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#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

If any of you would like a similar experience, please come and visit any time…

#152 Shanksteps- Malaria
Day 1: Today is Friday. 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? Plasmodium Falciparium! 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 (funny) 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.

Wandala was grunting and holding his abdomen. He is an elder in a nearby church. He has had abdominal pain for two days. He has an IV dripping into his right arm. He lies on his side to relieve the pressure from all the bloating. I palpate his distended abdomen, which has no signs of peritonitis. He says that he had diarrhea yesterday and that he has eaten bouille (porridge) today. I get a typhoid test that is positive and hope that with treatment possible intestinal inflammation will resolve. I also place a nasogastric tube.
The next day is our “day off”. Which essentially means that we don’t make rounds and they call us less often. This day it means that we have a few calls that we take care of in their carnet (little medical record) then Jacques calls about 10AM and says I need to see a child. He has had also had a distended abdomen for two days. This one has a small hard mass at the umbilicus. A strangulated umbilical hernia. I ask them to get him ready. I see a few other patients the nurses ask me to see. Then to the OR.
I open up under the hernia. As I get into the abdomen cloudy fluid comes out. As I inspect the bowl from the small opening I see a black area. After pulling this out, I see that it is a necrotic piece of bowl, Richter’s hernia. I resect the dead area and go about making the anastomosis. As there are no staplers here, I do a hand-sewn anastomosis that takes some time. I write my note and leave the OR, I examine Wandala again, he says he feels better and has passed a little gas. I do a few ultrasounds before returning home. Audrey is sewing OR masks and hats and table drapes.
Today Audrey is helping out with the nationwide polio vaccination. She is climbing mountains looking for vaccination teams. She is to evaluate whether or not they are maintaining the vaccines in a cooler properly, filling out the paperwork for the vaccinated kids, and marking the houses of the families vaccinated correctly. I go in the hospital at 7AM, before morning worship, to evaluate Wandala. He is still very distended. Says he had a stool last night. He does not really appear to be improving.
The blade slides through the skin, then fascia. Intestines burst from their entrapment. They are very dilated. There is a twisted area of sigmoid volvulus that has blocked off the bowl. Fortunately for him, none is necrotic. I decide to close and await another day to prep him properly and resect the redundant bowl.
As I step outside to head to my office to see outpatients, it’s cooler today, 102F. I dread what it will be at the end of March. HOT! Greg