Never a day without surprises

First of all, the "Richard" update. Against all odds and all expectations, he is improving. Last night and this morning, he consistently followed a light from side to side. More importantly, we even got two smiles out of him: conscious smiles. He no longer has a fever, and his breathing status has improved. I am cautiously optimistic at this point, with the emphasis on "cautiously." We go from day to day.

The second day at the clinic was busy, as I saw 15 patients. I admitted two more children for malnutrition. I have already gotten more adept at diagnosing malnutrition. All children, when they come into the clinic, have their weights and heights checked. There is a graph that we look at, which plots weight vs. height. If the child falls below a certain acceptable percentage of weight vs. height, then he is diagnosed with malnutrition. However, that graph is often misleading. Many of the malnourished children are edematous because of protein deficiency. They have excess fluid, and that excess fluid is usually in the abdomen and the lower extremities. But the edema artificially causes them to weigh more than they really do. When one treats the malnutrition, they often lose weight initially, because they lose fluid.

What is immediately evident about the malnourished children is that they all have the same look: the same total lack of expression, the same flat affect. They neither smile nor cry. They show no emotion. The picture below is an excellent example of a malnourished child. This is a three year old girl whom I admitted today. Note the swollen abdomen (filled with fluid), and, in particular, note the look on her face. That is the look of a malnourished child.

I have now become quite adept at writing orders for the malnourished patients; orders that include Vitamin A, Amoxicillin, Zinc, multivitamins, Iron, Folic Acid, and an anti-parasite pill called Albendazole. When they get to the unit, they are then started on a formula called F-75 (75 calories/100 ml.) made by the World Health Organization. There is a strict regimen that is followed in terms of how much formula per unit weight of the child per hour. More about that later.

My patient of the day was not malnourished. He was, instead, a four year old boy who had been bitten by a wild jackal. The jackal had gotten into their home, probably a hut, at night. The jackal had then bitten the boy's scalp, leaving three long linear lacerations. The mother had taken the boy to a local hospital the next day. Apparently, the wounds did not require suturing, but the doctors had appropriately put the child on antibiotics. They had also given the mother a paper telling her to come to our clinic for the anti-rabies vaccine. She eventually did so, walking nearly 60 kilometers (40 miles) to get to our clinic. When I saw the child, it was nine days after the animal bite; the scalp lesions had healed well, without any evidence of secondary infection. However, our clinic does not have the anti-rabies vaccine either, thus making her 60 km. trek pointless. We had to send her to another hospital, presumably another several hours away. The child does need the rabies vaccine, because there is rabies here, especially among wild animals. Will he get it? I have no way of knowing. One can only hope so.

I also learned today that, if a child in Burundi develops any type of childhood cancer, the chances of cure are zero. That's because there are no pediatric hematologist-oncologists in the entire country. Even if there were, there are no chemotherapeutic drugs here: too expensive. On the other hand, because of the available technology, it is unlikely that a child would be diagnosed with cancer here. But what's true in pediatrics is also true for adults: if an adult has cancer here, the chances of cure are also zero, again because there are no oncologists or chemotherapy drugs for adults either.

That is it for the day, signing off as I am known now: Muganga Petero