Neurological Symptoms...

Donatus happy with his Fever Clearing

Last week was a busy week for patients presenting with neurological symptoms.  I therefore did numerous spinal taps.  Between the Men's Ward and Pediatrics I had 3 new Cryptococcal Meningitis patients, 3 Toxoplasmosis Encephalopathy patients and 2 Cerebral Malaria patients.  Most were doing better today.  Unfortunately, we lost a 4 year old with Cerebral Malaria today.
 
Donatus is a 50 year old who presented with confusion, headache and fever.  He was started on medication for Toxoplasmosis Encephalopathy(parasite infection in the brain) and by the next day his 105 fever cleared as did his confusion.  He and his family are grateful for his rapid recovery.  He unfortunately has HIV so he will be started on medication for that this week.

Mercy

We have had the pleasure of spending time the last 2 weeks with Carol.  She is a Mercy Associate from Philadelphia who is working at the orphanage.  

Terry and Mercy

Yesterday, a man brought a 2 day old infant from the bush.  The mother apparently is mentally disabled and was unable to care for the child and the father apparently ran off.  The infant's uncle and grandmother tried carrying for the child and gave it pig milk.  They decided they could not manage so the uncle brought the child to the orphanage.  They were calling the infant Newborn and Carol, with their permission, renamed her Mercy.
 
Today, Mercy was doing well.  We pray her family will be able to someday take her back home.  They made a difficult decision out of love.

Dilemma

Emmanuel no longer with rigors and fever

Emmanuel is a 24 year old who was admitted 12 days ago with 2 months of cough and fever.  It was not surprising that he was HIV positive and his chest x-ray was strongly suggestive of Tuberculosis.  Last week we had no HIV or TB medications so it was frustrating watching Emmanuel endure his non-stop cough and recurrent fever.  Out of desperation I placed him on Cipro and Clarithromycin which both have some effect on TB but are not a treatment substitute.  I was able to start him on HIV medications Monday and today TB medications became available.  Hence the dilemma. 

The last 4 days Emmanuel has made a remarkable improvement on my substitute regimen.  With limited resources you frequently have to make best guess decisions.  I think Emmanuel has TB so I initiated his 6 month treatment program today.

Emmanuel's fever chart with sudden clearing of his fever

Sunday Rounds with Nurse Sunday

Prior to our arrival in Njinikom none of the Doctors did routine Sunday rounds.  The medical ward is staffed with only 2 instead of the normal 3 nurses on Sunday.  I caused concern on the Nurse's part when I showed up for Sunday rounds as they were really to busy to spend 2-3 hours with me doing rounds.  Terry was used to helping me with rounds from our prior short term missions so she was rehired as "Nurse Sunday". 
 
We both enjoy Sunday rounds as there is no line of patients waiting to be seen in the OPD.  Terry's presence seems give a more social aspect to the rounds as she interacts with the families as I tackle the medical concerns.  Since patients can not be discharged from the hospital on Sunday there is a larger than normal number of discharges on Monday, our busiest day of the week in the OPD.  I do all the paper work for the Monday discharges on Sunday which really saves me a lot of time and gets me the OPD much sooner.  A real Win Win. 
 
Sunday Rounds have also allowed us to share with visitors the impact of HIV on the lives of the people here.  Carol, a volunteer with Medicine for Humanity, joined us for rounds yesterday.

Finances

The daily fee for being in the hospital is 500 Francs, about one dollar.  The patient is charged for each lab test, x-ray, medication and surgical procedure.  Marcel who spent 2 weeks in the hospital with his cerebral malaria had a bill of $250.  His mother is handicapped and his grandmother is the sole provider for the family.  She was able to pay $17. 

Donations in our name to MDA allowed us to cover the rest of his bill and allow him to go home. 

Thank you all for your continued support. 

Marcel

Marcel is an eight year old boy who was admitted with high fever and lethargy 2 weeks ago.  He quickly became more obtunded and developed status epilepticus (non stop seizures).  He required an IV Valium drip and IV Phenobarbital to control his seizures.  His tests indicated that he had cerebral malaria.   He remained in a coma and I hesitated each morning before entering the PEDS Ward, wondering if Marcel would still be there. 

He was and after a few days he opened his eyes.  Over the next week he gradually woke up and today he was finally able to walk.  He is not totally back to normal yet but we are all overjoyed with his recovery to date and are optimistic about his complete recovery.

Marcel with his twin brother

Marcel standing up today