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.

TB, Ever Present

Timothy is a 16 year old boy who presented to the clinic 1 week ago with a history of cough of 3 months duration.  His Chest X-ray and sputum check showed Tuberculosis.  Timothy and his parents initially balked at the recommendation that he be hospitalized.  He is preparing for his A level exams.  It would be like sending someone at home taking his SAT exam while being extremely contagious with Tuberculosis. 

After one week of treatment his cough has dramatically reduced and Timothy has promised to have good cough hygiene next week while taking his exams.  Timothy is fortunately HIV negative.

Yannick Update

Anna and Yannick

Even though Yannick’s grandfather arrived to take him home last week, Yannick and his mother remained at the hospital as they did not have money to settle his bill. 

One of the nurses brought it to my attention today so with the help of your donations to MDA we were able to get his bill paid. 

The great news was that over the last week Yannick has dramatically improved from his cerebral malaria.  He is walking and talking normally.  Anna, his mother, is happy to have her son fully back and now heading home.

Vera

Vera is a 20 year girl who was admitted 2 days ago with a months worth of cough and fever.  She had been treated elsewhere with antibiotics without improvement.  She was very ill appearing and also suffers from Sickle Cell Anemia and her hemoglobin was 6.0.  Her Chest X-ray today showed a large heart shadow so Dr Ed and I did and ultrasound on her and she had the largest pericardial effusion that either of us has ever seen.  She does not have HIV so she unlikely has Tuberculosis causing her Pericarditis. 


Fortunately, Vera’s parents  were willing and able to take her to the Cardiac Center in Shisong about 4 hours away.  That facility is also run by the Tertiary Sisters of St Francis and is one of only a few such facilities in Sub-Saharan Africa.  Our prayers are with Vera and her family and we hope she makes a full recovery.



State of the Art Cardiac Surgery



Yannick

Anna and Yannick

Yannick is a 13 year old boy who was admitted 3 weeks ago comatose, with fever and seizures.  His tests revealed that he had cerebral malaria.  His fever and seizures quickly resolved but he remained in a deep coma for several days.  Anna, his mother, remained diligently at his bedside caring for him only the way a mother could.  Gradually Yannick began to wake up. Yannick is far from well but he is now able to feed himself, walk and follow simple commands.  He no longer is on any medications other than vitamins. 

His grandfather came to the hospital today and announced that he was here to take Yannick home.  We have done what we can for Yannick.  His recovery road is going to be a long one, but with a mother like Anna, I am sure he will reach the end of that road.  Keep Yannick and Anna in your prayers.



Dr. Ed with his soft touch



Dr. Ed Malphus arrived here this week. Ed is a Pediatric Gastroenterologist from Santa Monica, California. He has been involved with MDA for 20 years including serving as Board President for many years. This is his first opportunity to serve overseas and he has jumped into the work with both feet. He has already seen multiple cases of malaria, TB and HIV in his first 2 days. It is nice having someone here with his expertise on Pediatric and GI problems. I am looking forward to working with Ed for the next month.

Praises and his Mom

Today, I had the opportunity to meet Praises and his mother. Praises is a 4 year old boy who has been on HIV medications for 2 years. He came in for a medication refill. He is doing very well and is having absolutely no medical problems. It is a real joy to see the number of people doing well with this terrible disease.

Jim and Rose

Jim, Terry, Rose and Jim Jr.

Jim and Rose Unger left after a very successful mission here the last month. Dr. Jim put in very long hours working with Dr. Dabo who is the OB-GYN who has been here since October. Jim is an excellent teacher and Dr. Dabo appreciated “the Professor’s” help immensely. Everyone appreciated his kind and friendly style of care.

I know the children in the orphanage will be missing the attention Rose showered on them the last month. I believe the children will continue to benefit from the advice she passed on to their caregivers.


Jim and Rose with a farewell gifts


Terry and I will miss the warmth they added to our life here in Njinikom.

Divine

Mom Feeding Divine Today

Divine is a 20 month old child who was admitted yesterday with sudden onset of fever and seizures.  His mother had brought him to our hospital from Yoaunde, the capital and a 6-7 hour car ride.  Before we could ask why she brought him here she volunteered that his twin brother had died yesterday.  He developed the same symptoms 1 day earlier and was admitted to the University Hospital.  When he died yesterday morning and Divine began experiencing the same symptoms I can only imagine the fear that came over her.  She immediately gathered Divine and a few belongings and headed to Njinikom.  Fortunately Divine is doing better today with no more seizures.  What a tragic story to remind us once again what a killer malaria can be, especially with young children.

Apollo

Man with Apollo

While in Mbetta last week I saw a man who had an eye infection (conjunctivitis).  I was informed that the local people call it Apollo.  They believe the Apollo Astronauts brought back “moon dust” which now is the cause of Apollo.  With a smile I prescribed some old fashioned eye drops.

Mbetta

Mbetta Community Greeting

This last week I accompanied Sister Xaveria to Mbetta.  3 of the Tertiary Sisters of St Francis staff a Health Clinic in this remote village..  It was a 8 hour drive from Njinikom and the last 2 hours was on a very primitive road through the mountains.  Without a good 4-wheel drive vehicle and an experienced driver we would have never made it there.  As the rainy season gets worse the road will become impassable and will require a 6-12 hour walk to get in or out.  There is no Doctor yet the nurses care for about 40 hospitalized patients and see another 30 outpatients daily.  Because of the forested area and the weather being warmer they have more malaria patients than we see in Njinikom.  There were a number of pregnant patients in the hospital who lived many hours away and they came 2 weeks before their due date to ensure they would deliver in the hospital and not along the way.
  

Consulting with Gregory

The people of Mbetta graciously welcomed us on our arrival.  Sister was there to oversee work on repairing the convent and make arrangements for building a new Health Center.  I did rounds on all the hospitalized patients and then saw 50 outpatients the next day with Gregory who sees the majority of the patients and has earned the local title of “Doctor”.  Our stay was short but I was glad to provide moral support for the Health Care Team and their efforts to provide care for their people.