as low in the spine as it is or he would likely have complete paralysis of his legs. Hopefully TB meds will prevent further loss of strength in his legs.
Some things are no different than at home. The number of women in the hospital had dropped and I was happy to be able to do rounds in an hour. It took only a few days and a few very sick new patients to expand the time it took to do rounds. I like to do rounds to start the day but the outpatients begin lining up first thing in the morning so frequently I see outpatients for 2-3 hours before starting rounds.
One of my new additions is a lady with HIV and TB requiring a chest tube to drain fluid from her lung. She is stoic taking a few Tylenol for her pain.
Today was Market day so fewer people came to OPD. Terry and I were able to get to the market and experience the chaos.
Yesterday was a day of triumph. Victorine went home with a happy family. Her confusion resolved with increased oxygen after her blood transfusions. Hopefully her new HIV regimen will work for her as we fight her TB. Bill has been joined by Dr. Magued Khouzam for his last 2 weeks. They had worked together when Bill was in Uganda. They spent 4 hours operating yesterday on a lady with a ruptured splenic abscess. She was in septic shock but fortunately made it through surgery. Our prayers are with her today.
Victorine is the lady with HIV and TB who had a hemoglobin of 2.5. After 4 units of blood she was sitting up in bed today and told me she was "as strong as a lion". We are all more optimistic with her prognosis today.
A Day in the Out Patient Department
I saw another lady today from the capital Yaoundé who chooses to spend 6 hours traveling one way here for her HIV meds. She tried getting care there but frequently spent all day at a clinic there without seeing a doctor. I was happy to see her but it is a shame care is not easily available at the government facilities in the 2 largest cities.
There is a team of Orthopedic Surgeons from Holland has been coming to St. Martin de Porres Hospital for years. They exclusively work on children with crooked legs, usually extremely bowed legs. Because of this people come year long to inquire about getting their children's legs fixed.
I saw a 14 year old boy yesterday whose lower legs were only 1/3 the size of normal and extremely deformed. He amazingly could stand on these legs but he had worn out his prior crutches. He has had 4 prior surgeries but I don't think any thing further can be done. We were able to get his some new blue crutches and I saw him today slowly maneuvering thru the hospital with a big smile on his face!
The Women’s Ward was all excited today as one of the women had her 1 year old son with her. He was as cute as a bug and he knew it and had all the patients smiling with his antics.
With 14 beds in a confined area these patients help one another and share each others joys and sorrows.
There are 2 women on the Ward who have been there since my arrival. Being in the hospital anywhere for a month is not a good sign. One of the ladies in her 50's is being treated for HIV and TB. She has been extremely weak and yesterday her Hemoglobin had dropped to 2.5, the lowest number I have ever seen. It is a side effect of one of her HIV meds so hopefully with several blood transfusions and a medication change she will be better. The family has to arrange for donors so it may take some time as she doesn't have many family members.
Today I saw a new patient who fractured his lower leg in a traffic accident 4 years ago. He had a plate inserted but "the wound has healed slowly". I did not need a x-ray to see the plate, it was visible thru the multiple open draining areas over the plate. I am sure the bone is infected(osteomyelitis). He was very happy that he has continued to walk well, "it surprises many people" he boasted. He chose to go home and work for another 2 weeks before coming into the hospital for surgery.
It amazes me daily what people here endure and usually without complaint.
Busted Halo said "We are asked to see God in all things and at all times; that is why we are encouraging our readers to take their halos — busted and otherwise — along with them this summer, for our Summer Halo Contest. But we don’t want you to simply tell us where you find God this summer; we want you to show us."
So we did. We submitted a photo and now we need your vote. Visit the Busted Halo site and simply click on our photo to vote.
We learned so many things in our Formation Program. Some of it was for our spiritual health, but some of it was for our physical health. One of the things that was frequently emphasized was what I have dubbed "Boil It or Peel It 101". The bottom line is that we are not supposed to eat any fresh fruit or vegetables unless they have been boiled or peeled. It is pretty straightforward.
Do you know how you long for a fresh salad, especially when you think that you can't have one. This is the beautiful salad that we had for dinner last evening and it met the standards of the boil it or peel it rule. In addition, piping hot crepes were served with it.
Terry and I start our day with Mass at the convent with the nuns at 6 AM. Many of the Sisters work in various parts of the hospital and we feel part of the Team providing care to the patients here.
Like a song you can't get out of your head a reading from early this week has been on my mind. My paraphrase: God rewards those who joyfully serve him. It reminds me that not only do I need to serve Gods' people here but to do it cheerfully. Keep us in your prayers as we tackle the work here.
Our Blog posts are done on our computer at home then we go to the Cyber-Café at the hospital. We then get online with our laptop via a wireless router connection.
