Tuberculosis, again.

When I finished yesterday's blog on TB I really was not sure why I had chosen that topic.  I suppose it was because I had seen a couple of new TB cases yesterday.  

One of those was a 24 year old lady referred from an outlying health clinic.  She looked healthy but was recently diagnosed with HIV and had been coughing for 2 months.  I obtained a chest x-ray which was suspicious for TB.  We obtain 3 sputum samples over 24 hours looking for the TB bacteria.  She submitted her first sample yesterday and was to bring in 2 more this morning.  

While doing rounds this morning the nurse informed me she apparently started coughing up blood during the night and was brought back to the hospital this morning dead.  TB and HIV are deadly and we are reminded of that on a regular basis.

Tuberculosis

Tuberculosis.  A term we are all familiar with in the US but more from a historical viewpoint.  

It is alive and thriving well here.  One of the interesting statistics I read was that patients with HIV have a 15% chance per year of developing active TB.  We see it here everyday.  While most of it is Pulmonary TB it also presents in the neck, pericardium, abdomen, brain, spine, and kidney.  

Terry pointed out to me at Church on Sunday how many people were coughing.  I could not help but wonder how many of those coughs were spreading TB about.  

The government pays for TB treatment which is a good thing to enhance treatment compliance.  This x-ray shows a great cavity in the lung caused by TB.  

One of the millennium goals is to reduce the incidence of TB as it is still responsible for many deaths in developing countries and the economic toll is costly.

Called During the Night

Joe and I were called to the hospital during the night to see our 1 year old with the chest tube.  She had been doing great and we were contemplating removing her tube in the next couple of days.  She developed sudden breathing difficulties during the night and had developed a major air leak from her lung.  We ascertained her tube was functioning properly.  There was no one available to take an x-ray until this morning and she passed away as the x-ray was being obtained.  

It was difficult for us wondering what we could have done differently to change the outcome but nothing compared to what mom and grandma have to endure.  

Our prayers are with the family today. 

Junior

Here are some photos of Junior, from the story I shared yesterday. 

Joe and Junior

Dr. Joe Llewellyn, a general surgeon from Alaska arrived here Sunday.  He helped evaluate a 1 year old child admitted over the weekend with pneumonia.  She developed a pneumothorax and Joe showed me how to place a chest tube.  To our surprise she also had a significant empyema (pus between the lung and chest wall).  This tough little girl hardly fussed with the tube insertion and is looking much more comfortable this evening.

I am not trying to dwell on all the terrible cases but feel the stories of these people people should be shared.  

This morning I saw a nearly 4 year old named Junior.  He looked half his age and was wearing a school uniform and backpack.  He politely walked up and shook my hand.  He was accompanied by his grandfather who he came to live with a month ago.  Grandpa was worried about Junior's small size plus a persistent cough and rash.  Junior's mother is a prostitute and could not care for him any longer.  He sadly tested HIV positive.  The plus is that he is now in a safe environment and will be able to get the medical and social care he deserves.  

There have not been many 3 year old children that impressed me as much as Junior did today.

Courage and Dignity

This week there was a young man in the hospital with HIV and ascites.  The ascitic fluid looked like milk which is rare but almost always caused from Lymphoma(cancer).  I informed him that he likely had cancer and the closest place he could get treatment was in Yaoundé, a 6 hour drive  from here.  He asked if it would be expensive.  When I told him yes he quickly reasoned that his family could not afford it and he would just go home.  He showed no visible distress and thanked us for what we did for him.  

A difficult situation for all of us.  I admired his courage the dignity he displayed.  

Let us pray for him and his family and that the opportunities for treatment will be the same for all people in this world someday.

Monday

As usual it was a very busy Monday in the Out Patient Department.  

I had 6 new HIV cases today and 3 new TB cases, quite a change from back at home.  

The sad case was seeing a 7 year old come in for a 2 week follow up after being started on HIV medications.  She was accompanied by her 12 year old sister who was her guardian since their mother had died.  

