Working in an inner city academic hospital for the last three
years has exposed me to many very sick patients. However, working in Congo with the
significant malnutrition, lack of routine medical care, extreme poverty, and
existence of tropical diseases has given the term “pathology” a whole new
meaning. I have felt more enlarged
spleens and livers here in one day then in the last year at Saint Louis
University.
A few days ago we saw a child who complained of a sore throat for
the last few weeks. She had been seen in
an outlying community health center and only took a few days of amoxicillin due
to a rash that started after the initiation of amoxicillin. She still complained of a sore throat and had
a faint rough nonerythematous rash on her trunk with a few areas of
desquamation. We were suspicious for
scarlet fever from what sounded like an inadequately treated strep throat and
told the patient to return the next day after starting a course of
erythromycin. The next day she had
significant desquamation of her distal extremities as well as her axillary and
inguinal folds that was accompanied with a “strawberry” tongue. This was a textbook presentation of scarlet
fever, a disease process that we do not see in the United States due to the
widespread use and--some would argue--overuse of antibiotics.
Then there was the 2 year old child who slowly lost her ability
to walk. She was seen by a doctor in the
capital city and given medication for malaria without help. Her mother brought her to the countryside
hospital of Vanga for further evaluation with its reputation as being one of
the best hospitals in the country. She
had a small kyphotic deformity of her upper spine with signs of upper motor
neuron injury and was subsequently diagnosed with tuberculosis of the spine
otherwise known as Pott’s disease. She
is responding well to treatment and is a very cute little girl! We are praying that she will recover her
ability to walk as treatment progresses and the infection is better controlled.
On the internal medicine service, we saw a middle aged female who
had presented with shortness of breath.
Her chest xray showed a heart that filled up almost two thirds of her
chest cavity with an echocardiogram showing a very large pericardial effusion
that was found to be due to tuberculosis.
Then there was the middle aged women with an amoebic hepatic abscess
being treated conservatively with anti-parasitic medication or the man who was
paralyzed from the waist down after suffering a spinal compression fracture
from falling out of a tree while collecting food. To make the situation even worse for this
gentlemen the local custom is to put the paralyzed person’s feet in the fire in
order to try to regain the ability to walk.
He now has a third degree burn on his foot with exposed bone and will
probably need an amputation in the near future due to the infected bone.
Last week, there was a small party consisting of bottled Fanta
and Coke with fresh peanuts and rolls.
This was to celebrate the start of a national research trial for a new
medication for the treatment of trypanosomiasis, which is otherwise called
“African sleeping sickness.” African
trypanosomiasis is an almost universally fatal disease if left untreated with the
highest number of cases found in Congo.
There is great hope that this new medication will be as efficacious as
the old medications but with less side effects.
Yesterday, we saw a very sad case of gram negative bacterial
meningitis in a 5 year old. The child is
doing better with antibiotics and steroids but will likely have some
neurological damage.
There are many sad stories but there are also many encouraging
stories such as the young boy with severe tetanus who gives me a big smile and
high five whenever I see him in the pediatric ward or the man who praises God
for his improvement after antibiotics and debridement for his extensive lower
extremity necrotizing fasciitis or “flesh eating bacteria” infection. The Lord has poured out His grace and mercy
in many real and tangible ways. The
faithful hospital staff display the hope and promises of Jesus Christ
everyday. We may be limited in our
diagnostic ability, limited in the availability or affordability of
medications, limited in the various treatments, but we are not limited in what
God can do physically or spiritually.
Jesus, the Great Physician, came into this world to not just heal
physical maladies but to heal us spiritually by making us right with God. He has promised to wash away our sins as far
as the east is from the west (Psalm 103:12) and to complete the good work that
he has started in us (Phil 1:6).
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