Medical Vignette

This post has no redeeming value but is just an example of the challenges of diagnosing things here in the Republic of Congo.

Last week we received a 5 yo in a coma. He had a fever for several days, had been seen at another medical facility and started on quinine for malaria. 2 days before he came in he developed a huge mass in his abdomen and his parents brought him to us to see if there was something we could do. He also had developed seizures as well.

When we originally saw him he responded only a little to pain, had a fever but had no other signs of meningitis. He did have a mass in his abdomen that moved pretty easily. He was anemic (hematocrit of 27) on his blood work but other values were ok. I did a spinal tap which was normal as well. We performed an US and found out the mass was actually a huge bladder that went up to his belly button. We placed a urinary catheter and got an urine sample. He had an urinary tract infection. We continued antimalarial treatment and started antibiotics for urinary tract infection.

Our initial thoughts is that he had a partially treated form of cerebral malaria and a secondary urinary tract infection and that with treatment for the malaria he would wake up.
2 days later he did not wake up.


Below are three pictures that should help with the diagnosis (tentative) that we made


Big sluggish eyes bilaterally.
















Chart showing fever curve, without a lot of sweating.














shows the urinary retention


















So what do you think? If you care to respond just leave a comment

Top Ten Reasons I like working in Africa

#10. I can blame my poor penmanship on French
#9. There is no electronic health record
#8. I can make comments to myself in English and not insult anyone
#7. Everyone in the room knows the patient diagnosis and will tell me if they aren't telling me the truth
#6. I don't have to worry about ICD-9 codes.
#5 I get to pray for patients without getting flak.
#4. No paperwork (well very little)
#3. No commute.
#2. I can now ask someone "are you passing gas?" in 3 different languages.
#1. No Lawyers

The one that is bigger than the list though is that God has pleased that our family and I should be here. Thanks for helping us through prayer and giving

Little Things

It's amazing the cliches that have popped up around "little things"
"The devil's in the details" "Don't sweat the small stuff" "Details create the big picture" "God is in the details" "It's the little details that are vital. Little things make big things happen" Are just some of the few that I've come across. Our past few weeks and months have been full of "little details" The list that follows is only partial and has good things and bad things in them.

A irritant rash on Caleb which is taking a long time to go away. We've gotten our money's worth of free advice of how to rid it and he is still dealing with it. Where's a doctor when you need one?

Bot fly infestations on Caleb. These little bugs burrow under your skin to grow into flies and Caleb has had about 10 of them now. At least we are getting better about recognizing and treating them.

Anna had two moles that popped up on her shoulder and back and were growing pretty quickly. We were able to get them removed and sent them to the US for pathology reports. Both were benign.

Leaky roofs and bathtubs.

Venomous snake in the front yard that was killed by one of our guards about 15min after I had walked through the same area without a flashlight.

Going a week without internet.

Going on a month without gas to cook with and using a small kerosene camping stove to cook meals.

Now makes one week of no gas for the refrigerator and so we can't keep the same quantity of food on hand.

Our new stove arrived this past week.....but we still are waiting on the gas.

team dynamics. I you read the last hospital newsletter on our blog site you know that our team is growing. the two nurses are breathing life and advocacy for the nursing staff here. The others are trying to fit in as well. With the growth comes change and with change often comes conflict. Change also allows old wounds to open again. Our team needs to love. To receive God's love, to love each other, and to love all we come across during our day. Ok this isn't a small one this is a big one. But this big one is affected by all those little things.

thanks for continuing to pray for us.