Grace Chew’s Blog

7/3/2009: Day 24, Kapuna Hospital

The children’s ward round was in our slightly
incapable hands on Friday, because Dr. Valerie
was going to Baimuru for some HIV teaching, and
to bring Robbie and Debbie Petterson and another
medical student, Brent Cumming, back to Kapuna.
Thankfully for PNG timing, they didn’t leave till
past 9, and she was around after all during the
ward round to deal with the terribly sick patients, which there were.

Children’s ward round on Wednesday afternoon had
been busy and long, but I didn’t appreciate that
until now. It was a good thing many of them were
improving on their treatment, so I could say
“continue” quite safely. Then the CHW pointed to
a child and said “He’s fitting”. Alarm bells rang
in my head! And he truly was – not in a classic
tonic-clonic febrile seizure kind of way, but in
a more subtle way, that Dr. Valerie would tell us
later was characteristic of TB meningitis.

He’d been started on his TB treatment on
Wednesday, but was still spiking temperatures and
getting increasingly stary-eyed. He was given
phenobarbital to help him sleep the night before,
and Ruth and I were contemplating giving him
another dose, when Dr Valerie appeared on the
verandah. She decided that he should have a
lumbar puncture to positively diagnose TB
meningitis, not any other kind of meningitis, and
Ruth got to perform her first LP. It was crystal
clear, which made it TB, but by then he’d fitted
twice already, and his fits were getting longer.
A dose of rectal diazepam was given, but he
promptly moved his bowels and didn’t get the full
dose, so we had to give him another dose later,
to supplement the IM and oral Phenobarbital he
also got. With all that sedation, he was just
about out like a light, and I got to pass an NG
tube for him to get his medications and fluids.
Throughout the day he just lay there,
occasionally fitting, the fits becoming more
tonic-clonic in nature but fortunately not
increasing in length. My heart went out to the
family, and going through my mind the whole day was a prayer for little boy.

There was also a 10-year old girl who’d had IV
penicillin the day before, which had brought her
temperatures down to normal. Unfortunately, her
IV line came out before she’d had all her doses,
and the nurses tried unsuccessfully 3 times to
put another in. We decided to leave her be, but
in the afternoon her temperature went up again
and we had to put another line in for IV antibiotics.

A girl I saw in the ward round couldn’t stop
crying when I tried to look at her, and I
couldn’t see in her mouth for Candida or listen
to her chest at all! I spent a good 15 minutes
trying to coax her into keeping quiet but then
just sent her off to get her medicines.
Thankfully she was asleep when ward round was
over and I could finally examine her in peace.

Evening saw us still worrying about the fitting
baby and sick 10-year old girl, and still no sign
of Dr Valerie back from Baimuru! Thankfully the
adult and antenatal wards were relatively quiet –
only the old man with the mysterious knee
effusion which had seemed to respond to TB
medication had relapsed and gotten pain and
swelling in the knee again, but he’d also stopped
his NSAID doses, and restarting it brought the
pain and swelling down again, which was good.

Hearing Dr. Valerie’s voice was a sound for sore
ears! And after unloading all the issues in the
wards on her (and half-wondering how she did this
every day of the year) and realizing that we’d
done almost all the right things (and most
importantly not killed anyone!) a small sense of
satisfaction bloomed in my heart. The day felt
like the longest we’d had in Kapuna so far, and
definitely the most tiring and worrying, but
perhaps also the most satisfying. Seeing the baby
alert and sucking well from his mother’s breast
and not fitting any more this morning, and seeing
that girl who needed the IV drip keep her
temperature down, and seeing that the man with
the bad knee could move his knee freely again,
added to that satisfaction. So perhaps this is
why I’m willing to slog it out doing medicine…

Anyway, after this weekend we’ll be off doing
more doctor-ly duties on patrol, on the way to
Kikori. Expect tales of village living, and of
lots of babies being jabbed, and lots of searching for former patients!