Hapsatou

3 year old Hapsatou was in the hospital last week with pneumonia.  Pneumonia, along with Malaria and Diarrhea illnesses, account for most of our Pediatric admissions to the hospital.

Hapsatou was quite ill with high fever when she arrived but recovered quickly with 2 days of IV fluids and antibiotics.  What was unique about her stay was that her father was her caregiver.  In Cameroon it usually is the mother or grandmother who stays with a child.  One could tell that Hapsatou and her father had a very loving relationship.  They both had big smiles on their faces when she was well enough to go home.

Romaric

I don’t know what it is.  It could be with our mission coming to a close, my eyes are open wider, not wanting to miss anything.  It surely seems that each and every day another miracle is just there—to be seen, to be shared, and to be savored for the gift it is.

I haven’t told you about Romaric.  I was a bit of a doubting Thomas and I was sure that he couldn’t survive.  And then I remember....God is good....All the time!

Romaric is a little six year old boy.  He was brought in after five days of a very high fever.  His little body was rigidly held in the shape of a lightning bolt.  His neck was arched.  He only responded to the pain when Jim tried to move his head.

We did a spinal tap immediately.  When Jim and Dymphyna, the medical student saw the pus coming out of his spinal column, they both paused.  They knew that the lab results were not going to be good.  And they were correct.  Romaric had bacterial meningitis.  He was a very sick little boy.

Of course, there were other lab tests that also needed to be done.  Hopefully they would come out normal and the little guy would have a fighting chance.  That was not to be the case.  It seemed that test results just came one bad result after another.  In addition, to the meningitis, his malaria test was positive.  Then he was diagnosed with sickle cell.

So poor Romaric had meningitis, malaria, sickle cell crisis, and oh yes, he was severely anemic.  His hemoglobin was only 4.3.  With an assessment list like that, clearly the odds were against Romaric.

It has now been eight days.  Each day he has seemed slightly better.  
Really the only noticeable change until a couple of days ago was that he seemed to be in less pain.

And then today, we walked into the pediatric ward to see Romaric standing at the side of his bed eating a puff-puff.  Unbelievable!  No Miraculous!
 
All the time....God is good!

Twin B

1 month ago premature twins were born, weighing 3 and 4 pounds respectively.  The smaller one was the second twin which is normally the case.  Big brother also took most of the blood from the placenta as Twin B was noticeably paler.  Both babies did well for a few days then they both developed fevers.  The nurses felt it was just the incubators overheating but I placed both babies on antibiotics.  The next morning we surprised to find that the larger baby had died during the night.  Little Twin B was slow to gain weight but has continued to look good.  He just finished a second 10 day course of antibiotics after developing fever again last week.  This morning he topped the scales at 3 and 3/4 pounds.  His mother mourns for the loss of his brother but is overjoyed with his steady growth.  We are cautiously optimistic that he will continue to do well.

Zidan

6 year old Zidan arrived at the hospital 10 days ago.  He had pneumonia and he looked like he was 3 years old instead of 6.  He had classic signs of Kwashiorkor(protein malnutrition) with a big belly, swollen hands and feet with sparse, fine hair.  We were not surprised that his HIV test was positive.  It was clear by looking at him that he did not feel well.  The presence of a white doctor who did not speak his language was not a comfort to him.  After a few days of increased protein intake and treating his pneumonia his fear of me gradually diminished.  A few days ago I was finally able to get a small smile from him.  Zidan was discharged today and while I likely will never see him again I will always remember the reluctant goodbye wave he gave me with a small smile.

Jubilee

Saturday St Martin de Porres Hospital celebrated it’s 50th Anniversary with a huge Jubilee celebration.  The Hospital has been preparing for this the last year.  Most of the buildings received a face lift with new paint inside and out.  Much of the cement work throughout the hospital was replaced and the grounds were manicured.  The Celebration began with a Mass concelebrated by 4 Bishops and 46 Priests.  Numerous civic and government officials were in attendance.  Portable pavilions were erected and over 1200 people attended.  The weather was beautiful and the normal daily rains threated but never materialized.  It was a joyous occasion and Terry and I feel blessed that we were here to witness it.

