Sunday, April 8, 2012
Juba is an interesting place.
I found myself in our little local hole-in-the-wall Kenyan cafe called California Inn (I think) getting take-away. On the television was a Mexican soap opera, dubbed in English, with Luis Miguel singing a ballad in the background. The food was beans and cabbage, with chapatti that taste pretty much like tortillas. And of course there was salsa night on Thursday, where I got to meet a few people from Ecuador, Guatemala, Honduras, Argentina, and Panama who were working with the UN. Who knew of the South Sudan/ Latin America connection? Well, not me.
Work continues to be pretty intense. We had a man come in with a swollen epiglottis that suffocated in front of us and went into cardiac arrest. Another young guy in his thirties presented in a coma with a blood pressure of 240/120. There weren't many medications we could give him to effectively lower his pressure. He passed away overnight.
A young guy came in with a stroke, decreased consciousness, and a fever. In my little hospital in NorCal he would have been admitted to the ICU, blood work would have been drawn, and a CT scan ordered (with a follow up MRI from the neurologist in the morning). This young guy's family was too poor to afford most of the tests and treatments we ordered. His bed was also empty one morning this week.
Just about every day there is at least one patient that could benefit from a ventilator machine. Comatose patients that can't protect their airway enough to avoid choking on their own oral secretions, people with overwhelming infections leading to fluid and inflammation in the lungs called acute respiratory distress syndrome. We don't have a ventilator, so many of these patents just don't make it.
We've had some cases of people in kidney failure. There are no working dialysis machines in the country, just as I'm sure there are no working nephrologists in the country. An elderly, confused gentleman that was breathing fast turned out to have a creatinine of 17 (ten times the normal value, signifying massive dysfunction of his kidneys). The closest place he could go would have been an international trip to Uganda.
There are still surprising saves. A young man with meningitis so bad he couldn't bend his neck is slowly getting better. A confused woman with malaria and likely infected with TB who I was sure would expire last night was awake and sitting up this evening. A man came in confused with a history of three weeks of dysentery and a blood pressure of 70/50. With IV fluid, sugar, and antibiotic therapy, we were able to stabilize him. Hopefully he'll be with us in the morning. And I'm seeing some good changes in evaluation and treatment from some of the South Sudanese health providers we're working with. Little things, put good things.
And, we have mangos.