Unknown

I'm not sure what this baby has. I was thinking syphillis but I'm not sure. Do you have any ideas?

Our Cute Old Grandma

We go to the “hospital” that is near the base fairly often because we admit patients there. We use there beds but we assume care of the patient. It is a great arrangement because we are not legally registered to have people sleep overnight in our clinic and we can provide better care in some instances, so we work together.
We were at the hospital one day showing Ann and Chris from the Care Now Foundation around when we saw a little old grandma we recognized. She had been there 5 weeks earlier when we hd a patient there. This was strange because the hospital never keeps anyone over 2 weeks. We inquired about her and they told us that the family refused to allow her to be transferred to Maamba hospital because no one wanted to go with her. her in Zambia when someone goes to the hospital, a family member has to go with them to make cook and take care of them. The nurses responsibility is only to give medication. The hospital in Sinazongwe had taken her as a charity case and kept her, but she was getting worse. She could not go home because she was to sick to take care of herself and there was no one to go with her to the big hospital so she was left there to die. Well I think you can guess what we did, we took over her care.
She had congestive heart failure and they had placed her on Lasix, Aspirin, and Proponol orally. They treated her for a respiratory infection (PCN injections) because she had a cough, and tapped her abdomen taking off 6L in 8 hours. She had been there for almost 6 weeks with no improvement.
Our assessment revealed minor respiratory distress, HTN, ST with a S3 and S4. I didn’t have a heart monitor but from her rhythm I would bet money that she was throwing PVC’s. She had 3+ pitting edema all the way to her hips bilaterally. Her lungs were crackly in all lobes with audible wheezing and sternal retractions. Her abdomen was hard and distended with a positive fluid wave and she had no urine output was drinking water like we were in a drought. Her capillary refill was almost 5 seconds and her face was dark. I know that she is black, but her face was BLACK, I’m pretty sure that if she was white her face would have been a shade of blue from oxygen deprivation.
We tapped her abdomen, placed her on a bunch of meds, put her on the last O2 tank we had and left for the weekend. I fully expected her to be dead by the time we came back from Lusaka but when we walked in Monday morning (we had to go to Lusaka for the weekend) she was sitting up with all her tubes pulled out. She yanked out her urinary catheter and decided that her IV line was not necessary. I had taken some blood with me to Lusaka and ran some labs. i explained to her that her kidneys were fine and that the problem was with her heart. If she let me put the tubes back in and gave me 4 weeks she might be able to walk out of there. Up until this point she couldn’t even get herself into the wheelchair she had such a hard time breathing. She agreed and we started.




Stephanie and I went to the hospital 3 times a day checking vitals, abdominal girths, intake and output, and monitoring medications. She was a VERY hard stick and we couldn’t keep a line in her. We started with IV Digoxin but had to move to oral. We treated her with beta blockers, ACE inhibitors, diuretics, potassium, vitamins, antibiotics for a urinary tract infections, and tylenol for all the times we poked her. She was a super star and never complained once. Slowly slowly her edema started to decrease, her breathing got easier, and her color began to change. We brought her some new clothes and though she could barely stand she got up and did a little dance to show off her new digs.



After four weeks of medication and close monitoring of her ever changing erratic heart rate and unstable rhythm we discharged her home. Her edema is completely gone, she has been walking around the hospital on her own accord, and has no difficulty breathing. She has defied all odds and improved. With no oxygen, no heart monitor, and no IV but lots of prayer and determination this lady persevered and is now back home.

Another Snake Bite

Its a way of life her to walk through the bushes at night to get places. The only problem is that snakes also hang out in those same bushes. This lady was bitten by a puff adder on the top of the foot. The poison of a puff adder is necrotic to the tissue and the muscle usually causing contraction of the muscles and tendons with death of the skin and underlying fat layer. She came to us a long time ago and we had the wound almost closed but she stopped coming for dressing changes. There is nothing we can do for the leg swelling and scarring that is the effects of the bite and in this country it will have to stay like that. But the wound we can close. She came back when it became large and painful. The edges were tough and dead so she required a little bit of cutting to close it. We admitted her to the hospital for 5 days of IV antibiotics to keep her free of infection. I cut away all the dead tissue and leveled the surface giving the wound new tissue to grow and regenerate itself. She had her follow up visit 2 days ago the wound is now almost completely closed. Hopefully this time it will fully close and she will be able to walk better.

