Awanda

10 year old Awanda was admitted 2 weeks ago with Cerebral Malaria.  Terry and I had a 4 day holiday to Oceanside Kribi last week.  When we left Awanda was still in a coma.  The prior 3 days he suffered from recurrent seizures that did not stop until I added a Valium IV drip to his Phenobarbital.  

When we did rounds on Sunday Terry and I anxiously checked to see if Awanda was still on the ward.  He was there and was beginning to wake up.  Over the last 3 days he has improved to the point that he can sit and eat.  He walks with mom’s assistance.  He is trying to talk and a big smile returned to his face today.  Awanda still has a long way to go to get back to his prior self.  Since his Malaria treatment is now completed he is going home today to continue his recuperation.  Home for Christmas!  He will be in our thoughts until his follow up in 2 weeks. 

Remarkable

 John is a 45 year old man admitted 1 week ago.  He had been admitted to another hospital 1 week earlier with a stroke resulting in complete paralysis of his right arm and leg with almost a total aphasia.  He was extremely wasted so it was not surprising to find that he had HIV.  It was felt his stroke was from Toxoplasmosis and he was started on a second line treatment for it.  After no improvement after 1 week they asked for discharge from that hospital and presented here. 
 

I was not optimistic we could do much for him since he had shown absolutely no improvement in his paralysis after 1 week.  We fortunately have the combination of medications that are recommended for Toxoplasmosis.  Within a day John was speaking a few words.  By day 2 there was movement in his leg.  Day 3 he was walking with assistance.  Day 4 walking by himself with a cane.  Day 5 movement in his upper arm.
 

I had the pleasure of discharging John home today with full speech, walking with a cane and showing daily improvement in his arm strength.  I will see him back in 2 weeks and will then return to the Southwest Province to begin his HIV treatment.

Terry and I feel we got to witness a Miracle this Holiday Season.

The Good and the Bad

Marcel and Magnus

Sunday afternoon there was a knock on our door.  The hospital guard announced there was someone who wanted to see us.  In February I did a Blog about 8 year old Marcel who had Cerebral Malaria.  He had non-stop seizures and remained in a coma for days.  He slowly recovered and eventually was discharged functioning at about 80% of his prior level.  Our visitors were Marcel, his twin brother Magnus and their Grandmother.  They had stopped by to thank us for the care he had received and to show us he was now fully recovered.  They brought us a basket of eggs and a bag of dried beans in appreciation.  Despite difficulties speaking a common language we had a nice visit.

Today was a reminder that Malaria can be devastating.  I was called to the OPD shortly after I began Hospital rounds to see a sick child.  Grant was nearly 3 years old and been ill for 3 days with fever.  He was seen at a distant Health Center yesterday and referred to our hospital.  Due to distance and transportation issues Grant and his family did not arrive until this AM.  He was obtunded and had rapid respirations from acidosis.  He was extremely pale and his Hemoglobin was less than 6.0.  I started 2 anti-malarial medications, steroids and antibiotics.  Unfortunately Grant expired 3 hours later.  His parents had to suffer what nearly 1 million other parents experience yearly, the loss of a child to Malaria.

Last month there was news of a Malaria Vaccine that will likely be released next year.  It is not a perfect vaccine but will likely reduce the death rate in half, sparing 500,000 children and families annually.  Keep Grant and his family in your prayers.

Surprises

A Smiling Ranson

The medical wards contain people with varying degrees of illness.  Last week 37 year old Samuel and 4 year old Ranson were 2 of the sickest and their prognosis was not good.  Ranson was admitted with severe malnutrition as he would eat only carbohydrates.  He was extremely edematous and spent most of the day whining as I am sure he did not feel well. After 10 days of eating foods with more protein his edema began to diminish.  Yesterday morning we found an entirely new Ranson.  A smiling Ranson who was no longer whining.  It appears that Ranson’s mother let him choose his diet.  With his mother now understanding the need for more proteins in his diet, he will hopefully continue to improve.

A Smiling Samuel

Samuel also came in 2 weeks ago extremely confused.  Test revealed he had HIV and Toxoplasmosis Encephalitis.  Despite initiating treatment for his Toxoplasmosis Samuel showed little improvement last week.  This week also revealed a new Samuel, a smiling and now oriented pleasant man.  His Toxoplasmosis treatment will continue another month and I plan on starting his HIV medications in 2 weeks.

