Today we went on another remote site visit. It was a 3 hour drive. At 5:00am, we stopped to pick up our translator/nurse, Rode (pronounced Roe-day). As we pulled up in the dark next to the cornfield in her front yard, we saw she had someone waiting with her. The husband of one of our inpatients needed to go to his village to get more food because his wife was hospitalized longer than expected (no bedside hospital dinners provided here!). Dr. Kubacki allowed him to jump in the truck. The saying in Portuguese is, there’s always room for one more. They really take this phrase to heart, especially in light of transportation since it’s so hard to come by. We dropped him off about 2 hours into the drive. Taking him here allowed us to see just how far he and his wife had come to get medical care.
At the clinic, we saw some interesting patients. One woman came in at 7 months pregnant and had high blood pressure and swelling. She had pre-eclampsia, a disease of pregnancy that can terminate the pregnancy if the disease progresses. In the US, we would put her in the hospital and monitor her vitals, lab tests, and her baby with much attention. Here, we could only give her a medicine to lower her blood pressure, advise her to take it easy, ask God to help, and send her on her way. There is no way she would be able to make it to the city for medical care.
On our way home, we stopped at the husband’s village to take him back to the hospital with his food. To our surprise, the husband was waiting there with a group of people standing around a little 12 year old boy sitting on the ground. We got out of the truck to greet the people, and one man in the group handed Dr. Kubacki the little boy’s medical card. The man started explaining that the boy had gotten a burn on his chest and arm as a toddler. Ever since then, his ability to walk has severely decreased. He wondered if we could do something for the burn so that he could walk again. We looked at the boy, and he stared quietly back at us. His legs and feet were emaciated and bent due to contractures- his tendons becoming tight. I put my hands out for him to grab and try to stand, and he had difficulty raising his arms and grasping onto my hands, let alone try to stand. This was no burn incident. This was Duchene’s Muscular Dystrophy, a genetic disease of muscle degeneration. This disease onset is coincidentally at the time this kiddo got his burn, at 2-3 years of age. He will only live to be about 20 years old because the disease progresses to involve the ability to breathe. Its difficult for me, I’ve found, to tell someone there’s nothing that can be done to heal their disease. Since people had to carry the boy for transport, we are looking to find a wheelchair for him.
When we arrived back in our home village, Cavango, we noticed the lights on at the hospital, which is not a good sign for evening hours. We entered in, and the nurse on shift told us there was a baby with malaria. We entered her exam room to find a 2 year old held in her grandmother’s arms, breathing loudly and rhythmically, with a blank upward stare. The child had cerebral malaria- when malaria effects the brain. In only 7 days of having the high fever, she developed into this grave condition. She traveled from hours away, with her father having to pay someone to take them on motorbike. Dr. Kubacki has never seen a baby with a case of malaria this severe survive. He told the child’s mother and father the prognosis: she was unlikely to live because the malaria has effected her brain. We would try to help, but our thinking was that she would not survive the night. We fluid-resuscitated the child and started antimalarial meds, but were unable to give the child the lifesaving blood she needs due to the inability to provide transfusions. The child’s breathing improved, but she continued to have seizures. I am again frustrated/saddened by the lack of resources there are for these people, yet encouraged that we could help with what little medical equipment we have. It has been quite the learning curve, having to provide care without having enough tools to do the best job for the patient.
If you know me, you know I am an animal lover almost as much as I am a people lover. On our way home from Camboli, we ran over a dog that trotted into the road. It was just another sign for the day of how extremely fragile life is, and in a strange and unpredictable way (illness, trauma..) it can be gone.