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It is Friday evening near sundown.  Maliki comes to my door to have me come see a 13 year old boy.  He says the boy may have meningitis, but is not sure and having bizarre reactions.  He has borrowed the motorcycle of the man who brought in the boy so I hop on the back and we head into the hospital.  Nearing the hospital he has difficulty slowing down as he finds out he breaks are not working well.

I walk into the ER and see an old woman holding the abdomen and back of the boy.  I ask Ibrahim (the boy) what is bothering him. He says that for two days now he has had sudden pain in his abdomen that then goes to his back.  Or it grabs his throat as if choking him.  As I am talking to him he cries out and grabs his throat with two hands.  About ten seconds later he appears fine.  I ask him about taking any drugs, or stuff others gave him, he hasn’t.  An uncle says that the day before this started he had a homosexual experience with another boy his age. The nurse starts making a clicking noise (surprise).  I remind the nurse to be professional, and that he should not display any reaction to things the patients tell us, whether we are surprised or not.  I give the boy water to drink and he gulps it down without problem.  I think of tetanus, rabies, meningitis, cerebral malaria, syphilis, and demon possession.  Doubt the last is on your differential in the USA, though maybe it should be!  Papa Sidi (our Chaplain) happens by and I ask him to pray with me for the boy.  The boy says he is Muslim and believes in Allah.  I tell him to trust in Allah and we are going to pray to God for help and healing.  The two of us, the nurse and student gather around the boy and we pray. Pray for healing and protection for this boy.  I look for some medications in the pharmacy to start his treatment for some of my differential diagnosis.  When I come back the boy is crying out and naming the names of sorcerers that he says are choking him.   The family decides that this must be his real problem.  They take him home to find a more powerful sorcerer to help him. I pray that God will protect him and that God’s name be glorified rather than a sorcerers.  Please pray for Ibrahim.
Trying to follow Him, Greg

#156 Shanksteps

Wednesday it was unbearably hot.  It was 113deg F in the shade as it has been but then it felt much hotter.  We had finished work and had gone home.  About 5 PM the wind kicked up.  It started really gusting.  Dust was thick in the air and we could not see across the soccer field in front of our house.  Even out to our own gate it was difficult to see.  We rapidly closed all the windows.  The power went out.  Wind with the power going out is usually a bad sign, it usually means that the power lines and poles are down somewhere between Mokolo and Koza.  This means that it will be many days before we get our power back.  It in fact is still out!  No power means no autoclave, no X-ray, even when our generator works.  It also means no water!

So the wind is howling and dust is in the air.  Then it starts to rain.  We usually get one solitary rain in April then it waits till June to start the rainy season.  The wind is whipping trees back and forth.  Branches are falling all around.  The tin roof over our truck is now loose on one side and waiving wildly in the wind.  Hail starts to fall all around.  On the tin roof of the house it gives a deafening sound.  Water starts to drip though our ceiling at different places.  Some the same as last year, others different.  I try to catch some in buckets, moving things out of the way.  The rain pelts the ground for about half an hour. A small river is flowing through our yard and leaving under the gate, and through the chain-linked fence. After the rain we hear chopping. There are many downed branches and people are running from all over to claim a down limb and start chopping on it.  I guess after it is downed it is not considered stealing, but only when it is still up on the tree. So I decided to go to the hospital and see the damage.  After walking out of my house I see our power lines are going down to the ground. A large tree branch has fallen on them and the bear wires are pulled down to the ground.  Further on I see a large power pole down.  A building behind my house had half of its tin room blown off.  On other hospital buildings there are tin pieces pointing to the sky or gone.   Workers saunter by telling how either their house or neighbor’s houses had lost their roofs during the storm.  Some houses even fell down with the rain and wind.  I ask how the patients did, and everyone is fine.  The nurse was just getting ready to call me when the storm began, so he asks me to see two patients in the ER.
To the right as I walk in is an 11yo boy laying on his back very still. His left leg is shorter than his right and pointed off at an oblique angle.  I can immediately see a large gash on his left knee going around to the back of his leg more then 10inches long.  His right foot has a huge gash that has separated the skin of the sole of his foot from the foot itself in a huge flap connected at the heal.  He appeared as if he was in significant pain but didn’t make a sound until I examined the leg that was pointing off to the side.   He had a femur fracture too.  The uncle who brought this boy into the hospital said that the two were playing on a rock when it rolled and crushed their legs beneath it.
To the left was a 10 yo boy laying on his side moaning.  His foot was wrapped in a cloth.  As I unwrap the cloth his toes and sole of his foot hang, detached from the rest of the foot that is left.   A metatarsal (midfoot bone) sticks straight out from the top of his foot, as does the bone going to the smallest toe on the same foot.
Both the boys need to go to the operating room.  I send someone to call Ganava and Jacques.  I return home and change cloths and head back with the medical students currently here.  Ganava is not in town and Jacques is late in coming.  The students and I set up the two in different OR rooms and we start cleaning the injuries.  Since there is no electricity, and the generator will not start, we work by headlamp.  First each gets an IV, Valium, Ketamine, antibiotics.  Then the scrubbing begins.  One med student on each child and myself and another giving meds, going back and forth between each room.  Jacques arrives and helps Travis on the child with a femur fracture and large lacerations.  I help in the other room where Elisa is cleaning, Kalaza, the boy with the badly crushed foot. We complete the amputation about mid foot.  Taking off the bones that are sticking out.  In the other room the huge lacerations are closed with drains.  I then go back in there and place a pin in his tibia (lower leg bone) to put him in Perkins traction for his femur fracture. Both boys are taken to the pediatric ward and the bed adjusted to accommodate traction.  Meaning, bricks put under the foot of the bed, weights placed with a string to the tibial pin, and the framework holding up the mattress let down so the leg is flexed at the knee.  We head home in the darkness, watching intently for scorpions.  It is their season now and I don’t want to experience one again.
It’s about 9:30PM and the temperature has cooled off to about 97degF.  It makes for difficult sleeping conditions. I shower, don’t dry off, and drip my way to bed.  I lay trying to not have any part of my body touch another part.  I drift to sleep before drying.  I awake a couple of hours later drenched in sweat and repeat the shower process to sleep again.  It makes me very thankful for electricity and water when they do come back.  We are now five days after the power has gone out and still no sign of the electric repairmen.  We are praying for repairmen.  Greg

