all in a day's work

Sending home a little 7 year old sickle cell disease patient who presented extremely ill, unstable, septic a few days ago, but now is walking out on his own, the wonders of IV antibiotics. I've been caring for Aligonila since he was born, struggled many times in his early years to get him knick-of-time lifesaving transfusions, and sat with his mother's tears when her other child with sickle cell was brought in dead from his grandparents where he had been staying. This family is the same one supporting little Lydia whose burns are healing. . . soft-spoken and genuinely concerned father who numbs his burdens with alcohol . . . this is a taste of small town family medicine, the continuity over time and the spread of relationship over a complex web of consanguinity.

Staff meeting topic of the day: teeth, their normal pattern of erruption, the basics of preventive hygiene and care. It is a topic I want to focus on for a while, because of the insidious and destructive belief that "bhino", a bad or false tooth, in an infant's gum is the source of diarrheal disease and removal by razor blade incision can cure. In fact, the removal often leads to death as the baby stops drinking or the wound becomes infected. Rousing discussion from the staff in which it became clear to me: these people are not REALLY convinced themselves that the "bhino" hoax is wrong. There is lingering doubt in their minds. They would prefer to get the gums cut and then inject the baby with penicillin. Cover all the bases, witchcraft and science. If the staff are ambivalent, no wonder the villagers take their babies to ritual specialists for this dangerous procedure! I try to affirm the underlying good of this culture's value on children, of their desire to do what it takes to cure . . while suggesting that culture constantly changes and there are choices involved in what we embrace and reject. The intersection of medicine and anthropology always interests me, the connection between behaviour and health, between belief and action.

Last inpatient of the morning: a premature baby who in six weeks has held onto life and climbed from just over 1 kg (2.2 pounds) to a whopping 2.08 kg today (4 1/2 pounds). I realize her teenage mother's entire experience of parenthood has been in that hospital bed, she is gigglingly happy for the victory but intimidated to leave our care and be discharged. Last outpatient: a 2 year old with the tiniest head I've ever seen, almost no substance above the eyebrow line, blind and deaf and spastic, but with a matching suit of clothes and healthy skin, evidence of a mother's careful sacrifice month after month. I'm humbled by her perseverance, though unable to offer much more than seizure control and vitamins. Last kitubbi-at-home patient of the day: a two month old with a heart rate almost too fast to count, 260-300 beats a minute, whom we've treated for a few days in the hospital for infection or dehydration. But this baby looks and acts well, it is just a rollicking heart that can't hold out like that forever. So we bring him home where I have a fridge, fill a bag with ice water, and while Heidi monitors his heart with a stethoscope I basically smother him with a freezing damp face pack. He holds his breath and the newborn diving reflex kicks in, breaking the gallop down to a reasonable trot of 150 beats/minute. I don't want parents to trust tooth-extracting witch doctors, but I do want this mother to let me apparently suffocate her baby . . .

Scott comes back from Bundibugyo town with packages galore for the team, Nathan's mom and my mom, Stephanie Jilcott and friends of the Massos and Pierces and Heidi, a delayed Christmas. And he brings Ivan's PLE scores, division 1, which puts him in the top 5% in the nation this past year. We are thrilled for him.

On to pizza preparation and team meeting as a surprise rain soaks the ground, cleaning and catching up with correspondence. All in a day's work.