Thanksgiving

 Thanksgiving in Njinikom

It was a normal workday here in Cameroon today but it was a wonderful Thanksgiving never the less.  I found myself reflecting on what I was thankful for.  Certainly the usual things came to my mind first.  Good health and a wonderful family.  What kept returning to my mind was that I was thankful for being here in Njinikom, Cameroon.  I am thankful that God put all the pieces in my life together in such a way that Terry and I ended up here, doing his work.  We are surrounded here at St Martin de Porres Hospital by wonderful people.  We enjoy the work.  Helping people in need is not difficult, and as many have said before about being involved with MDA, “you receive more than you  give”.
 
Let me thank all our supporters for helping us on our path.

A Telling Look

Cynthia Feeling Better

Cynthia, a 6 year old girl has been in the hospital the last 3 days with Malaria.  She has been very ill with high fevers and has been lying in bed like a limp dishrag.  She has been miserable.  This morning I started my rounds in the Pediatric Ward at bed 1 and worked my way around the 8 bed ward.  As I finished bed 5 I looked up to see Cynthia waiting for me.  I did not have to ask a question about her condition.  The beautiful smile on her face told the entire story.  Her fever was gone, her appetite was returning and she should be able to go home in a couple of days.  Cynthia’s smile made my day and it was only 30 minutes old.

Dutch Treat

Crooked Now

Straight Forever

The Dutch Orthopedic Surgeons are here for 2 weeks for their semi-annual visit.  They will be operating on over 70 children with crooked legs.  Cameroon has an incredible number of children with severely crooked legs for a variety of medical reasons.  Every bed in the hospital is presently occupied and some beds even have 2 children in them.  The Dutch have been coming here for many years and over 1000 children have benefited from the surgeries they provide.  It is a joy to see the smile on the faces of the children as they look at the casts on their now straight legs.  Most of the children will remain here for 8-12 weeks until their casts can be removed and Physical Therapy can be started.

Julius

Julius in April 2011

Julius is a 16 year old man who has spent the last 3 years at St Martin de Porres Hospital as a patient.  Julius has Juvenile Rheumatoid Arthritis and has suffered with recurrent open leg sores that have kept him from going home.  He has been in he surgical ward but over the last year I have occasionally seen Julius for a new medical issue.  Despite crippling effects from his arthritis there were never any medications available to treat his JRA.  I consulted several Doctors at home and those here on short term visits and was able to secure some Methotrexate, a chemotherapy drug used to treat JRA.  We got Julius started on medications in June and very quickly began to see his leg wounds improve along with reduction in his joint pains and swelling.

Julius is a very engaging young man and has become a fixture at the hospital.  He has befriended many of the visiting Doctors and Nurses.  Despite his debilitating illness, years of painful dressing changes and confinement to his bed and wheelchair he has kept a smile on his face and a cheerful disposition.  The medical team from Belgium who was here last month introduced a wound care ointment consisting of honey and vaseline.  In 2 weeks time Julius’ wounds made  enough further improvement that he was able to be discharged this week.  He will remain on his methotrexate and hopefully enjoy life back at home with his family.

Julius Headed Home

Feast Day

Thursday was Feast Day of St. Martin de Porres whom the hospital is named after.  We had the usual big celebration.  The OPD was closed and Mass was celebrated at noon in front of the Maternity Ward.  The weather cooperated and tents shielded everyone from the sun.  A program followed with skits from different hospital departments and Native Dancers.  Food was then served in the hospital hall.  There was a wonderful spirit of celebration shared by the hospital staff and community members.

Young and Old

Shelma has spent nearly 2 months in the hospital with fever, cough and Failure to Thrive.  At 6 months of age she was under 9 pounds and very frail.  Mom is HIV positive.  We treated her for pneumonia but her fever did not clear until we treated her for TB.  2 weeks later HIV medications were added.  Despite feeding her every 2 hours she has gained only 1 pound.  She was finally able to go home today.  Hopefully she will continue to gain weight as her immune system recovers.

This afternoon I had the pleasure to meet Theckla, a spry 110 year old lady.  It took quite some effort for her 81 year old son to convince her to come to the hospital with cough of 1 weeks duration.  Her exam was quite good so she will hopefully improve and be able to go home in a few days.

Tuberculosis

TB with large Cavity on X-ray

 The new TB Ward in progress

At any time we usually have one or two patients in the four bed TB Ward.  Today we have seven patients who have contagious TB which is taxing our ability to quarantine these patients from the other patients in the hospital.  With only having the one ward it requires having men and women sharing the same room which is not very ideal.
 