#153 Shanksteps: Malaria: A Study

Day 1: It is Friday evening. Greg was called away to a meeting Monday- Wednesday so I was left to “hold down the fort”. It truly wasn’t too bad; there were no surgeries; I was able to sleep for 8 hours during the 3 days. I took Thursday off to “recuperate”, so why do I feel sooooo tired. MALARIA. And I thought my stomach hurt because I was drinking too much coffee. Again: MALARIA. That dizzy spell I had on Monday in the middle of clinic that I thought was due to not drinking enough water. MALARIA. The nightmares and difficulty sleeping – could it be due to stress or…MALARIA. I mentioned something to Eliza today and she said that I ought to get tested. Afterall, the test is free and the lab was on my way from the Peds ward to the Clinic. So, after telling the lab tech to take my blood, but not expect to find anything, was I surprised to find MALARIA. So, that’s why I’ve been feeling to crummy lately.

Since I feel like I’m going to die every time I take Quinine, Greg thought it would be educational (entertaining) if I kept a malaria journal for the next 7 days and explained to all of you what I was experiencing. So, welcome to my world of malaria and quinine.

Day 2: Saturday morning. I’ve only taken 2 doses of Quinine and already I feel like my brains have been replaced with cotton balls. Quinine causes cinchonism – or in non-medical terms, “buzzing” in the ears. In some ways this is a blessing. I sleep better with “white noise” (ya know: waves crashing, birds singing, fan turning etc), so the quinine has given me an involuntary, never-ending “white noise”. However, it also gives me nightmares (none too serious yet), and dizziness. I experienced the latter on the way to the bathroom. Good thing our hallway is not too wide as I used both sides to steady myself. I must have looked like I drank a little too much millet wine last night…

Some people have PTSD (Post Traumatic Stress Disorder) after experiencing a terrible event. I am sure I have PQSD – Post Quinine Stress Disorder. Every time I take Quinine, I feel like I’m going to die, or wish I already had. Fortunately, this is only the 4th time I’ve taken it in the 5 years we’ve been here. So, this morning I prepared my stomach for the assault. I ate egg gravy and toast to thoroughly coat my stomach with something resembling paste, as I am convinced that each and every quinine particle has a razor edge, or maybe teeth, in which to eat through my stomach. So far so good. My stomach is still hanging in for the fight. My tongue is another matter altogether. When the quinine tablet hits the back of the tongue, it is a gentle reminder to the rest of the body of what is to come. Quinine is terribly bitter – much more so than sucking on Aspirin. Once the quinine has infiltrated the body, all food and drink tastes a bit like quinine – and it gets stronger each day. YUM!

Well, it’s 9am and I’m off to take a nap – my first of many for the day. Only 18 more doses to go. Talk to ya again tomorrowJ

Aud

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