Underestimated

The last week has found the majority of my hospitalized patients having HIV related illnesses.  Yesterday 11 of the 14 ladies in Ward 1 were HIV positive and 5 of them also have active TB.  

There are days when I think the number of HIV patients in Africa is underestimated based on the numbers I am seeing in my small slice of the continent.  The good news is that more HIV patients are receiving education and treatment.

Oliver

Last Friday evening I was called to see Oliver, a 32 year old man.  He had been having headaches for a month and had been seen at another hospital on 5 occasions for these headaches.  He had been treated for malaria, typhoid and migraines, but the headaches continued.  Friday afternoon Oliver became confused and began throwing up.  

His family then brought him to St. Martin de Porres Hospital.  I did a lumbar puncture  and Oliver had Cryptococcal Meningitis along with HIV.  He was started on medication Saturday and became oriented by Monday.  

Today, he is feeling much better with some mild headache.  He is doing amazingly well for a bad combination of illnesses.

Patience and Harrison

It is nice to see patients who are doing well as opposed to those with protracted illnesses who finally come in after the traditional doctor has not affected a cure.  

Today, Patience and her son Harrison came in for their HIV medication refills.  Harrison is 3 years old and doing very well.  He was very inquisitive and like most 3 year olds really liked to give you "five".  Mom likewise was doing well and visits like these are nice to remind us that all is not lost.  

HIV can be managed with education and medication. 

Treat the Patient

David's x-ray with depression top left

David is a 19 year old who was referred from a hospital 100 miles away with a diagnosis of "depressed skull fracture".  He was cutting down a tree 2 days earlier when it fell and hit him on the head and shoulder.  He was seen the next day complaining of both headache and shoulder pain.  X-rays were obtained and a depressed skull fracture was present and he was sent to our hospital because we do orthopedics. 
 
David appeared quite well and I could only find some minor scratches on his head with no swelling.  His mother could not remember him hitting his head when he was younger.  I elected to obtain a lateral skull x-ray since I could not find a depression on his skull to go with his x-ray finding.  The additional x-ray also showed the depressed skull fracture.  By then David's father arrived and remembered David had fallen out of a Mango tree as a young child.  

David with Parents

Conclusion:  Indeed David had sustained a depressed skull fracture, but as a child and not 2 days earlier from the falling tree.  

David's case is a good reminder to treat the patient and not necessarily the lab or x-ray finding.

Sunday Rounds

I believe I previously talked about Sunday rounds.  Prior to my arrival they never happened.  There are only 2 nurses working on Sundays in the medical wards compared to the normal 3.  I am now able to do rounds on my own with the help of Terry on Sundays which has eased the concern of the nurses.  I now see all my patients on Sunday so if Mondays in the Out Patient Department are too busy I can limit rounds to the sicker patients and those going home.  

It is actually more relaxing doing Sunday rounds and I have a chance to visit with patients and their families.

Many Hands Working Together

The Belgian Team

New Physical Therapy Department

Sister Xaveria has cultivated relationships with many people and organizations around the world.  The last 2 weeks there has been 5 volunteers from Belgium working at the hospital.  2 nurses and a pharmacist worked on the medical and surgical wards.  They instituted a new system to distribute patient medications and worked on improving hand washing policies.  
 
A medical equipment technician installed new lights in the operating rooms and worked on other equipment in need of repair.  The physical therapist was very busy and opened a physical therapy staffed by 2 hospital employees.  This group sends a team here every 6 months and it was enjoyable working with them.  We look forward to their return in the future.  Their presence illustrated how God's work is being carried out by many hands working together.

Dick and Jane

Dick Talbot and his wife Jane Fehrenbacher arrived last week.Dick is a Dentist and Jane is an MDA veteran having done a long term mission in Zimbabwe in the 1960's.  Dick has been extremely busy at the Dental Clinic since his arrival.   He is working with Dorothy who has been staffing the clinic for many years.  Dorothy has had no formal training and Dick will certainly be able to enhance her skills.  She has been looking forward to his arrival for some time.
 
Dick was able to secure a large number of dental supplies from Direct Relief based out Santa Barbara.  Mission Doctors Association also procured some necessary supplies.  It was like Christmas here last Friday when Dick was unpacking the supplies for Dorothy, Sr. Relindis and Sister Xaveria.  Terry and I are enjoying their company.