Sandrine

14 year Sandrine is one of the many HIV orphan here.  Unfortunately medication was not available to reduce the transmission of the virus from mother to child at that time.  Sandrine lives with her grandmother who is taking care of several grandchildren, a common occurrence.  Sandrine started on HIV medication 5 years ago and has had ongoing problems taking her medications on a regular basis.  Her CD4 count rose from 39 to 519 after her first year of treatment and since then it has been on a steady decline with it now being 9.  Failure to take her medication on a daily basis resulted in the development of resistance of the HIV virus in her body, i.e. the medication is no longer effective.  Rather than growing Sandrine has lost 16 pounds and literally is mostly skin and bones.

We discussed placing her on our second line of medication last year but it was felt she needed to become better at her medication compliance before starting her last chance medication.  In Cameroon we have only 2 medication combinations unlike in Western Countries where over 50 are available.  Sandrine starts her new medications today and we all will do our best to encourage her compliance.  In addition we hope that additional medications will become available in the future.

Sam

Terry and I first met 32 year old Sam about a year and one half ago when he was admitted to the hospital with HIV, TB and Cryptococcal Meningitis.  Initially he was very wasted and mentally obtunded.  As he slowly recovered we met the real Sam, a pleasant man with with a huge smile.  He spent nearly 2 months in the hospital so we got to know Sam and his mother quite well.  Our donors paid his hospital bills and he eventually made it home.  Unfortunately Sam and his family could not afford Fluconazole, a medication to prevent return of his Cryptococcal Meningitis.  Sam did well for a few months then his condition deteriorated.  He was too weak to come in for his HIV medications so one of the counselors would deliver his medications to him and update us on his progress.

Last October Sam’s mother could no longer care for him and brought him back to the hospital.  He had been lying in bed so long that he had the worst bed sores that I have ever seen.  Both hip bones were exposed with sores involving more than 1/2 of each buttocks.  Sam was barely conscious and was obviously septic from his wounds.  I seriously thought about not treating his infection thinking there was no possible way Sam could recover.  As I pondered what to do Sam whispered, “help me Doctor”.  Sam made the decision for me and we started antibiotics and daily cleansing of his wounds.  Dr Laura Dooley had just brought us a large supply of Fluconazole so we started Sam back on it.  Slowly Sam showed improvement and his smile returned.

Around Christmas Terry and I realized Sam was just not going to give up.  We also realized his
wounds were never going to heal on his primarily carbohydrate diet.  We began supplying Sam with sardines, peanuts and eggs to increase his protein intake.  I also tried to see Sam during his dressing changes at least once a week and cauterize his wounds with silver nitrate.  Gradually Sam started gaining some weight and his wounds became smaller.  With determination Sam got out of bed and began walking with the aid of a walker.  His mobility slowly increased and Terry and I had to walk through out the Hospital to find Sam for his protein deliveries.  Sam’s smile was never bigger than yesterday when he was finally discharged.  He will be staying near the hospital so he can continue with dressing changes until the last of his wounds are completely healed.  Terry and I feel blessed to be a witness to one man’s determination and a real miracle!

Elizabeth

6 months ago we first met 25 year old Elizabeth.  She was being treated for recurrent Tuberculosis.  Unfortunately she developed Hepatitis from INH, one of the five medications in her treatment regimen.  We withheld her medication for a week and then restarted the medication at a low dose and then gradually increased the dose.  At home we would have come up with a replacement drug for the INH but here there are no alternative drugs.  Elizabeth was doing well and sputum tests in January showed no sign of TB.  Last week Elizabeth returned to OPD very sick.  She was jaundiced and her liver was extremely enlarged.  She also was retaining fluid and was in heart failure.  She likely had damage to her heart valves from Rheumatic Fever when she was younger.  Her problems were triggered by the INH medication again.

