Sunday, September 16, 2007

Blood Sick Doctor

September 10 – September 16

Hello, and welcome to my blog. A big thanks to Cindy Su and Bruce Heller for convincing me to stop sending out group emails and finally setting up a blog. I’ve up-loaded the old emails as well and added a few pictures. Enjoy!


On Wednesday I was “blood sick doctor”, the rather ominous sounding title for the doc who is in charge of reviewing the labs (“blood”) and being available to manage the “sick” kids that come in the door. Now, some would say that all of the patients at an HIV clinic in southern Africa are sick, but really most are fairly healthy. Granted, they might have pulmonary tuberculosis, pelvic inflammatory disease or strep throat, but they’re walking in by themselves and can usually walk out just as fine after a routine clinic visit. The sick visits are the kids that are decompensating and need stabilization before sending them out for them to return to the clinic the next day or for admission to Queen Elizabeth 2 hospital (QE2). These are the ones who need oxygen due to asthma attacks or bad LIP (lymphocytic interstitial pneumonitis), the kids that are acutely dehydrated and need ORS (oral rehydration solution), or as was the case on Wednesday, the ones with pneumonia, severe malnutrition, bulging fontanelles and 4 days worth of seizing. First was an adolescent with cough, fever, fatigue – hopefully just a community acquired pneumonia, I chose high dose amoxicillin and clarithromycin and told them to follow up before the weekend if she wasn’t doing better. Next came the infant with severe malnutrition, regional BCG disease (swollen vaccine site on the arm and a large ipsilateral axillary node), and a bulging fontanelle. We performed a lumbar puncture, gave antibiotics for possible meningitis, started TB treatment, ordered a chest x-ray, worked on the refeeding schedule and (you might be guessing “admitted the child”) sent the child home to follow up in 2 days. Last was the real sick child. Another infant, this one had been seizing for 4 days and was finally referred to us from a community clinic. A rectal dose of diazepam, though paraldehyde (yes! From MUDPILES) was also considered, calmed the seizures initially. We performed another LP and this time the fluid looked like someone had spit a loogie (lugie?) into the test tube. I have never seen frank pus slowly ooze out during a tap until today. We did a quick gram stain on a drop of the CSF, looked at it under the microscope and saw tons of white blood cells and gram positive diplococci in pairs – most likely Streptococcus pneumonia causing the meningitis. Unfortunately there is no pneumococcal (nor H.flu) vaccination program in Lesotho. As the child had begun seizing again, we dropped a nasogastric tube, loaded him with Phenobarbital, and admitted him to QE2 for intravenous antibiotic treatment with high dose ampicillin (100 mg/kg Q 6 hours) and once a day gentamycin (7.5 mg/kg/day). His prognosis is not good.

Social Life

Baylor vs SOS orphanage

This Friday our clinic took on our neighboring orphanage (not the orphans, but their adult staff) in a fierce (not really) football (soccer) match. Basically, the Baylor team is made up of the local staff (cleaners, guards, translators, drivers) that rock and the white doctors (sorry Anu) that suck, with the exception of Tony, one of the returning PAC docs. I have never played soccer, except when I would get my butt kicked once a year by the small barefoot boys in the Honduran village where Baylor has been building a clinic. I have no skills with my feet. None. Granted, I am able to run quickly from one end of the field to the other, but it’s mostly pointless since none of the locals purposely pass me the ball. Nonetheless, we tied, and we had more fun, too. The women from the clinic sang songs throughout the match and would flood onto the field when we scored. Now all I have to do is get them into Ultimate Frisbee…

Saturday we took a day trip to Teyateyaneng, or T-Y for those of us that can’t pronounce it. It’s famous for its hand woven tapestries and rugs. I took some pics of some of the good ones. Aside from a brief near death experience when we were accidentally driving on the wrong side of the road, we had a great time.

Basotho Hat

Sunday morning started with an amazing brunch at Seema and Guada’s house – pancakes (with the much coveted real maple syrup – hand delivered from North America), quiche, fruit salad (guava, papaya, kiwi, strawberry), and banana bread, among other things. The table was full – PAC docs, Nick (a visiting med/peds resident from Houston), and Djin-ye (a med school graduate from Berlin). A quick trip after brunch to QE2 showed that the infant with meningitis was still alive, then off to hike up the mountain where the past kings and royal family are buried. The hike was great – a cool breeze accompanied us up a hill with some good rock climbing (left my climbing shoes and chalk bag in my closet), free roaming horses, scrambling lizards and expansive views of mesas and plains dotted with evergreens and cacti. We saw the famous conical hill where one of the early past rulers hid from his enemies. The shape of the hill then became the design for the unique basotho hats that many of the locals wear and is one of the main cultural icons for the kingdom. Hope all are well. Let me know what you think of the blog; until next time –


Della said...

no wonder you're tired! that's a great picture. is that the lesotho-type hat that you're wearing?

Cheryl said...

My first blog! Had to ask your Mom for help. Love this & especially the great pics! My sister-in-law is still not out of the woods with the liver transplant, but each day is one step forward. Take good care!

Cindy said...

Jefe -- I'm glad I inspired you for this blog. What great (and often sad) stories. You're doing amazing work. And now, no need to steal procedures from fellow residents, eh? Plenty to spread around. I'm kidding. (I just took an intubation from an intern recently...)

Barb said...

Thanks for the blog. Now we don't have to bug your mother for news. For some reason, though, she doesn't seem to mind talking about you and your brother. Looking forward to the next installment from Africa. Take care.