It was sad thinking of the family situation but I had to admire the strength of the big sister as she walked out of the room with her hand on her sister's shoulder, guiding her.  

Pray for their family and their future.

An Early Decision

Mass at the Church, Sunday

Sunday morning begins with an early decision.  6 AM mass or 8 AM.  The thought of sleeping in is nice but after getting up at 5:30 every morning our internal alarm clocks are hard to turn off.  6 AM mass is said in the native Kom language but they have the best choir.  8 AM mass is in English but frequently without a choir and might start an hour late.  We chose 6 AM today and I brought a book on Henry Nouwen to read during the sermon which I would not be able to understand.  It was the right choice.  Let me share a passage that spoke to me today. 
 
.....communion generates community because "the God living in us makes us recognize the God in our fell humans," and that community itself "always leads to mission."  Mission, ministry, and service all serve as "the overflow of our love for God and for our fellow human beings."
 
I have had a warm glow inside me today as I have reflected on the passage.

Fragile

I was called to see a 4 day old late yesterday.  The baby had been born at home and had not been sucking the prior 24 hours with fever.  The baby did not look well and IV antibiotics were started for sepsis.  I headed to maternity first thing this morning to check on the baby to find out he had died at 5 am.  Life can be so fragile here and his family will be in our prayers and thoughts this weekend.

I also have a lady on the ward who has been in all week with belly pain in fever.  With antibiotics she has been getting better and with less pain I can now feel a mass.  We are suspicious about an abscess and the Surgeon, Dr Lazar, is now following her with me.  I think she will need surgery despite her improvement. 

What a Challenge

In so many ways we are all alike.  

September means in Njinikom what it means in America.  It is the start of a new school year.  It is hard to not feel the excitement and the apprehension that the students were feeling as I prepared for the start of the school year.  

I was aware of the larger class sizes here by comparison to those that  my grandchildren attend.  No amount of talking about it could have prepared me for what it felt like to walk in to the classroom and get my first look at my Form 1 class.  I had been told in the morning that my class had 45 students in it.  Somehow between that morning at 7:30 and 1:30 that same afternoon my class had grown to 61 children.  After class, the principal informed me that students were still arriving and that I could end up with perhaps 70 students in that class.  

How many ways can I say what a challenge.

We need your vote! Again!

As you know we are part of the Busted Halo "Don't Forget Your Halo" photo contest.  

And thanks to your votes, we won the weekly photo contest.  

 

We are now in the running for the grand prize and possiblity of winning a pope bottle opener :). 

So we need your vote again!  

Please take a minute and visit the Busted Halo site and simply click on our photo to vote. 

Thank you!
 

From Ashes to Riches

Theresa with Flavia in 2004

When we were here in 2004 my favorite patient was Flavia, a sweet little 5 year old with HIV who suffered from chronic lung infections.  Despite difficulty breathing she always mustered a big smile and a "Good morning Doctor".  We got to know her mother Theresa as Flavia was in the hospital most of that month.  

Unfortunately, Flavia died shortly after we left.  

Theresa 2010

At dinner last evening I asked Sister Xaveria about Theresa.  To my surprise she stopped by to see me today.  She is working at the hospital as an HIV counselor.  Her other 6 children are all doing well including 2 who are attending university.  

Despite the devastation HIV has brought to Africa, with medications and organizations like Project Hope, families are rising from the ashes and thriving.

Check the HIV test...

I have had a 45 year old lady on the ward the last 10 days with Congestive Heart Failure. She has not responded well to conventional treatment. I was concerned she may have Pericardial TB, especially after her HIV test was positive.

Today I did an ultrasound on her and it appeared she had fluid around her heart with a thickened pericardium(consistent with pericarditis). I started her on TB drugs today and hope to see an improvement in the next week.

Whenever things don't make sense medically it becomes prudent to check an HIV test.