A Few Interesting Points From The CIA World Fact Book
Average life expectancy at birth
US: 78 years
Lesotho: 39.9 years
Lifetime risk of maternal death
Sierra Leone: 1/6
NW Europe: 1/30,000
Countries with the highest HIV prevalence (% of the population living with HIV)
Swaziland 38.8% (1st)
Botswana 37.3% (2nd)
Lesotho 29.8% (3rd)
USA 0.6% (71st)
Only African country with Spanish as one of its official languages
12th highest GDP per capita in the world (Luxemburg is 1st, US is 9th)
But most of the people live on less than a dollar a day, since all of the money (oil) is in the hands of the politicians
A Hard Week At The Baylor Center of Excellence (COE)
The COE is getting busy. We are seeing over a hundred patients every day, with several newly diagnosed kids and adults per day. The new kids are always our sickest ones, as I’ve mentioned in prior blog entries. Several of them have been losing weight, and suffering from fevers, cough, diarrhea and malnutrition for months before they are brought in – frequently by their grandmothers, as the mother has recently passed away. They often come in with skin stretched on bone, with so little muscle and fat. They are basically on Death’s door. We work hard, giving them strong antibiotics and oral rehydration solutions specially formulated for severely malnourished children. We battle over starting and restarting IVs for the administration of the medicines and for emergency fluid replacement when they go into shock. Anu admitted 4 of these very sick children on Monday, and I admitted 3 children on Tuesday, most of which sadly have passed away. Later in the week a woman came in and spontaneously went into labor in the blood drawing room, delivering a stillborn fetus that had probably stopped living a week before. The next day I found myself on a panel that is in charge of writing Lesotho’s national prevention of mother to child transmission of HIV guidelines. It is an unfair world where a recent residency graduate plays a big part in making these kinds of decisions for an entire country. During the week we saw some kids that were incompletely or inappropriately managed at outside hospitals dumped off at our clinic, hoping for better care and more resources. I saw my first case of ophthalmia neonatorum, an experience I won’t forget. Seema was seeing this newborn in the exam room next to mine. The child was born at home and started having eye discharge during the first week of life. After about a week of eye goop, the mother finally brings the baby to our clinic. She has a rag that she’s been using about once a minute to wipe pus off of the closed eyes. I went to better examine the eyes, and while trying to open the lids a thimble full of pus came out from under the lids. The lids were so swollen I couldn’t open them. I was amazed, others were shocked, the mom wasn’t impressed. No one fainted. Those of us that see kids in the office have met a hundred new moms who come saying that their baby has “eye discharge”. The med student or resident in training needs to know how to differentiate harmless eye discharge from true ophthalmia neonatorum. There is no confusing what I saw that day for harmless eye discharge. If all of the new moms of the world could see what I saw, none of them would ask if the scant eye boogers that they have to wipe off in the morning once in awhile were dangerous eye discharge. Seema treated the child with ceftriaxone and erythromycin, treated the Mom, and asked for the dad to come in. That’s because the pus coming out of the baby’s eyes was likely caused by infection from gonorrhea (and probably also chlamydia) – transmitted to the child while traveling down the birth canal. Yes. Gonorrhea of the eyes. I’ve never seen this in the States, due mostly to the fact that most newborns get preventative eye medicine at birth (and partly due to a lower rate of gonorrhea in the US). While reading up on eye medicine for the newborn, I found a study in Kenya showing that iodine eye drops not only are cheaper than the meds we use in most of the world, they worked better and were less irritating. This study was done 13 years ago! My best guess why we haven’t changed to iodine drops is that Big Pharma (the pharmaceutical industry) can’t market cheap iodine and prefers us to use their expensive meds. Gotta love Big Pharma.
A Louse In The House?