Elizabeth had a difficult weekend being extremely short of breath.  We prayed all weekend that there would be no power outages as she desperately needed supplemental Oxygen from an oxygen concentrator that requires electricity to run.  We fortunately had fewer outages than normal and we were all encouraged Monday morning when she looked slightly better.  I figured everyday she could manage gave here liver a chance to recover from the INH insult.  Yesterday morning Elizabeth lost her fight and left a grieving family trying to understand why someone so young was no longer with them.  Elizabeth, like so many people here, endured a terrible illness with great dignity.  She and her family remain in our prayers today.

Praises

19 month old Praises was brought to the hospital by her mother 10 days ago.  She had been ill for the prior one week with fever and diarrhea.  She spent several days in a small Health Center and they reported that she had vomited up a tapeworm but despite their treatments she showed no improvement.  She was very ill and lethargic on arrival.  All of her tests failed to reveal what was wrong with her.  She passed blood in her stool for several days last week  and she remained as limp as a doll.  Over the last couple of days Praises has become more responsive and even called for her mother for the first time this morning.  Our limited diagnostics can be frustrating with cases like this.  We keep her in our daily prayers and are hopeful that we will see see more shine in her eyes each day.

Typhoid Joel

3 weeks ago 8 year old Joel arrived at the hospital critically ill.  He had a fever of 105 with jaundice and abdominal distention.  Tests revealed he had Typhoid and also was a Sickle Cell carrier with severe anemia.  After 3 days of treatment with IV fluids, blood transfusions and antibiotics Joel showed no improvement and I was worried whether he was going to survive.  The next morning his fever finally started to go down and a little glimpse of a smile could occasionally could be seen on his face.  Over the following 10 days Joel gradually became a happy smiling 8 year old boy with a ear to ear grin.

He was discharged over a week ago but has remained on the Pediatrics Ward while his mother went home to get money to cover his hospital bill.  The other mothers on the ward have collectively provided for Joel in his mother’s absence.

Achain

The Tertiary Sisters of St Francis operate 6 Hospitals in Cameroon.  In addition they have 40 Health Clinics in out lying areas around the hospitals.  These small clinics are staffed 24 hours a day by nurses and have 10-40 inpatient beds.  The nurses do deliveries and provide medical care for large areas where there are no other health care facilities.  Last Friday Terry and I traveled to Achain, the Clinic farthest from our hospital.  The road goes up and over several mountains and at times was no more than a path.  Most of the time the road is like a dry rocky river bed.  The road is impassible during the rainy season, more than 6 months of the year.  Sister was correct in predicting that the truck would need to go in for repairs when we got back.  We lost the exhaust pipe after bottoming out one too many times.

The staff at Achain was friendly and were happy to see us.  I think they were most happy to see the supply of medications and IV’s that we brought with us.  We consulted on a large variety patients.  One lady we saw had a large breast abscess.  We were able to drain here abscess sparing her a difficult trip back to our hospital.  The staff provided a wonderful lunch for us at the conclusion of the clinic.  The rain may prevent us from a return trip to Achain.

RSV Blues

The dry season brings an increase in the number of respiratory infections here.  The Peds Ward has been filled the last 2 months with many young children with Pneumonia and RSV Bronchiolitis.  We have nearly depleted the supply of Albuterol that Dr Ed Malphus brought us 2 years ago.  We use the Albuterol for breathing treatments for the children who are wheezing.  Fortunately most of the children respond well to antibiotics, steroids and breathing treatments.

Today I was able to discharge home 4 children all recovering from their respiratory infections.

Junior doing well

Stella doing well

Food Poisoning

Celestine

Last week we had 5 people arrive at the OPD complaining of vomiting and diarrhea after eating a meal of coco yams.  We later found out that a total of 15 people had eaten the coco yams and all 15 became ill.  2 young boys and 2 elderly women required admission.  3 year old Celestine was the sickest and he had multiple seizures over the next 12 hours.

