Submitted by Julie Ronecker

Today at clinic we were exposed to a variety of very serious illnesses. A dermatologist who graduated from our school joined us on the same day we saw a massive ankle infection with exposed tendons, subcuta

neous tissue, and overlying infection. Without a biopsy or culture, our best guess was Mycobacterium ulcerans. The woman had recently been scratched by a cat and the resulting skin infection was quite impressive. She underwent wound debridement, was given antibiotics that would penetrate the skin, and was informed about the need for further surgical debridement. Additionally, we saw a child who was 8-years-old and diagnosed previously with

sickle cell anemia. She was extremely ill, clutching her abdomen, and with cough and fever. On physical exam, she had splenomegaly to below her belly button (approximately 10cm below the costal line) and scleral icterus. Fortunately, her hemoglobin was 7.6, which for chronic sickle cell anemia is fairly normal. We discussed the need for her to get check up visits regularly and for careful monitoring of her hemoglobin yearly.

However, the mom brought up a good point: Would these extra check-up visits cost money? Unfortunately, regular visits like this could be costly and thus it was decided to watch her closely, bring her in during the acute crises, and keep her away from contact sports.  She was sent home on an antibiotic and counseled for the eventual need to be placed on a medication such as hydroxyurea.

We were also able to do several ultrasounds on women at various stages of pregnancy. The women loved to see their babies’ beating hearts and bodies within their uteruses. It brought such joy to them! We also continued to do knee injections and shoulder injections for patients with severe osteoarthritis. The most important part about a successful knee injection is when resistance is hit to move the needle into a different spot and aspirate to ensure injection within the synovial fluid. Steroidal injections are extremely effective and can help reduce the degenerative bone destruction occurring within the joint. It is important not to do more than one injection in a three-month period for risk of tendinopathy, tissue tenderness, and tearing secondary to weakness.

We also did several successful teeth extractions secondary to either infected or dead teeth. Patients were sent home on adequate pain medication to compensate for the painful procedure. We also diagnosed several new HIV cases and these individuals underwent counseling and began ARV medication treatment. ARVs are provided by the government of Kenya and the clinic has approximately 220 active patients that they track and follow.

At the end of the day, we were able to meet a young boy who Bonyo saved as a child. The 8-year-old was born to two HIV+ parents and within the first year of life experienced extreme failure to thrive. This kid would have died if not for Bonyo donating milk from a cow to feed the child for a year during the crucial stages of growth. Breastfeeding in HIV+ women is contraindicated for risk of transmission to the baby, thus, it is necessary to find an alternative source. Cows milk can be a safe and effective way to help kids with failure to thrive who cannot breastfeed. The child is now 8-years-old and enrolled at a local elementary school, but still visits the clinic regularly to visit Bonyo.

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