Fortunately we are in the process of building a new TB Ward behind the Medical Ward.  This has been possible with some very generous contributions from MDA supporters.  The new TB Ward will have separate rooms for men and women and will provide more aeration making it safer for staff and families who are caring for the patients.  The facility will also provide us a place to isolate extremely contagious patients such as those with Cholera.

Vitalis

Vitalis feeling better

Vitalis is a 4 year old boy who was admitted several days ago with abdominal swelling and generalized edema.  He has generally not felt well and has been crying a lot.  He has one of those cries that is piercing and you hear it from 2 wards away.  As I entered Ward 2 today it was quiet.  To my delight I found a smiling Vitalis grinning at me from his mother’s side.  We are treating him for Nephrotic Syndrome and today his swelling was down and his spirits were up.  Hopefully he will continue to recover.

Compliance

Earlier this year the government supplied HIV medications were in short supply.  Rather than getting their normal 1-2 months of medications patients received only 3-14 days of medication and occasionally none.  This required more frequent trips to pick up medication with obvious increased time and transportation costs for the patient.  At the time I wondered what effect the shortages would have on the patients compliance long term.  

Today 53 year old William presented with 2 months of fever, cough and diarrhea. William has HIV and had been on HIV medications since 2008. He had been very faithful about collecting his medications monthly. In January when he came in there were no medications available and he was told to come back in 1 week and see if we had any then. William never returned until his illness today. Did he initially notice no change in how he felt off his medications? Did he figure if we had no medications it was no longer important to take them. Regardless, every month he missed made it more difficult to come in and explain his absences. William will hopefully recover from his present illness which may be TB. His HIV may be now resistant to his prior medications. If that is the case we have only one medication left to give him. 

California Connection

Presbyterian Intercommunity Hospital has a Family Practice Residency Program in Whittier, California.  Each year, 2 of the 6 FP Residents are chosen for a Tropical Medicine Track within the residency program.  The selected Residents spend 1 month during their 2nd and 3rd years of training doing a Tropical Medicine Rotation in Africa.  Dr Laura Dooley accompanies the Residents on those rotations.  Last month Dr Laura accompanied Drs Eric and Kristen to Njinikom.  Because of Dr Laura’s experience of working in similar African Hospitals, they quickly took over care of all the patients on the Medical and Pediatric Wards.  It was wonderful to work along side these Drs for the month and discuss diagnosis and treatment options.

The experience went well for all parties involved so it is hopeful that this will become a yearly event.

Bees

Monday morning an elderly man presented to the OPD after being stung by hundreds of bees.  His face was extremely swollen and his voice was hoarse.  Fortunately, he had no difficulties with swallowing or breathing.  After removing a large number of stingers from his face and arms we admitted him and gave him some IV steroids.  Within a few hours  his swelling was significantly reduced and he was able to return home the next day.

Preemies

Last year a nursery was established adjacent to the Maternity Nurse’s Station.  Most days it is empty as the babies usually are with their mothers on the Maternity Ward.  Sick or premature babies are kept in the Nursery.  Since we are still in the rainy season it was time to pour.  

This morning there were 7 preemies in the Nursery ranging from 2.5 to 4.0 pounds and all were doing well.  The first 6 got incubator space only because there were 2 sets of twins.  The hefty 4 pounder is relying on a half dozen blankets to keep him warm.  2 of the babies were born at Health Centers and referred here because of there small size.

Janice

Once a year we have a site visit from the MDA office.  Janice England, Lay Mission-Helper Director, did our visit this year.  We met Janice in Bamenda last Saturday and had the opportunity to have lunch with Debbie and Frank, 2 new Lay Mission-Helpers from the Kumbo Diocese.
 
We returned to Njinikom and Janice spent the next 4 days with us.  We had become good friends with Janice during our Formation time in Los Angeles.  It was nice to be able to catch up on each others lives after not seeing each other in 15 months.  Janice was able to visit the hospital and Terry’s school and investigate potential positions for LMH volunteers.  We had a wonderful celebration with the Sisters in the Convent Tuesday evening before Janice left.  Janice is spending 2 days with the Archbishop of Bamenda before returning home to Los Angeles.

Victorine Update

I have written about Victorine previously.  One year ago she was knocking loudly on Death’s Door with  HIV, recurrent Tuberculosis and a hemoglobin of 2.5.  She amazingly recovered although her weight dropped to 66 pounds.  

