Me, walking into the hospital.
It’s hot. It’s tropical. And there’s all sorts of tropical diseases because of it.
Malaria in little kids under the age of five is the first thing that stands out. Every day there are many children extremely sick with cerebral malaria. 80-90 percent of them get better. But every week, some of them die.
Perhaps little Mohammad, between one and two years of age, comes with a mother or grandmother for more than a day’s walking journey. Sometimes the mother comes with a baby in a papoose. Mohammad presents with a fever and malaise, with vomiting, dry cough and seizures. If you present with that combination, you’re diagnosed with cerebral malaria. If untreated, he’ll seize, become septic and die. Often you’ll need to be treated with anti-malarials and antibiotics and IV fluids.
Some of them are very cute but it’s very sad to see how sick they are. There’s something about these little kids that are especially cute, maybe cherubic. One little guy I saw had such little muscle strength that he had a hard time keeping his neck up.
The nature of tropical medicine is full of celebration potential, but intermittent heartache. There’s a high burden of infectious diseases with severe pathology affecting young people. And whether it’s hepatitis or typhoid or osteomyelitis or meningitis, you see it all the time. It is unique to this place–not unique to Nalerigu just not in North America. These kids are life and death sick.
There’s simply a much higher birth rate here, and there’s high perinatal mortality, and high infant mortality. It is slowly getting better in Africa over the decades.
There are frustrations. We don’t have ampicillin. There isn’t any for septic babies. They should have it, and they don’t have it right now.
They didn’t have anti-snake venoms for 3 weeks. They don’t have ability to test for sugars–if you have IV anti-malarials that lower blood sugar, and the actual disease of cerebral malaria causes lower blood sugar, you can’t check for blood sugar levels which can cause a bunch of troubles in itself.
Entry to the OR…
I have seen some young kids have some major abdominal surgery for typhoid fever intestinal perforation. That is very sad. They are very stoic. If they don’t improve or turn around right away, their tummy gets hot and you have to assume that they have an intestinal perforation and they must go to surgery or they will die. Antibiotics will not cure them at that point. It’s really sad to see a five, a ten or a fifteen year old kid be so unhealthy and have a big laparotomy scar.
It’s sad, and they don’t have good painkillers for them afterwards. They seem quite courageous. There’s no screaming, or yelping, or signs of attention-getting. They’re not trying to tug on you to get something from you. Twelve to sixteen kids in bed cribs extremely sick. And then to see that twenty of them are sitting in their mother’s lap but half of them should be in those beds.
The very busy hospital…
Many of those kids should get a blood transfusion. You have to have a hemoglobin of 40 to get a blood transfusion.
It’s sad to see people with hepatitis. I know of a sixteen year old with an enormous liver in crisis and probably with cancer probably because he was born with Hepatitis B. These are all things in North America that are preventable because babies are immunized with Hepatitis B.
I saw a kid that was sixteen, diminutive, who for six to seven months has had a limp and swollen in his left thigh. At some point, he will have seen his local clinic and now he’s walked more than a day to get to this hospital and diagnosed with osteomyelitis. It eats away at the bone, and the bone becomes ‘moth-like eaten’. Now that he’s had it for six to seven months, he will need to have an ortho surgeon in Tamale, will be much shorter than his peers and will continue to have persistent troubles with his femur. He might have HIV or sickle cell anemia too. We didn’t keep him here long enough to find that all out. His father is going home to get money so he can get care in Tamale. He has health coverage with Ghana, but the cost of going to Tamale is very expensive (we flew into Tamale—a three hour drive for us).
They have physician assistants and Ghanaian assistants, and have ability to take care of people with or without missionary physicians, but the capability of the hospital, is able to handle bigger volumes and deal with more complex cases because of the help they get.
My instinct is that Ghanian people are stoic in the first place, and have an above average ability to tolerate troubles. Hearty. Super hearty.
Some get help, some don’t. You feel good for the ones that get help and feel rotten for the ones that don’t. It’s exhilarating, seeing people go from very sick to normalized, in a very short period of time, and disheartening for those who don’t. It’s gratifying to see so many of them recover.