Yesterday's three-hour humdinger of a storm will guarantee that we'll have no electrical power in Maseno for awhile, so I'm working off the laptop's battery and typing (vs. dancing) as fast as I can, hoping to save and post this entry whenever we have "air time" again. We cannot complain; a drought and water rationing in Nairobi put our own mere power outages in perspective. We even had a 13" TV in the living room until it fried last night. It was quite a luxury -- although the local (Kiswahili) channel seemed to provide the only reliable reception. We could sometimes find Al Jazeera, however, and could occasionally even get BBC. Perhaps needless to say, every station in Maseno reports regularly on US politics. It will be interesting to be here on election day!
Meanwhile, we are celebrating the fresh morning air and sunshine, enjoying Emma's oatmeal, and readying for morning rounds at Maseno Hospital. The census was down when I arrived Sunday morning, but we had five new admissions before the day was out. Monday was Kenyatta Day, a national holiday; however, as always, there is no respite from illness and poverty in rural Kenya. In the Outpatient Department, a young mama presented with bilateral lactorrhea. She stopped nursing her youngest child two years ago, but lactation spontaneously recurred shortly thereafter. Two weeks ago, it stopped; her breasts are swollen and painful but not abscessed. She is being evaluated for a possible tumor of the pituitary gland and will return Friday.
On Ward I, we saw Washington, who came in too late for treatment for testicular torsion; he will be referred for an orchiectomy since we have no anesthetist here at present. John presented with severe headaches and has been referred to the CCC for VCT (voluntary counseling and testing for HIV) after Dr. Hardison ruled out cryptococcal meningitis. Another patient came in with gastric distress after attempting suicide; he had swallowed a liter of Formalin following an argument with his employer.
On Ward II, three-week old Abigail was admitted with possible malaria and has now spiked a temperature. Eunice, who had a stillborn baby two weeks ago, was transferred from Ward III/Maternity with recently-diagnosed HIV, probable TB and and a possible pulmonary embolism. She is 28 years old, in acute respiratory distress, and will probably not survive the day. Evelyne is recovering well after treatment for a Bartholins cyst. Two young HIV+ women are suffering acute pain with herpes zoster (shingles) -- one, involving the classic T-9/T-10 dermatomes, presented with one-sided pain and coalescing pustules around her right side; the other, with T-3 and C-8 involvement, has granulating tissue in a wide swath across her chest and back. She was misdiagnosed three weeks ago at another hospital as suffering from "spider bites." It is probably too late for antivirals to help either patient; we are limited to treating their symptoms -- codeine for pain, since there are no morphine drips and no Fentanyl patches here -- and encouraging both women to continue their ARV's. The majority of our patients are HIV-positive, with the accompanying immune suppression that invites a variety of complications.
Margaret, 43, however, is HIV-negative; she has nine children and will, sadly, be transferred to a hospital in Busia, her home town, for potential amputation. Her gaping "septic foot wound" -- which we had almost hoped was "just" gangrenous -- turned out to be malignant melanoma, and her lymph nodes are enlarged. Helen, 17, is suffering from unilateral swelling; she has been diagnosed with microphilia (elephantiasis) and will be treated with steroids. Kezia, a blind and deaf 81-year-old woman, came in with a fractured femur and will be transferred for surgery; she is fortunate to have a family that can afford it. And Otisa was admitted last night: after yesterday's heavy rains, the corrugated iron roof of her mud house had collapsed on her, broken her ankle and killed her one-year-old grandchild.
The list goes on... as do the prayers. Asante sana, dear friends.