She comes in monthly for her HIV medications and I am in awe every time I see here.  She has now gained 75 pounds since her discharge last year.  I think Victorine enjoys the smile her presence puts on my face.

Happy Transformation

Kerena is a 2.5 year old child who was diagnosed with HIV several months ago.  She was malnourished and had little strength.  She was started on HIV medications and given additional nutritional supplements.

Kerena returned today for her monthly medication refill.  Terry and I were both delighted to see the radiant smile on her face.  She was very interactive with us, something she had no energy for a few months ago.  She still has a long recovery road ahead of her but life seems to be enjoyable for her now.

Early

There has been a young lady in the maternity ward the last month with recurrent premature labor.  Dr. Dabo has been caring for her and yesterday her uterus won out and she delivered a 3.3 pound boy 10-11 weeks early.  I was worried how developed his lungs would be. So far little Emmanuel is doing well.  He is in an incubator which is warmed with a light bulb and he has a feeding tube.  Each passing hour at this point increases our optimism regarding his survival.  

Keep Emmanuel and his family in your prayers.

Returned

Welcome Back Terry

Terry arrived back from home on Saturday.  We had a nice return trip from Douala on Sunday.  She has been handling the usual jet lag quite well, or at least from my perspective.  She had a staff meeting at school yesterday and her classes begin on Tuesday.  My nurse Germar will be on holiday the next 3 weeks so Terry will be filling in for her when her teaching duties allow during that time.
 
Today, I was very thankful for the financial support that many of you have given Mission Doctors Association.  It has allowed Terry and I to help many individuals who could not afford the tests to diagnose their medical problems and the medication to treat those same problems.  This morning I had a young mother and her 9 month old child both diagnosed with HIV.  Mom did not have the 6 dollars for the required tests needed before beginning their treatment.  Your donations allowed me to proceed with their tests and treatment.  Likewise I had several other patients in clinic today who received similar help.  We all have a role in helping others.  Thank you for your support.

Contagious

 Smiling Germar with fading measles rash

 I had reported a couple of weeks ago that we had a family in the hospital that had the measles.  We put then in a ward by themselves because measles is highly contagious.  

Last week my nurse Germar became ill.  She initially had fever and headache so Dr Eugene treated her for malaria.  When she then complained of sore throat and cough I added an antibiotic.  She did not improve and her cough worsened so Dr Eugene sent her home for 5 days of rest.  

She came back today looking better but she reported that she broke out with measles shortly after going home on Saturday.  A good example to us all on the contagious nature of this illness.

Crystal

Crystal and Staff praying before starting surgery

Crystal Cunningham arrived in Njinikom Thursday for a 3 month mission.  Crystal recently completed her Surgical Residency in Pennsylvania and took her written Surgery Boards a few days before her departure.  

Despite the usual jet lag Crystal began working the next day.  Saturday I helped her with a difficult case.  We spent 5 hours in the OR with a lady with multiple adhesions and a sigmoid volvulus.  The lady is still very ill but stable.  Keep Josephine in your prayers the next few days.

Baby David

Mom and Baby David

Baby David arrived at the hospital nearly 2 weeks ago at 2 weeks of age.  He weighed 2.2 kg at birth and had not been nursing well for a day.  His weight was 1.8 kg and he was lethargic and dehydrated.  He was given IV antibiotics and fluids along with breast milk by NG tube.  He was not looking very good the first 2 days then gradualy showed signs of improvement.  He is now nursing again and gaining weight.  He will likely be able to go home next week.   The Maternity Staff is all feeling good about Baby David as most of the infants who come in ill have been sick too long for therapy to be effective.

Following Up

Mom, Melanie and Arnold

We have over 1000 patients who are receiving their HIV care at St Martin de Porres Hospital.  I record a social history on their medical book and encourage patients to get their children and spouses checked for HIV if they have not done so.  Unfortunately, I frequently find that the testing is not done.
 
Hilda is a young mother who recently was found to have HIV.  I had given her my usual recommendation to bring her children in for testing.  Hilda arrived today to begin her HIV medication and her her 6 year old twins in tow to be tested.  I shook her hand telling her she was a good mom to bring them in.  Her response was “I can not let my family crumble”.  A universal response that most mothers have.  To everyone’s delight Arnold and Melanie both tested negative.

