Patients

The bright side to all of the sad cases on the wards is that I’m seeing a lot of pathology that I will never get to see in the states. A few of the little kiddos currently on Ward 3:

--Harriet. A previously normal, healthy 11 year old girl with a 9 month history of worsening headaches. About 6 weeks ago, she woke up one morning and was blind. Since then, she’s had increasing paresis of her limbs, as well as decreased overall level of consciousness. By the time she got to our ward, she was essentially in a coma. It took awhile for her family to get the money, but she eventually had a head CT, and it showed that she had a massive craniopharyngeoma (brain tumor) that was pushing on her optic nerves (hence, the blindness) as well as jamming up the normal flow of CSF, so she also has hydrocephalus. The neurosurgeon took her immediately to the theater (OR) to put in a CSF shunt. If she improves, they will consider attempting to remove the tumor, though she presented so late that her prognosis is not good.

--Patel. Again, previously healthy, 7 year old boy. He’s had a 6 month history of yellowing eyes and increasing abdominal girth. This boy’s liver is massive – by far the largest liver I’ve ever felt on an adult or a child. He had an ultrasound that showed a large mass in his liver – what the radiologist thought was hepatocellular carcinoma (liver cancer), but this would be extremely rare in a kid this young. So, we’re thinking he has either a lymphoma of some kind or some kind of parasitic liver infection. But, we haven’t yet been able to biopsy, as you first have to be sure his blood clotting ability is normal (the liver synthesizes most of the blood clotting factors), and the lab has been out of reagent to run the test for the past week. Supposedly they got some today and hopefully we’ll soon know exactly what he has.
*Edit: Though I am posting this on Tuesday, I actually typed it up on Monday night. I got into work this morning and found out that Patel died overnight. Sigh... I don't know how much more of this I can take*

--Mary. 13 year old girl with a history of rheumatic heart disease, now in florid congestive heart failure. She had an echo that showed terrible heart function, and that she really needs 2 of her valves replaced. Of course, in a resource-poor setting this is extremely difficult. If the family can get the money (a very big if), she would have to go to Nairobi to have the surgery done. And, as pediatric cardiothoracic surgeons are few and far between, she would have to be placed on a 6 month to 1 year waiting list. Sadly, I don’t think she has 6 months to 1 year to wait. The family is still discussing the options and working with our social worker, but things are not looking great.

--Robert, 8 years old. I may have mentioned Robert before. He was a favorite of mine. He had AML, and presented SO late that his eyes were essentially completely out of his head. He had frequent nosebleeds and gum bleeds, as well as bleeding from his eye sockets. He was getting massive chemo, and was actually improving somewhat for awhile. We got to rounds on Friday, and the entire right side of his face was swollen. I mean, hugely swollen. He was almost unrecognizable. The consultant thought it was probably a dental infection/abscess that just progressed at lightening speed since Robert had no immune system left (and dental care here is quite bad). The plan was to drain the infection, start on heavy-hitting antibiotics and wait till he recovered to start chemo again. None of that ended up happening, as Robert died over the weekend. It may have been sepsis from his infection, or just his leukemia finally taking over, or maybe both. Either way it just makes me so sad. And of course, his dad is such a sweet, nice guy. He is one of the few parents we have here who speaks English, so I always liked going in to say hi to him and Robert. He was very calm about his son’s illness, saying that if it was God’s will for Robert to live, then he would live. And if not, he would try very hard to accept that.

How about something a little more uplifting. Today I got conscripted to lead a parent discussion group. These happen every Monday and Friday, where a physician (usually Dr. Tran) will sit in the Sally Test Pediatric Center with any of the parents of our patients and discuss a certain topic and answer questions. Well, Dr. Tran’s nanny has malaria, so she was trying to find someone else to watch their kids, and asked me would I mind going? So of course, I don’t mind. Oh and by the way the topic is potty training. Yeah, don’t really know much about that one. So I go in, and the translator is there, and he says, ok, let’s get started. Go ahead. So I’m like, ok… um…does anyone have any questions to start off with? Well, of course no one does. So, I ramble on about everything I remember learning about potty training (the expanse of my knowledge filling all of 5 minutes), and then we still have 55 minutes left. Enter awkward silence. Luckily the translator had done this particular topic before, so he was able to engage the moms (and one dad) a lot more. By the end of the hour, the parents were swapping stories and tips back and forth. Which really is more helpful than a white coat yakking at them for an hour anyway. The other interesting thing about the conference was that one of the moms there had a baby with Down’s Syndrome. Definitely the first African baby I’ve seen with it, but unmistakable nonetheless. The baby’s almost 2 years old, and her mother was expressing frustration that she hadn’t even started potty training yet (kids start quite young here compared to the US – as early as 5 months!). It was uncomfortable for me to try and explain to her that her child would be delayed in all areas – including this one. Not that I couldn’t do it in a tactful way, but it was awkward with 15 other parents listening intently. Ah well, at least there’s no HIPAA here to worry about.

After work I walked into town by myself for the first time. I went to the bank (exchange rate was up one whole shilling today, wahoo!) and the grocery store and I didn’t even get lost! Afterwards, I met up with Priti and Dayna and we shopped around town for a bit, then walked up north of town to the Imani workshop. Imani – meaning “faith” in Kiswahili – is a part of the AMPATH program. It is a workshop that employs only HIV positive Kenyans, and they make and sell a wide variety of very nice things such as bags, jewelry, shirts, skirts, etc. The dressmaker was out today, but we’re going back Wednesday, at which time she will measure us, we’ll get to pick out our fabric, and she’ll custom make African skirts for us. We got to look at the fabrics today – there were SO many and they are all absolutely gorgeous. I’m very excited about my skirt.

Lorein got her hair braided. Actually, it was a 2 day process, totaling about 18 hours. It looks SO good. I’m totally sold now, I figure if a pale, blond-haired, blue-eyed Dutch girl can have braids and have it look so great, I should be able to pull it off ok. I’ll probably get mine done in a month or so, just before I go home.

Planning for a new adventure this weekend is underway. In honor of Dayna’s last weekend (she leaves on Monday), we’re planning a nice, relaxing weekend in the Rift Valley, at Lake Bogoria or Lake Boringo. If we hire a private driver – which we probably will – we’ll spend one day at each lake. Lake Boringo has hot springs. It will probably be the 5 girls who went to Kakamega, plus Abby, a social work student from IUPUI who just arrived this week. I’m excited!

In other not so exciting news, I found a cockroach in my bed tonight. Actually, a mamma cockroach and a bunch of baby cockroaches. Eww eww eww eww EWWW! I’m normally not a complete girly girl when it comes to bugs and such, but really, IN MY BED??? Come ON!!?!?! So, I immediately stripped everything off, put clean sheets on, and hung my blankets outside for while. Still though, really really gross. Priti immediately checked her bed over as well.

Here’s hoping I’ll remain bug-free for the remaining 5 ½ weeks. Lala salama!