Liberia #20
How big does YOUR hernia have to be before you want it repaired? Now Ive seen old pictures in textbooks of men with their scrotum in a wheelbarrow because it is so large with elephantiasis. But for a hernia, not quite that large. How about when your scrotum is the size of a lemon? An orange? A grapefruit? Ive seen all these sizes this past week. Single side, both sides, young men, old men. All with pain that they have supported for months to years.
Im called to see a 14 year old girl in a car. I go out and listen to the story. Her father is well dressed in his slacks, nice shirt and tie. She sits in the front seat of what looks like a Honda accord. She has had rectal bleeding for 2 days. A week ago she had headache and fever. A little diarrhea yesterday. She hasn’t been around anyone sick or any dead people. I determine that she has enough symptoms to warrant an evaluation at an Ebola Treatment unit. I do not examine her. I prescribe some Cipro and Flagyl, in case this is dysentery, and refer her to the ETU.
“Doc, dere a burn” What? “Dere a burn outsite”. Ruth is telling me that there is a new patient with a burn outside. I ask where and she calls the name. A grandma, carries up a 1year old boy with both legs blistered and the right foot, white. I put on my gloves. The boy is not crying. As I touch a couple areas he crys, then stops when I stop. I touch his white foot, nothing. This is likely burned deep enough, that it has burned the sensation nerves. We check his temperature, and ask all the usual screening questions, to which all the answers are no. I have them weigh him and then start calculating how much fluid to give him within the next 8 hours then rest of the day. (there are specific formulas for this in burn resuscitation) I ask the family to find honey, so I can do the dressing with it.
Another girl arrives in a car outside, and Im asked to go down and evaluate by the PA. This week the PA’s are working- so much nicer not to have 30 patients in clinic waiting for me. This girl is late teens, or early 20’s. She has sores all over her body that they say have been there for a couple months. There is traditional “medicine” (looks like dung and grass) on the top of both feet which are each a huge sore. In Cameroon this would be to “draw the pus out” It is very effective. Imagine, you put cow dung on a open sore, and sure enough, pus comes out!!! She has had some vomiting and looks a bit pale, had a fever yesterday. This could all be from the chronic wounds, but Im not taking chances. I decide to prescribe her some medicine and send her home. I tell the family how to clean off that dung, and put honey and a dressing on those areas twice a day. I give her antibiotics and iron. If they do these things, she is likely to do well. If not, she won’t make it. This is the sad reality of living in the land where Ebola resides, everyone is cautious or over cautious. Many hospitals are still not providing any real services, partially because of staffing, partially because of fear…
A man arrives this evening who is short of breath. He has been this way for the past three days. He has a host of labs done at another hospital, and a chest x-ray. The labs show he is HIV positive, and has a high white blood count. The x-ray shows near complete white out of one side and markings of pneumonia on the other. I admit him and start treating for suspected HIV related lung infection. By the time he makes it to the floor he is dead.
I want to go for a run/walk on the beach, but am called to see another boy. He is 22 and has a urine catheter poking out of his lower abdomen from his bladder. It had been placed more than a year ago when he couldn’t urinate. He has been changing the catheter each month as requested, till this time when it has been 2 months. He went to another hospital and someone tried to pull out the old one and put in a new catheter. The old one came out partially. The balloon was outside the skin, but the tip wouldn’t come out. I gave it a good pull, stretching out the tube from 1 inch to 3 inches. The patient was all over the place but the catheter didn’t move. I didn’t have any instruments in my office. So I went to the storage room to look around. The OR was already locked. So I find a pair of clamps and put alcohol on them and poke them one in beside the tube. It was a slow process, causing a bit of pain. A catheter that has stayed in a while develops some hard stone like, buildup on the tip. So I slowly crushed this and eventually was able to get out the catheter. I reinserted another sterilely. He was much happier. I hope he can get a urethrogram and then come back, we may be able to help his stricture.
It is way past dark, so no run on the beach tonight.