Parencentesis

So the way you learn medicine is to see one, do one, teach one. Ok but what if you have seen one like 3 years ago but you patient REALLY needs it. Do you do it anyway? In Africa yes. Stephanie and I had a patient in the hospital in congestive heart failure with a an abdomen the size of a 9 month prego lady who very badly needed a parencentesis. She was in respiratory distress from all the build up of fluid and we were out of oxygen at this point. So.....here we go. She was a trooper and everything went fine. The biggest needle we had was an 18G and she didn’t even flinch. I was as gentle as I could and we pulled off 1 liter of yellowish fluid every 8 hours. We didn’t want to mess up her electrolytes, we had no monitors and had no idea what her levels were. She breathed much easier after that. Oh by the way did I mention that we had no power and did the whole thing at night with flashlights. You have to love this place.

Medical teams are always fun to have because they bring new life to our medical ministry. We get to go to new villages, we have a good laugh at all of their reactions to third world medicine, and we meet new people. But my favorite part about medical teams is that I get to learn new things from the nurses and doctors that come. The scope of practice here in Zambia is a lot broader than it is in the states, and even wider for those that work in the bush. When there is no one else around you do what is necessary to help....whatever is necessary. Of course you have to work with in reason :) It is great to be able to learn new things from all the visiting doctors because it gives me new knowledge and confidence to work where I do. When the UK medical team came to visit Dr. Sam taught me how to aspirate a knee. It’s something that I had seen many times before in the ER, but had never done. So far I have never had to do but it was a fun thing to learn. Well last week I actually got the chance to do it. I don’t think my patient enjoyed it but I had a blast. It went very well. Thanks Dr. Sam!

Burned Face

There are not to many things that shock me. After being here for 3 years I have become quite used to some of the “strange” cultural customs concerning medicine and physical treatment of ailments. It takes a lot to get a rise out of me, but this one made me angry. Not so much because of culture but because of neglect and that no one cared enough to help.
A mom came to clinic with her 9 year old son who had a hat covering his entire face. She had to lead him around like a blind kid because the hat was covering his eyes, he didn’t even have a breathing hole. I was quite curious why he was wearing this, but he shrieked and ran when I tried to remove it. After 45 minutes of questions and interrogation of the mother though an interpreter the truth came out. The father had pushed the child into a cooking fire. His entire face had been burned off, that why he wore the hat. He had no burns on his hands because the father had held them behind his back so he could not struggle. To make matters worse, this had happened 3 years ago and he had received no medical treatment. They gave him Tylenol for pain and put the hat over his head so he would not scare people away.
Ok, take a breath and try to push past the anger and frustration that is welling up inside. That’s what I had to tell myself to be able to face this family and take care of the child that they so brutally treated. I finally got him to remove the hat and this is what I saw.



It was obvious that the eyes could not be saved, we need to focus on the reconstruction of his face so this kid could feel like he could walk around without the hat. Easier said then done. It took a few weeks to find a plastic surgeon that would help us out, and it was a huge blessing that he agreed to do it for free.
He is now on his 7th surgery. He has had both of his eyes removed, scar tissue removed and smoothed over. They are now working on reconstructing his lip. He still wears the hat but has agreed to let there be a mouth hole.
In the states he would have been removed from the home and placed in foster care. Here, there is no such thing as foster care and staying with his family is the best place for him. So how do you prevent this from happening again? Fanwell, one of our health workers has been ministering to the father ever since we met them and has been trying to get him to stop drinking. That is the best we can do. We have to trust that the Lord will protect him because in this case we can’t.

Burned

It was a fairly quite day at clinic, we had the pretty typical cases of colds and coughs filtering in. We were almost finished for the day and ready to go home with a father brought his 7 year old son for a complaint of difficulty seeing. Thats all the chart said, so I thought it was going to be easy. When he came inside I saw that it was going to be anything but easy. It turned out that the child had epilepsy and had fallen into a cooking fire burning the entire right side of his face off including both hands from trying to catch himself. His father had taken him to the local clinic 2 years ago when it happened and they gave him tetracycline cream to place on the burn. Surprise it had not done anything. He had now lost all vision in his right eye, all hearing in his right ear, and was left with no hands. He needed help.
We sent him to the same plastic surgeon that had helped us before and they have done a beautiful job of removing his eye and making his eyelid look like it’s closed. They reconstructed his lip and are now working on building him an outer eye. The next step is to open the ear canal and see if the inner ear was damaged and if he can regain his hearing. They are still not sure if they will be able to do anything about his hands, but they are not giving up quite yet. Plastic surgery and prosthetics are no where near as advanced here as they are in Wester world, but there are visiting surgeons occasionally so we still have hope.