Kara (fellow PAC doc and one of my two roommates) found a very small bug on her back when she was changing her shirt. She squashed it, and realized that it was full of her blood. We all took a close look, and voted that she most likely had body lice picked up from a patient at clinic. We also by a non-unanimous decision voted her off the island. I kept the squashed bug in a piece of clear tape and looked at it under the microscope at work the next day. Upon closer look under the scope, we saw a creature of uncertain identity but one that did not resemble a body (or other) louse. That night I woke up because I felt something crawling on my foot. I’m a vegetarian and don’t like to kill things, but I occasionally make exceptions for evil creatures I find in my bed. I caught the thing and squashed it. In the morning I opened UpToDate (a medical resource on the computer) and on a hunch opened the article on bed bugs. Yep. I was right. The thing I found crawling on my foot was a dead ringer for the bed bug featured in the article. What in the world? I’m not a particularly dirty guy. The sheets get washed, I bathe fairly frequently, I don’t wear clothes I find in alleys. We have a really clean, modern house. There are no thatched roofs or mud floors here. Going into crime scene investigator mode, I found another 2 that night, losing one on the floor in the living room (much to my roommates’ dismay). I quickly learned a lot about bed bugs. Bed bugs are a little gross. They suck your blood. They can live for a year. They are found in dirty homes but also well-kept abodes. They have a sweetish smell when squashed (like a South Texas stink bug). They come out of cracks and crevices at night, attracted by your body heat and carbon dioxide, and they feed on you while you sleep. They are associated with areas where birds and bats roost, and they can live for a loooong time without a blood meal. I bombed my room with FumaTab, something I bought at the store that has more health warnings on the label than a nuclear bomb and behaves like a ninja smoke bomb when lit. I quarantined myself to the couch (again to Anu’s and Kara’s dismay). I slept there for 7 days as the smell of the Fumatab’s carcinogens slowly cleared. One day I came back from a run, and Anu said to me, quite seriously, “You’re going to have to stop sleeping on the couch. Because Kara is going to start sleeping on the couch”. She showed me her bed, which was totally infested. Of course that meant that it wasn’t a louse on her the week before - it was a baby bed bug, a nymph, if you will. So now, about 3 FumaTabs and a can of Doom insect spray later, we seem to be bed bug free. We’re both back in our own beds, and Anu’s room, somehow, still seems to be bed bug naive. Apparently they prefer Mexican food and California cuisine to Indian food. Hopefully they aren’t in our couch. Hopefully they aren’t looking over my shoulder while I write this about them. They might get upset. Unfortunately, the chance is moderately high that they’ll surface again. Then we’ll call the exterminator. If that doesn’t work, we’ll get new beds. If that doesn’t work, I might come back to the US. Or better yet, Antarctica. They don’t do particularly well on icebergs. See attached NYT article.
8th Trip to Mokhotlong
It was good trip. I came in on Sunday night, having made the beautiful 4 hour drive without incident and arrived at the Touching Tiny Lives orphanage in Mokhotlong proper where I’ve been staying. This has been a cool place to stay. I get to hang out with Dan and Mo, two North Americans who have been working here for several months. They are fun to hang out with, and coincidentally happen to be good cooks. The orphanage is well funded from the US, so they have hot running water, electricity and dial-up internet.
I spent the week in the typical fashion: rounding with the local docs on some of the inpatients, driving to rural health clinics in the mountains, mentoring nurses on the care of HIV positive and negative patients. The weather has been great; it’s starting to rain less but isn’t terribly cold at night. It’ll start snowing here in May or June.
I saw a variety of patients during the week: HIV positive adults with lung cavitations caused by tuberculosis, sick and healthy HIV positive kids and pregnant women, a term pregnant woman with 5 days of a big swollen tender leg, likely caused by a blood clot that could break off and float to her lungs - possibly killing her (there’s no access to PTT monitoring at that hospital, and at times nowhere in the country. We started her on subcutaneous unfractionated heparin and flew her to the capital). There was a young boy with a Colles’ fracture, an impressive case of pruritc papular eruption, a 12 fingered baby, severe nipple eczema, hydranencephaly with hydrocephalus, and a 2nd case of ophthalmia neonatorum. This one had been “treated” by a nurse assistant a few days earlier with chloramphenicol eye drops and trimethoprim/sulfamethoxazole. We started the right drugs and think the baby will be fine (the infection, when left untreated, can cause blindness).
Back At The COE
Work in Africa has brought a mixture of strong emotions. You’ll find a family slowly wasting away due to lack of money, education, and power. The man of the house just won’t let them test for HIV until it’s too late. Then you’ll see a new mom who did everything right from the beginning – like the woman who I met in the first trimester when I had just arrived in Lesotho – and the newborn baby’s test shows that he is HIV free. Both instances affect your soul.
Lesotho’s First 80s Party of 2008
So the 80s was an interesting time. I was reminded of this decade of my life as I found myself “pegging” (aka, “tight rolling”) my jeans, putting on clothes that didn’t match, and creating my mohawk for the 80’s party on Saturday night. A
mid the sounds of Toto, Bon Jovi and Journey, we enjoyed a bit of caipirinhas, drinking games, and dancing. There isn’t much more I can say about the party. Is there really much more to say about 80s parties? Let the pictures do the talking.
News From The Farm
By brother David and his wife Jessica just celebrated their 6th anniversary together. Dave, I owe you a twenty. Just kidding. I’m very excited to think about spending some time together with you guys when I get back home, and maybe we’ll even get a chance to meet up off the continent before then. I love you.
I’m excited to say that my mom is enjoying her first weeks of retirement. She put in a ton of years at Del Mar College in Corpus Christi, Texas, and they are missing her already. I can’t remember life before coming to see Mom at the office, hearing her laughter from down the hall, and selling Christmas wrapping paper and chocolates to the nice ladies and gents in the office. I want to send a big hello to all at the Registrar’s Office that read the blog – your support has kept mom sane (relatively) and helps me all the way out here as well. Thank you.
Happy Moshoeshoe’s Day,