Nathan & Megan’s Blog

Howdy!

Hey everybody,

Its been a couple of days since I’ve written (Megan’s better about writing), so I thought I would update you all on things here.  I’ll start off a little different tonight.

 Case Examples (its kind of like House, MD)  Sorry I’ll try not to be too graphic

1) 2 year old boy presents to the clinic with headache, fever, “yellow urine”, and mucous (red) stools.  Questions you’d like to ask…..Yes the kid has been vomiting, yes the kid has diarrhea.  We’ll stop there because that is usually as much as will get translated (unless we’re really persistent).  So you want the physical exam (next part).  Kid is warm, sweaty, pale conjunctiva, Heart rate is fast, some what sleepy/lethargic.  What is your differential diagnosis??? 

        Answer…..Malaria. 

 This a pretty common thing we see here, especially in rainy season.  At times I don’t believe it is so rampant, but the peds ward is full of malaria.  Most of the time it is not so bad, but after looking at the blood under a microscope and seeing the parasites if they look bad enough you’ll check to see if their anemic.  We transfuse for hematocrits >18 (hopefully they have a family member).   Lots of times they’ll have seizures due to the illness.  We have had a few kids really sick and not due well.

2) 49 year old female with waist pain (everyone has it), mice under skin, neck pain, fever, head ache, legs swelling.  Not much more to be had from the translator either.  Exam is mostly normal  (the people are very stoic about pain here).  Differential diagnosis.  Waist pain usually means low back pain. 

           Diagnosis: arthritis of the neck….probably malaria too

    Its amazing that most of these women do so well here.  When you walk around you see tons and tons of women carrying 20-30 pounds on their heads.  Pretty much anything you can think of.  Loads of sticks, water, food, etc.   We can’t do too much for them other than motrin and tylenol.  I don’t know how to tell them not to carry stuff on their heads since they rely on it so much.

We get lots of stuff like that in clinic.  We still haven’t determined what mice under the skin means.  We do see a lot of common stuff here as pointed out earlier.  Kids are a little different in that a lot of admits are for malnutrition, malaria, and respiratory stuff.  Also lots of newborns/preterm kids with fevers.   Common diagnoses for adults are pregnancy, heartburn, diabetes (most people do not have refrigerators for insulin), hypertension, arthritis, colds, abscesses, hernias, etc.  So, a lot of our training helps us out with that.

Call is usually when you see interesting stuff.  Although usually at the end of the day we help with procedures and stuff.  Lots of crazy skin infections and wounds (from bike wrecks and stuff).  Its been a really good experience with suturing and working with our hands. 

 Before I quit, the volunteers, myself and Megan included, tried fufu (a local delicacy yesterday) that a peace corps volunteer brought.  fufu consists of smashed yams.  Kind of like 1/2 cooked mashed potatoes with play dough consistency.  They usually eat it with soup (kind of a curry).  It was ok I would say.  The soup was good, the guineyfoul (chicken like) was good, but fufu not so much.  Its kind of like a filler (pasta, rice), but weird tecture.  But it was definitely worth trying as normally we have western food.

 The next two days are mine and megan’s last calls.  We leave for the capital on monday and site see for 2 days and head back wednesday.   We’re still doing well and will keep you updated.

 Nathan

 p.s. Chris Wheeler: If you want more details write me and I can share them, otherwise I’ll fill you in next time I see you.