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.