Since the power goes off multiple times a day it limits the available transmission time. The Café is open 8AM-8PM Mon-Sat. Unfortunately Sunday, when we have the most time they are closed. I have been checking the Blog for your comments, and we really appreciate them. I am not able to answer the questions directly yet - so will try and respond with future posts for now.
Answers to prior comments;
* We have no Vancomycin but MRSA does not appear to be a problem yet.
* Average daily income is $1 a day.
* Fortunately, HIV meds are paid for by the government and so are the meds to cover HIV related illnesses.
Today I admitted a 14 year old boy who looked half his age and weighed only 44 pounds. Initial impression is malnutrition but his labs are still pending. I am hoping his HIV test is negative.
It was a very busy Monday as usual in the Out Patient Department. After assisting on 4 C-sections last week I did my first C-section in 30 years today. Everything went well and my ability to do C-sections should help when the Surgeons are tied up or gone.
Assisting Bill in Surgery
It has been nice working with Bill Walsh this last week. I also reduced a broken displaced wrist on Friday. The power was out so we were unable to obtain an x-ray. Taking someone to the OR without an x-ray in the US would not happen.
I also helped Bill debride a burn today. A 70 year lady had a seizure at home and fell into her cooking fire suffering a 25% body 3rd degree burn. She has significant infection already and she will be in our prayers the next few days.
Saturday was our first excursion to Bamenda, a city of 250,000 about an hours drive from St. Martin de Porres Hospital. We were able to shop at the two supermarkets, The Vatican and New Life. We managed to pick up a few things that remind us of home, like Kellogg's Corn Flakes as well as a couple of luxury items. I now have a mirror above the sink, and it's red frame is a bonus.
There is no doubt that the highlight of the trip however was eating at the Dreamland Bar and Restaurant. We had our first truly American food in a month. We had a hamburger and french fries. The hamburger was chicken, as the restaurant was out of beef but it was delicious. We gave the restaurant our five star seal of approval. We also made a brief stop at the open air market before getting on the road in order to make it home before dark. I am sure that we will dream of a return to Dreamland sometime in the future.
I surprised the nurses again today by rounding on patients on Sunday, not a standard practice here.
Janette is the 10 year old who had bacterial meningitis and now has been in the hospital for 3 weeks. She has slowly been coming out of a coma and today she had a big smile when her name was called. The smile was even bigger on her mom's face!
She still has a long way to go but everyone is thankful for the progress so far.
Yesterday was a very busy day. I assisted on 3 Cesarean Sections. Unfortunately, the last one was a lady who delivered Twin A at a small rural clinic at 6PM. She arrived here 3 hours later with the arm of Twin B delivered and no heart tones. Twins are always a high risk delivery, especially at night in a developing country with no emergency care options. Hopefully mom and Twin A will do well to ease some of the pain. Today a lady was transferred from a small rural hospital 12 days after her auto accident. She thankfully was alert and oriented despite her untreated depressed skull fracture, displaced arm and femur fractures. Her Guardian Angel has been working overtime. It has not been unusual to see cases like this appear in the OPD.
You have to just move forward and do what you can for these patients. It is gratifying to be here at St Martin de Porres Hospital where people are not turned away.
Monday is a busy day at the Out Patient Department My first case was an 8 year boy who had surgery for an infected femur (osteomyelitis) 18 months ago. He did not return for follow up but mother decided he should be checked now since his leg wounds have not healed in the 18 months. Unfortunately he has a chronic Staph infection and the leg is 3/4 the size of his good one and has no movement of the hip or knee. Dr. Bill Walsh (a veteran surgeon mission doctor) will get to consult on this case when he starts this week. I also made my debut in the theater today. Nothing exotic, removal of an ingrown toenail. Not everything is Tropical Medicine here.
Jim and Terry Hake have been at St. Martin de Porres Hospital in Njinikom, Cameroon since July 2010. With the prayerful support of their family and friends, and relying on Our Lord to be their daily companion, they are in the second year of a three year mission.
I saw a 14 year old boy yesterday whose lower legs were only 1/3 the size of normal and extremely deformed. He amazingly could stand on these legs but he had worn out his prior crutches. He has had 4 prior surgeries but I don't think any thing further can be done. We were able to get his some new blue crutches and I saw him today slowly maneuvering thru the hospital with a big smile on his face!
The Women’s Ward was all excited today as one of the women had her 1 year old son with her. He was as cute as a bug and he knew it and had all the patients smiling with his antics. 
Janette is the 10 year old who had bacterial meningitis and now has been in the hospital for 3 weeks. She has slowly been coming out of a coma and today she had a big smile when her name was called. The smile was even bigger on her mom's face! 
