Medicine in the Heart of Africa

This week is the week. This is the week I have been looking forward to because I was going to start to working regularly at the Nyahuka Health Center. With a healthy dose of fear for what might await, mixed with the sadistical excitement that only a doctor has for unusual findings and diseases, and a desire to engage the needs of this community we are already beginning to love, I got on my bike and headed to the hospital. Monday went well. I saw a few patients with Dr. Jennifer Myhre and a few on my own, asking Jennifer thousand questions about each. All in all, it was a mirenbe (peaceful) day.

Tuesday, before heading to the hospital, I found myself negotiating with the men doing four different projects at our house, treating patients that showed up at our door step. I did not make it to the hospital before I was picked up to go to a district health meeting to discuss the 47% malnutrition rate in our district that severely cripples mental and physical development of our children. Before this meeting was over, I was called away to another where Scott and I signed a couple dozen papers working out details about the new road that will be cutting through World Harvest Mission land. This road will bring much improved access to the resources of rest of the country. Thankfully, Jennifer had checked on the patients before the first meeting and made sure things were stable.

So today, Wednesday, after treating another patient at my doorstep, I headed back to the hospital.

Our team was already hard at work with a child that was brought in late yesterday with severe Kwashiokor Malnutrition. The child is 2 years old and his mother died a few months ago and the current caregiver wasunable to give him proper nutrition. He is now so severely malnourished that his body has no protein left to hold fluid within his tissue. The fluid has leaked into his skin, which is now sloughing off. We were unable to find a place to give him an IV line, so we placed a needle into his bone, where we were able to give him a blood transfusion and some much needed fluid. Heidi, a WHM teammate and a nurse, spent another hour covering his body with burn bandages to prevent joint strictures and infection.

We then moved on to our next sickest child, a 7 month old who had diarrhea. He may have had a chance of living through the diarrhea, but the parents took him to a “traditional healer”/witch doctor for treatment. I put the PC “traditional healer” in quotes because he performed an “extraction of a false tooth.” This is a common practice of theirs where they slice open the gums of babies to release “false teeth” to end the diarrhea. There are no false teeth and the gums become severely infected. Our child, who has diarrhea, now cannot eat. The parents had also refused IV antibiotics because of another traditional belief in internal sores, which are worsened by antibiotic medications. So we watched and pled. Today the child developed tachycardia (fast heart rate) and tachypnea (fast breathing) as his little heart and body started to go into failure from the malnourishment and anemia. After many pleas and a desperate prayer over the child, the parents finally agreed to an intramuscular injection of an antibiotic and a blood transfusion.

The next child has been in and out of the hospital, barely able to maintain enough weight to live. This time, Jennifer started her on TB medications and today, 14 days into the treatment, she has reached the minimal weight goal for health!

We next moved to my little friend who was admitted 3 weeks ago, also with severe edema from Kwashiokor malnutrition. He has lost 5kg of edemic fluid, revealing the fact that he is severely below the minimal weight needed to survive. However, he smiles at me and I can see the brightness of his eyes without the swelling eyelids and cheeks that once made his face unrecognizable. We are packing him with protein rich formula. The loss of edema indicates his body is now making protein and we are beginning to be hopeful for a recovery. A small child in the next bed also struggles to grasp hope of surviving. She was born 5 weeks ago without an anus. A fistula allows her to release stool, saving her life. Still, she presented two weeks ago with puss oozing out of every orfice. Today, she has gained weight again. With signs of the infection subsiding, we began looking for a hospital that will take her and perform the much needed surgery.

The next 20 beds are filled with children that have Sickle Cell disease, HIV, malaria, pneumonia and/or severe malnutrition. We finished the rounding in the ward with a child with severe 3^rd degree burns on his abdomen from hot tea, an erosive flesh eating bacteria on a 7 month olds nose and a premature infant who has miraculously made it to its 33 week of life (4 out of the womb!). We are thankful he is still alive this morning, but we are sad that the other mother of a similar age premature baby has left in the night. She heard her husband (whom she had not seen in 8 months) had died and she feared his spirit would haunt her if she did not visit the grave. She took her child and there is little hope of it surviving.

It is quite overwhelming to see these children

suffering. I looked around the room several times, realizing how incapable I am to treat them because of my lack of knowledge and our lack of resources. I also thanked the Lord a thousand times for Jennifer, Heidi, Nathan and the nursing staff who patiently loved these children and taught me what we can do.

After taking a little breath, we moved across the room to see the referrals from the outlying health centers. Here we treated a child with a swollen knee, concerning for a severe joint infection that could leave her cripple if not take her life and a child extremely lethargic- probably with severe malaria. The dismalness was counteracted with several children with sickle cell doing well on the preventive treatment course of zinc, penicillin and folic acid. Sickle Cell normally has a 98% death rate by the age of five. They had actually come back to get more medication and there is hope that they will survive.

We took the child with the swollen knee to the treatment room to withdrawal fluid. While prepping the patient, Jennifer was called away to a child that was “not doing well.” The child had an underlying diagnosis of HIV, developed cerebral malaria and began seizing. I finished aspirating the child’s knee and then opened up another strange abscess on the head of another patient and then went to join her. The seizing child was resting quietly. In fact, much of the crying and moans had stopped. The blood for transfusions was hanging (another small miracle) and the medicines were being given. I thanked the nurses, Jennifer, Heidi and Nathan, quietly thanked the Lord and slipped out to check on my wife and children. Amy had texted me that safari ants were attacking the house.

Please pray for these children. Jennifer promised that everyday is not quite like this. Then she added, “However, daily, life hangs by a thread here.”