The first day of work

Before I go to the past, I will continue to give you updates on Richard, the little boy who we rescued Monday night. I wish the news was better. His neurological exam continues to be of grave concern: he is still not responsive, and continues to be very irritable. He is, at best, semi-awake. I fear that he had an ischemic neurologic event as a result of low blood flow to the brain that night. I will keep you all informed from day to day.

There were over 100 patients registered to be seen by 9 A.M. that day. They generally arrive by 8-8:30, many, if not most of them having traveled hours on foot on an uphill climb to the clinic. I saw only the babies and children, but there were plenty of those.

Simply learning the system was difficult enough. Each patient carries a small, paper notebook called a "fiche." The fiche contains the medical history. Much of the time, we have to make a new fiche at a given visit, either because they left the old one at home or because it is a new patient. I then register by hand all the data in a notebook, that data including name, first and last, age, sex, colline (hill), zone, and commune that they live in, followed by symptoms. The work was difficult, but, if nothing else, fascinating. I give you below a partial list of the patients I saw that morning.

1) 9 mo. old with moderate malnutrition, sent home on multivitamins and medication for parasites (Albendazole)

2) 6 year old female with scabies: treated with Benzyl Benzoate.

3) 6 year old boy, weight 24 lb., admitted tot he malnutrition ward for severe malnutrition

4) 9 year old boy with moderate malnutrition and pneumonia, sent home on Amoxicillin and multivitamins

5) 4 1/2 year old boy with fever and severe leg pain, past history of 5 transfusions, but no diagnosis made. Almost certainly has sickle cell disease, and is having a sickle cell crisis. Needs I.V. fluids and strong (narcotic pain medication). Appears jaundiced and very anemic, and presumably needs another transfusion, but can't do that here. Sent home on Paracetamol (their version of Tylenol), and father will have to carry him (child in too much pain to walk) two hours to a hospital that can do that

The last one is a bad story, and it is incomprehensible from our point of view. Such a thing could not happen in the United States. But, as I have learned already, this is Africa, and, even more specifically, it is Burundi. One cannot have the same expectations here as one has at home. My daughter asked me the next day if I knew what happened to the child after he left here. A logical question, but the answer is that there he is no way of knowing what happened to him; there is no ability to do follow-up. Occasionally, home visits are performed here, and I expect to go on some of those. however, this little boy in sickle cell crisis is a whole different situation. We have no way of communicating with these patients once they leave the clinic.

6) 9 year old girl with malaria and pneumonia. She was very sick, but not sick enough to be hospitalized. She was sent home on Quinine (for malaria) and Amoxicillin

7) 14 month old boy with moderately severe malnutrition. We advised that the boy be admitted to the malnutrition ward for treatment. However, the mother refused, because she has eight other children at home. She lives a four hour walk away from the hospital. She had to take care of the other children. The way it works on the malnutrition ward is someone, usually the mother, has to stay with the child in the hospital in order to feed him the high-calorie nutritional formula, first by syringe and then by spoon or cup.

This 14 month old child, who could not be admitted, was sent home on something called Plumpy-Nut, which is a very high calorie, protein supplement. It has has peanut butter in it (the kids love it). Also sent home on medication for parasites. As a demonstration of how tasty it is, here is a picture of a child on the malnutrition ward eating eating Plumpy-Nut. His enjoyment for it is obvious.

I will give you many more details about the malnutrition ward in coming blog posts. Will leave you now, with so much to tell, and not enough time right now to tell it. Muganga Peter (Dr. Peter, or as I am known now, Petero)