Wednesday, March 14, 2012
Paediatrics in Kenya
This week included: Nadia, below, who was found abandoned in a field with her umbilical cord attached, presumably shortly after birth. Someone brought her to Kijabe, where the police and child welfare are now involved. She was named by the nursing staff and is loved and held and fed. Seems unlikely that her mother will be traced. And a sampling of others from the last couple of days: cryptococcal meningitis, a rare fungal brain infection in a child with AIDS. Bacterial meningitis leaving a 12 year old spastic and uncommunicative. Viral meningitis in an otherwise normal kid. Pneumonia, and more pneumonia. A new case of TB, and old case of TB needing retreatment. Your basic gastroenteritis with crazy imablances of body fluids and electrolytes. A 4 year old whose parents brought him from near Somalia carrying an xray that shows his fibula (small bone of lower leg) has been almost completely eaten away by infection in the two months it took them to get care. A 2 year old covered in scabies. A 7-pound 1 1/2 year old. A teenager with sickle cell and pain. A little girl with nephrotic syndrome, a kidney disease. A baby whose mother stopped breast feeding too early in an attempt to prevent him from becoming infected with her HIV virus. A severely jaundiced 1-month old who stopped breathing while we were drawing his blood. A preemie who had lost a third of his weight after going home too early from another hospital. Toddlers with rickets, and more rickets, irritable and weak and developmentally delayed and breathing too fast. Malaria (rare here). A new diagnosis of a bleeding disorder called Von Willebrand's. Urinary tract infection. Congenital anomalies of the intestines, and the brain. And the face and the heart. We end with this little baby from the Maasai Mara, which is not just a game reserve but also people's home. He wasn't feeding or growing well due to a cleft lip and palate. But when he remained rather dusky blue on lots of oxygen Mardi wisely suspected congenital heart disease. His young parents were worried about the bill and ready to just leave, but thanks to the Needy Children's Fund we were able to pay for an ambulance ride to a cardiologist for a real diagnosis. Sadly Brian has no real connection from his heart to his lungs, and can only live until the ductus arteriosis (normally present in fetal life but closes after birth) fully shuts down. Then he will die. Our palliative care team and chaplain and I sat down and explained and prayed and made a plan for him to go home comfortably.That's a sampling of is carried into our doors in a few days. Sometimes I wish for something simpler, for consistent and treatable problems so I can feel more competent. But if I stop to think about it I know it is a gift to be challenged and stretched. To be learning. To be carrying the lives of these children in my hands, and to hand them off to my partner as well. To be honest with bad news and limitations, and to encourage those who are fearful. To form those brief but intense bonds with parents at the bedside. Agnes' mom found me today before she left the hospital, and gave me a big hug. In the non-stop pulled-in-ten-directions work these days she reminds me that it is worth it.