Sister Renata

Sister Renata and Bishop George

Sr. Renata is a nurse who has worked on the medical wards since I arrived last year.  With her ever present smile and sense of humor Terry and I have grown very fond of her.  I was most fortunate to attend her Profession of Final Vows in the Kumbo Cathedral yesterday.  Over 200 Sisters from all over Cameroon attended, it was a full house.  I was seated with the Choir which put me in a great position to take pictures and also enjoy the wonderful music.  It was a 4.5 hour celebration which flew by.  I was able to meet Bishop George who has been a friend of Mission Doctors and Lay Mission Helpers for many years.

It was wonderful to experience the joy exhibited by all the Sisters as 7 new women joined their ranks.  They have a beautiful sense of community and they made my stay in Kumbo/Shisong memorable.

Sister being welcomed to the Family

Measles

Last week Tim and I were called to see a Mom and daughter who were admitted with measles.  After having seen a variety of rashes called measles the last year, I was skeptical that we were actually headed to see actual measles.  A younger child at home had a rash a few days earlier then Roseline developed fever, cough, runny nose and red eyes followed by a rash.  Mom developed fever 2 days later and both were very sick with high fevers.  The nurse was right, they had the measles, something I had seen at home only one time in my 30 years of practice.  They do vaccinate children here for measles but the percent of children getting vaccinated here is not high.

Roseline ready for home

 Roseline recovered quickly while here mother was finally free of fever today.  A 8 month old sibling also developed a full blown case of measles.  Since he was already sleeping in mom's bed we treated him as an outpatient and he too was much better today.  I would have preferred to keep Evelyn in the hospital one more day but the family opted to go home today.  Dad promised to pick up the workload and let mom rest until she felt better but I suspect she will take up the household tasks immediately.

Blackwater Fever

Ibrahim is a 6 year old boy who presented to the hospital 2 days ago.  He had experienced 3 days of fever, abdominal pain and headache.  He also had not had any urine output the prior 24 hours before admission.  His labs revealed he was extremely anemic and his malaria smear was positive.  A catheter was placed  revealing very dark urine.  This confirmed our suspicion that he has Blackwater fever, an old term to describe a complication of severe malaria.  The severe destruction of red cells in the blood results in the kidneys shutting down.  Yesterday we gave Ibrahim a blood transfusion, IV fluids and a diuretic.
 
As Tim and I walked into the Peds ward this morning Ibrahim’s eyes were wide open to our delight.  As we walked further into the ward we could see that his urine bag was nearly full telling us that his kidneys were working.  We could not help but thanking God for the small miracle that happened overnight.  He suffered a seizure this morning which is not uncommon with Malaria.  Overall he is much better this evening and we are optimistic he will be better tomorrow morning.  

Keep Ibrahim in your prayers.

Relindis

Mom and Relindis

Relindis is a 20 year old university student who was admitted 2 weeks ago.  She had started on HIV medications 6 weeks earlier and developed increasing headache and double vision over the preceding week.  She had increased pressure in her head causing her symptoms.  Her condition may be from her immune system waking up and responding to infection or worse could be from a brain tumor or malignancy.  At home she would have had an immediate head CT or MRI.  Here we were able to treat for possible meningitis and give her steroids for the swelling.
 
Over the 2 weeks Relindis gradually improved.  As her headache cleared and her vision cleared she was able to communicate better.  She is a very delightful and articulate young lady.  Her mother was equally delightful.  It was a joy to see them both smiling as she was discharged today.

Friendly Place

I arrived back here in Njinikom one week ago.  I have recovered from my jet lag quicker than on any previous trip.  The thing that has struck me this week is how friendly people are here.  I have been welcomed back by everyone and they all have asked how my family was and were quite sincere in wanting to know.  

I miss everyone back at home but have a comfortable feeling working and living with the Cameroonian people.  They really seem to value relationships more than material things.  I hope I can become more Cameroonian in the next 2 years.

Life is Good

I have returned, to Cameroon that is.  Terry and I had a wonderful month spending time with family and friends.  Terry is spending an additional month back home since her teaching duties do not begin until September.  Dr. Tim Cavanagh and Maria Curlej, CRNP did a wonderful job filling in for me while I was gone.  I know that many of the patients and staff will miss them when they leave.  It would be extremely difficult to do this 3 year Mission without the help provided by all the short term volunteers.

While I was gone I reflected on the last year.  It was a year of many emotions.  There was the anxiety wondering how I would fit into this culture.  There were times of frustration practicing medicine with limited resources.  There were many times of sadness when patients lost their battles with illness.  There were many times of joy as mothers watched their very ill children recover.  There were exciting times as HIV patients regained control of their lives after starting medications.  There is great satisfaction knowing I am here as part of God’s plan.

