Sarah Cooper’s Blog

Lots and lots of malaria

 Today was another clinic day.  I was working with Dr. Faille, who is a career missionary in Nalerigu.  He grew up in Nalerigu and went to the states for medical training.  His father founded the hospital 50 years ago.  Dr. Faille is trained in family practice, but he has worked alongside surgeons from time to time here and has picked up different techniques from other visiting surgeons.  When visiting surgeons are not here, he acts as the surgeon performing a wide array of operations.  This makes his clinic population a much different variety than a true “family practice” clinic (which does not exist here, but I’m trying to get at the difference in working with two of the career physicians here.  The other family practice doc’s name is Dr. Hewitt and the OB/GYN is Dr. Dickens.)  I admitted one patient for malaria vs. appendicitis vs. typhoid fever and another patient for meningitis vs. malaria.  I was able to perform her lumbar puncture! 

 I had another patient that was emaciated.  He was an adult that weighed only 40 kilos and complained of fevers and pains for 6 months.  He also had a cough, but for only one week.  I sent him for an HIV test, which was negative.  This patient came late in the afternoon and I was unable to do a blood film and check for malaria.  (This is impossible after noon because the volume is so high in the lab.)  I ended up treating him for malaria and typhoid fever.  It seems that it is almost a waste of resources to check for malaria here because it is as common as high blood pressure in the states.  He will be coming back next week for us to check a Chest XR (rule out tuberculosis) and stool sample.

 After clinic we went down to the Theatre for some minor procedures.  A little girl was seen in clinic who was breathing very quickly.  Fortunately she did not have a fever.  Dr. Hewitt extracted about 3 ccs of pus from her chest during clinic and decided that she needed a chest tube.  Dr. Faille put in the chest tube and tons of pus came out of this empyema (pus collection).  I think that it was close to 500 ccs or half a liter.

 Tomorrow morning, I am looking forward to scrubbing into an ovarian torsion surgery.  I haven’t watched one of these before.  Dr. Dickens (OB/GYN) recently moved here with his family to complete a two year committment to the hospital.  He was busy moving in last week, although we were able to get to know him and his family at dinner each night.  I am looking forward to gaining more perspective of women’s healthcare in this third world region as he returns to work.

 I would like to take some time to describe the facility.  The hospital is broken up into several wards, which are basically just a large room with many beds in it.  The patients are responsible for their own food and most of them has a family member assisting in their care.  There are at least 30 babies in the pediatric ward and about 20 women and 20 men in their respective wards.  There is an isolation wards with three sections.  The first is for severe skin infections, many which require frequent debridement or possible skin grafting (Dr. Faille performs).  There are about 12 patients in this room now.  The second section is for meningitis.  Nalerigu is in the West Africa “Meninigitis Belt”.  Right now, this room is housing about 6-8 patients.  Apparently during outbreaks there will be a couple hundred cases.  The last outbreak was in 1997.  The third section is for tuberculosis.  There is no one requiring that service right now.  There is a tuberculosis clinic which is held once a week, but I did not help with that this week and I don’t have much knowledge of it.  There is also a maternity ward.  The routine cases are handled by midwives.

 The possible tests that we can order are very limited.  We can get a blood film (malaria), stool sample (parasites, etc.), white blood cell count, and a urinalysis.  We are also able to do a gram stain to look for bacteria in the lumbar puncture specimen (meningitis) and check it for white cells too.  As I talked about before, it is tricky to get the information out of the patients that we need.  I have access to translators, but they have a limited medical understanding and it’s difficult to convey the appropriate information to the patients.  When you consider these hindrances, in addition to the fact that I’ve never seen hardly any of these tropical diseases before, I feel like it is my first day of medical school again!  The physicians here are understanding and I’m sure used to other Americans going through a similar transition.