"Half a Hospital"

It is sometimes frustrating to practice medicine in a developing country because the resources are so limited. "Routine" chem screens are not routine and are, in fact, very difficult (and very expensive) to come by. Third and fourth generation antibiotics do not exist. Without a surgeon, we cannot do more than the most basic procedures in Maseno. Dr. Hardison shakes his head and mutters, "We'll never be more than half a hospital."

But half a hospital is better than none if you are Eunice or Otima or Daniel or Fillister or Margaret. To our great, albeit guarded, joy, Eunice is still alive, apparently responding to the aggressive, if limited, treatments that Dr. Hardison prescribed. Her fever is subsiding and her respirations are easing. She is still gravely ill, but we pray with her Mama that she will continue to improve. Otima's broken bone has been set, and Ibuprofen has been dispensed. She will be discharged in time to go to her granddaughter's funeral today. Daniel was seen in the Outpatient Department this morning and referred immediately to Kisumu for surgery. Had he waited any longer or gone somewhere else, a delayed diagnosis of his inguinal hernia might have created the necessity for major surgery/bowel resection.

Fillister, accompanied by her three-year-old daughter, Doracilla, was admitted with the classic symptoms of TB. Severely scarred and disfigured by burns from a stove explosion two years ago, she was then abandoned by her HIV-positive husband. Fillister may well be positive, herself. In addition to testing and treatment for probable TB, she needs to be tested for HIV, and so does her little girl. HIV infection, resulting in a depressed immune system, is of course the primary reason people contract the countless opportunistic infections we see here. (Later NB: Fillister is HIV-negative; hurrah!)

Margaret was admitted after being run over by a piki-piki (motorized boda-boda). We tended her injuries, did a chest xray because she complained of a one-year history of coughing, and discovered that she, too, has TB. Margaret was then tested for HIV and was found to be positive. She will recover from her injuries and will be referred, with her husband, for VCT (Voluntary Counseling and Testing).

Both of these women should be able to live long and productive lives, thanks to anti-TB treatment and free anti-retroviral medications. But Margaret's marriage, also, may well dissolve through no fault of her own. The rate of HIV infection in females in Africa is much greater than that for males. Polygamy is legal in Kenya. For men. If a male is infected... well, we can all figure the odds for infection, as well as for abandonment.

As afternoon rounds are about to begin at our "half-hospital," though, I remember that even in America, the other half of getting well is always hope.