The week in review - medical segment.

I have decided to have a nonmedical and medical post this weekend, which gives you some flexibility in how much you want to read about the nitty-gritty of the hospital.  Most people seem to like the medical aspect, though,  and I will try to explain things in "regular English" too.  :)

The ward is busy right now (15-18 patients each day this week), and I think the type of patients are fairly typical of an average week.  I continue to be impressed with the high level of medical care that is provided to these kids with debilitating illnesses and conditions, but the reality is that we cannot always provide everything they need. 

Joseph is a 17 month old boy who came in with tuberculosis and congestive heart failure.  He was found to have an elevated left hemidiaphragm on his first chest xray, but the stomach bubble looked normal and it was unclear why the left hemidiaphragm was elevated.  That xray was not good quality and only PA (straight on, as opposed to from the side).  Lateral chest xrays are very difficult to get here, even if you order them.  

Joseph hanging out on his bed, doing much better than when he arrived.

A subsequent xray showed actual loops of bowel in his chest.

So, this little boy had a previously undiagnosed congenital (born with) diaphragmatic hernia!  (His stomach/intestines and spleen were in his chest cavity instead of his abdomen.)  When he was stable enough to go to the OR (called theatre here - even the spelling is British), he was repaired by our incredible pediatric surgeon, Erik Hansen.  Below is his immediate post-op xray, and he was doing beautifully!

Post-op...looking good!

Another little boy, named Philemon, also came in with a diagnosis of tuberculosis.  He had been on appropriate medications for 6 weeks but had continued to worsen.   Unfortunately, he was too sick already and there was not much we could do for him.  He acutely decompensated on the floor and was taken to the ICU, but died shortly after arrival.   He was our one death on the ward this week.

Notice the large pneumatocele on his right, not to mention the diseased lung tissue.

After the pneumatocele burst, his right lung totally collapsed.

Victory is a little boy who has one of the most patient, gentle mothers that I have met here.  She doesn't speak much English and my Kiswahili is still very rudimentary, so we can't have a conversation, but I love to watch her with him.  I thought he was going to die 3 or 4 weeks ago before we got a handle on his infection - and he needed blood but it took 3 days to find blood that matched his type!  She waited patiently with him, sharing his bed, and has never questioned what we are doing.  They have been here such a long time, but they may be ready to go home on Tuesday!  I asked mom how far away they live - 12 hours by matatu (a little Kenyan minibus packed with people)!!  Imagine being in a hospital with your very sick little boy for weeks, and then having to get into a crowded minibus and travel 12 hours home.  We have to plan to have his discharge ready early so they can catch an early matatu.  Please pray that he gets to leave and makes it home safely - I am going to miss them.

As I have mentioned, Rick and I are covering the pediatric ward during the week right now, but when we take call we cover kids in the ICU and nursery too.  A couple of weeks ago, I went to the delivery of a 27 weeker - she was 970 grams....that is 2.1 pounds!   She did not even need to be intubated, but breathed on her own with the help of CPAP (continuous positive airway pressure).  What a champ! :)

Baby M right after stabilization.

Baby M a couple of weeks later - not even on oxygen! :)

On my most recent call night, I was called to the resuscitation of a 37 weeker, who actually looked more like a 34 weeker.  She was only 1.45 kg, or 3.1 pounds, so she had not had a very healthy intraunterine life.  She looked like such a serious old woman who had already had a hard 8 months or so!  She needed oxygen, but I think she will do well.

Back to the ward, this little baby was admitted for severe malnutrition and rickets, but she is otherwise a totally healthy and developmentally normal 5 month old......only she weighs 2.7kg.  That is about 6 pounds.  She is only crying here because she didn't want to be undressed - she was a cute little thing often playing with a couple of small toys her mom had.  If you look closely, you may be able to see the knobs on each rib that one gets with severe rickets - in medical slang, it is called a rachetic rosary.  I had never felt one before coming to Kenya, but now I have felt many.

Six pounds at 5 months.

Mom wanted me to take a photo with me too. :)

On Friday, I had to tell one mom that her previously healthy 10 month old will never be normal, presumably because of the recent meningitis she had.  Also that day, I had to tell two different families that their daughters had cancer.  They both have a fairly good prognosis....if they are able to be treated.  One has Non-Hodgkin Lymphoma - that dad was stoic and focused during the entire conversation.  He asked good questions, but I could not get a good feeling for whether he would take the girl (a 5 year old) for treatment.  They live fairly close to a government hospital that offers chemotherapy, but the waiting lists for treatment are long and the costs are prohibitive for some families.  The other girl is still an inpatient in Kijabe - she came in with new onset severe headaches and seizures.  We were able to get an emergent head CT for her which showed a likely low-grade astrocytoma.  I think we will have to use the Needy Children's Fund for her MRI (about $200) to better delineate the tumor to see if she is a surgical candidate.  Kijabe Hospital has a very good neurosurgical department, so she is in the right place here.

During my talks with these families, I have found them to be very open to praying together - whether just with me or with the chaplain too.  The chaplaincy department here is so important - they come visit with the patients, learning about their lives and needs in a deeper way than we can; they come to family meetings that bring bad news to bear; they follow up with patients and families and help us know who needs financial help; they really care about these families and want to model Christ's love to them.  I am so thankful to be on a team with them!

For the most part, the patients have to overcome tremendous obstacles to be treated - transportation, finances, time away from family obligations or work.  Last week on Thursday, a father came to take his daughter and wife home because the wife was in danger of losing her job due to missing too many days.  I talked to the dad about how, if they left, I would need to see her back on Saturday, to which he agreed.  Then, as I have gotten into the habit of asking, I inquired about how far away they live - 5 hours.  So, they were going to leave at 4 or 5pm, ride a matatu 5 hours home so the wife could work on Friday, and then come back and go home again on Saturday.  Life is hard here.


Love,
Sarah
Matthew 11:28   Come to me, all who are weary and heavy-laden, and I will give you rest.