Dr Eugene visited the Family Compound and was able to secure some of the cooked yams and sent one to the Hospital Laboratory for culture.  Today the Lab reported a heavy growth of E. Coli grew from the yams.  While Dr Eugene was at the Family Compound a neighbor showed up and boldly claimed he was so tough that no yam could make him sick.  Against Eugene’s advice the man snarfed a yam down.  We later heard that about 2 hours later the yam was oozing from both ends of his intestinal tract.

Everyone is doing well now.  We removed Celestine’s IV today and hopefully he will be able to go home tomorrow.

Tracy

2 year old Tracy was brought to the hospital 5 days ago by her parents.  She had been hospitalized 3 days earlier in the Southwest with fever.  Her condition deteriorated with development of profound lethargy, prompting her parents to bring her to us.  Her medical record from the other hospital contained no information about her diagnosis or treatment.  Unfortunately this lack of information from other health care facilities is very common.  Tracy’s father could hardly contain his anger when I explained the lack of information sent from the other hospital.  I was concerned about meningitis so we did a spinal tap immediately which was negative.  Her Malaria test was positive and her Hemoglobin was very low.  She was aggressively treated for Cerebral Malaria and given a blood transfusion.  Her father was extremely excited the next morning telling me the moment her blood transfusion began she started getting better.

Over 48 hours Tracy woke up, initially crying, then looking about the room and then talking and walking.  She was well enough to be discharged today.  Her parents were delighted that Tracy’s recovery from Cerebral Malaria was the fastest that we have seen.

Shortages Again

Last January, February and March we experienced severe shortages of the government supplied HIV medications.  No explanations were ever provided.  Our 1000 patients on HIV medications suffered greatly as they made many trips to the hospital and returned home with no medications or only a few days worth of pills.  We had many patients who stopped returning until they became too sick to stay away.

Unfortunately, January 2013 has seen the same shortage of medications that occurred last year.  We were able to secure a few medications on Saturday and today huge crowds of people waited patiently outside of Project Hope praying that there would be enough medications for each of them.  We are all praying that this shortage will not continue.

Triplets

Terry and I had were able to go to Kribi for a 3 day holiday on the ocean last week.  We got in late Friday and Saturday morning while doing rounds we found one incubator packed with babies.  In our absence a lady walked into the hospital and vaginally delivered triplets.  All four babies weighed 4 pounds and are doing very well at 5 days of age.  Mom is struggling with breast milk production which is understandable.  Terry is anxiously waiting for them to grow enough for a picture of her holding all three babies.

Witch Doctor

Before patients ever see us they frequently have already seen the local Traditional or “Witch Doctor”.  Today 7 year old Ibrahim entered my examine room accompanied by his parents.  Ibrahim’s arm was in a homemade sling.  There was an obvious deformity of the proximal forearm and the skin from his elbow to his hand was scabbed and discolored.  Dad relayed that Ibrahim had fallen 2 weeks ago and they knew the arm was broken by the obvious curvature.  Off to the Witch Doctor they went and the arm was covered with medicine followed by a wrap that Dad said was too tight.  A week later when the wrap was removed the entire forearm was blistered and still crooked.  Additionally Ibrahim could not move any of his fingers.  The local health center was their next stop and antibiotics were appropriately prescribed.  With no return of movement at 2 weeks post injury his parents decided the hospital should be their next stop.

Little Ibrahim sat stoically as I examined him.  The prior blisters were all scabbed today and there was no sign of obvious infection.  There was circulation to his hand as it was warm and capillary filling was present.  Unfortunately there was absolutely no movement below the shoulder, likely the result of a tight wrap the week after injury.  Hopefully the nerves in his forearm will recover in the next few weeks and he will regain some function in his hand.  It is difficult seeing cases like Ibrahim’s that could have had a different outcome had they entered the Health Care System through a different door.