Life is good.  I look forward to the next year.

Victory

Victory is a 2 year old boy who was admitted last week with boils on his neck.  He unfortunately was found to have HIV.  Dr Tim has drained the boils and he is improving daily.  His parents are not accepting his diagnosis of HIV and want to take him to another hospital to have it confirmed.  We have no problem with a second opinion but are fearful that opinion may come from a traditional doctor and delay or prevent proper HIV treatment.  Hopefully Victory’s parents will accept his diagnosis, we know they want what is best for him.
 
My blogs will be less frequent the next 5 weeks as Terry and I will leaving to visit family and friends.  Pray for safe travel for us.

Not Back at Home

Three Generations

Tim and I were seeing an infant in the clinic today who was brought into the exam room by grandma.  When we inquired about the child’s mother we were told she was out in the hall.  Further discussion revealed to us a local custom.  When the first grandchild in a family is conceived the mother-to-be moves back home with her mother.  She then stays at home until the child is born and then stays an additional 2 years.  Mom then moves back home with her husband and grandma then raises the child as her own. 



Tim at Work

We talked later with Sister Xaveria about this and she related that the custom is dying out now that civilization has arrived.  I can not see this custom catching on back at home.

HIV Kids

Today we started 2 children on the Peds Ward on HIV medications.

2 year old Kerena was admitted last week with chronic diarrhea and was severely malnourished. The first few days in the hospital she cried incessantly. After convincing her mother that she needed more food Kerena's crying ceased with the increased food intake. With a full belly it turned out she had a beautiful smile and big dimples.

4 year old Marivon was admitted at the same time with fever, cough and diarrhea. She had both pneumonia and HIV. Her pneumonia has nearly cleared and Marivon can almost tolerate my presence at her bedside now. Both girls will be going home in the next couple of days and should do well with their new medications.

The New and the Old

Dr Ed Malphus left on Thursday.   There has not been a Pediatrician here in years so he was able help the staff in caring for the many Pediatric patients, especially newborns.  His presence will continue to benefit many patients for some time to come.
 
Ed’s departure was followed by the arrival the next day of Dr Tim Cavanagh.  Tim is a Family Practitioner from Phoenix.  Tim and his wife Sheila spent 3 years at St Theresa’s Hospital in Zimbabwe with MDA.  He spent 3 months in Cameroon last year working in Kumbo.  Tim was most gracious to help here in Njinikom as Terry and I will be headed home to see family and friends in 10 days.  It is reassuring knowing that I will leave my patients here in his good hands.

Jacenta

Jacenta is a 35 year old lady who came in today to refill her HIV medications.  She started on them 7 months ago after complaining of months of recurrent diarrhea.  She now feels perfectly fine and has gained 20 pounds.  Seeing someone as happy as she is inspires us all to continue with the work we are doing.

TB, ever present.

In our HIV patients we continually need to remember Tuberculosis.  10-15 % of the HIV patients will develop active TB each year.  Because of their immunosuppression they will not always present with classic Tuberculosis symptoms.  Additionally their TB may be non-pulmonary in location.
 
Deborah is a 34 year old lady with HIV who has been in the hospital for over 2 weeks.  She has been spiking fevers of 105 daily.  Despite her fever she continued to smile and claimed to be well except for headache related to fever.  She has been treated for malaria and been given antibiotics for every possible bacterial infection.  Despite this, every night Deborah  continued with spiking fevers.  Last week Dr Eugene started TB medications.  It took 5 days but finally Deborah’s temperature has been normal for 2 days.  She was so happy to be discharged today.

Loa Loa

Loa Loa is the “eye worm” that is endemic to portions of Cameroon.  It can appear on the surface of the eye and being 1-2 inches in length it is quite visible.  

Dr. Eugene stopped by the house the other day very excited.  He had been called to see a patient on the Surgical Ward with eye irritation.  The patient had a very active Loa Loa worm visible in his eye.  It was not long before Dr. Eugene, Dr. Ed, Dr. Jim and Nurse Sunday were all gathered around the patients bed.  I am not sure the patient was more bothered by this worm squirming around just under the surface of his eye or by the presence of all us “worm gazers”.  

Armed with some numbing eye drops, scissors and forceps I went after the worm.  The worm certainly did not like being under the spotlight and soon retreated into the upper corner of his eye out of my reach.  The patient is receiving medication to kill the worm and is improving.  

Every patient complaining of eye irritation this week has been scrutinized for the presence of Loa Loa.