Hope

Today, a 20 year old pregnant lady was referred to the clinic.  She was found to be HIV positive during her first pregnancy 2 years ago.  Her husband refused to allow her to take meds preventing transmission to the baby and has not allowed the baby to be tested or mom to have any follow-up.  After this not so wonderful man took another wife 2 months ago mom decided she had enough and came into be placed on medication.  Hopefully she will be able to get her first child in for testing.  

Most men here seem to have a good grip on the HIV situation but today's case illustrates how some remain very ignorant of the disease and the available treatment options.  

Project Hope and others have made great strides regarding education but more still needs to be accomplished.

On Call

I was called this evening to see an  unconscious 7 year child.  The child was started on HIV meds in January and was doing well so mother stopped her medications in April.  She has been ill the last week with fever and a swollen thigh.  She became unconscious today.  

The child is covered with Kaposi Sarcoma lesions and the left thigh was swollen to twice the normal size with a large open ulcer.  Her hemoglobin is 7.3.  She will hopefully respond to antibiotics and malaria treatment along with a blood transfusion this evening.  Then onto her HIV and probable osteomyelitis of the femur.  Noncompliance to long-term medications is a continuous problem here but is more difficult to deal with when an innocent child is the victim.  

Pray for this sick little girl and her family.

Tumbu Fly

Reaction on the back of Terry's hand

Terry and I had noticed we both were getting significant reactions from bug bites this week.  

We consulted Sr. Xaveria outside the Chapel yesterday morning about the bites and she quickly expressed a fly larva out of Terry's hand.  The Tumbu fly lays its eggs on the laundry when it outside drying.  Everything is then ironed to kill the eggs.  If that does not happen your body heat hatches the eggs when you wear the clothes and the hatched egg burrows into your skin.  The larva then feeds on you until is ready to emerge as a brand new Tumbu Fly.  

Tug of War

Sister came back to the house and with the aid of a safety pin extracted 8 more worms from Terry.  

Yesterday afternoon Joe got to operate on me and add Tumbu Fly extraction to his surgical repertoire!  We suspect the power went out while Prisca was doing the ironing and the iron was not hot enough to kill the eggs.  

Rice, Larva and Matchstick

If this is the worst malady we experience here we will have a healthy mission experience.

Dancing Jim

It is tradition here at St. Martin de Porres Hospital to have a farewell gathering as the time for a short-term doctor to leave is near.  The sisters and many of the hospital staff are guests at the party.  Just such a celebration took place a few weeks ago, when it was time to say good-bye to three of our dear friends, Elise Frederick from Mission Doctors Association, as well as two surgeons, Dr. Bill Walsh and Dr. Magued Khouzam.  Typically, the entertainment includes traditional music and native dancers.  As the native dancers entered the hall, their group had grown by one not-so-native dancer. 

It seems that Dr. Jim had been called up to the ward a bit earlier for an emergency.  Timing is everything. He could not resist the opportunity to 'join in the dance', much to the delight of everyone.  It is difficult to know who enjoyed it more Jim or all the rest of us.

Whirlwind

Yesterday was a whirlwind.  I saw 50 Out Patient Department patients including 11 new admits.  We had so many kids with pneumonia that one of the women's wards was turned into a second Peds Ward.  

Today was nearly as busy and it was nice to have Joe here as he was able to take care of a lady with a thyroid nodule for me and then later a man with a surgical abdomen.  The 33 year old man has had increasing abdominal pain for 4 days.  To everyone's surprise he had a gangrenous gall bladder with about a gallon of pus in his abdomen.  

Hopefully his young age will help him pull through.

Communicating

About 1 week ago a 25 year old man named Isaac was admitted.  Isaac was a muscular man with some irrational behavior, headache, fever and numbness on the right side  of his body.  He was HIV positive so one first thinks of Toxoplasmosis or Cryptococcal meningitis when there are neurologic signs in a HIV patient.  HIV itself can cause an encephalopathy.  Isaac's spinal tap did not show crypto but his blood test revealed Toxo.  He was started on both HIV meds and Toxo meds.  He showed improvement for a couple of days but then slipped into a coma with no movement of the ride side of his body. 

His mother speaks very good English and yesterday I was able to inform her and his brother that Isaac might not recover.  Unfortunately Isaac passed away this morning.  

I felt good about the fact we were able to have yesterday's conversation and that the family had some warning.  Frequently the language and cultural differences prevent me from communicating well with patients and family.  It is a reminder to me to speak clearly with my body language so patients and family know I am trying my best and care.

Assume nothing

Today I saw a mom who brought her 6 and 8 year old daughters into the Out Patient Department.  Mom and the 8 year old were getting their HIV meds refilled.  The 6 year old was there for a cough.  My first thought was that mom was on treatment when the 6 year old was born and she did not get infected.  

Just like at home never assume anything.  History revealed that the 6 year old has never had HIV testing despite the HIV unit frequently reminding mom to bring the 6 year old in for testing.  Sure enough, the 6 year old tested positive today.  

The good news is that she has been healthy to date and that her status has now been identified and can be dealt with.  The bad news is that she missed out on 6 years of early treatment and only time will tell if that was detrimental.