Today started with rounds, which included our sick male patient with pneumonia being managed with antibiotics and fluids, our child and young female with malaria, our two non-dilated pregnant women with abdominal pain and UTI, and our readmission for generalized fatigue and pneumonia. Rounds at the hospital are conducted by the medical providers who stay with the patients overnight and include some friendly “pimping” of the student doctors. For those not in the medical field, this involves asking questions of students to keep them engaged, thinking, and prepared for intern year. At the end of the day, wrong or right, we are all still a team and all still learning.
In clinic we saw many interesting cases, including a pretty severe case of herpes simplex virus on the bottom lip. The history included appearance and ulceration that started two weeks prior, and physical exam pointed away from squamous cell cancer (no lymphadenopathy, no lip palpable mass, no indolent course of presentation) and more toward HSV. We also completed numerous knee injections.
Several people also completed sexual education at the clinic. We taught a group of ten 18-22 year old students about family planning, access, and communication. They asked fantastic questions and seemed very engaged. The class was a mix of males and females and the goal was to increase communication between the two genders regarding this topic as well as to educate.
We do want to end this discussion with a particularly saddening story that occurred today. We were faced with a seizing 1-year-old the moment we got to the clinic. The boy had been having a tonic clonic generalized seizure for over 45 minutes and was extremely ill. He was tested for malaria, which returned positive, and we immediately gave him acetaminophen and IM/rectal diazepam. Unfortunately, starting an IV proved to be extremely difficult as the boy’s veins were collapsed secondary to hypovolemia. Several attempts were made in all extremities as well as his external jugular vein. After thirty minutes, a peripheral IV was eventually gotten and fluids started. The process was agonizing. Minutes of seizing turned into over an hour. After this hectic process, he was still breathing but remained rigid without pupillary or reflex responsiveness. Many times we experience pure hell as providers. Here was this 1-year-old child with his whole life ahead of him. Had he had been born in the United States he would have presented by ambulance in less than five minutes and gotten rapid intraosseous access. He also would not have presented with the illness of malaria. It’s unfair, unfortunate, and sickening. But it’s the reality and without the clinic many more children with malaria would not be diagnosed and not be treated. We left the clinic today without knowing if the boy would survive the night, and can only hope that the cerebral damage is not extensive. The best possible care was provided to this infant in a resource-limited setting. And, we must remember to keep our heads up because there are other patients tomorrow that need our care.