Foreskin Follies

That's what the doctor calls the current "occupation" of Maseno Hospital. Eighty 13-year-old boys are here for five days of education and circumcision, a pilot project funded by NGO's and facilitated by the CCC, in a well-documented effort to reduce the spread of HIV/ AIDS in Kenya. Three more waves of eighty adolescents each are scheduled to come during the next three weeks. A gaily-striped tent has been erected on the hospital lawn, and colorful plastic mattresses have been spread, wall-to-wall, on the floor of Pediatrics.

Fortunately, the hospital census is down, but the patients we have are sicker than ever. Among others, 80-year-old Truphena was admitted today. Her daughter brought her in after a young mentally-ill grandson had stabbed Truphena twice in the chest and tried to strangle her.

Phoebe Leah, 28, has been here for three days with her two-year-old son. Both are weak and listless, wasted by AIDS. Mama weights 35 kg, and Zedekiah weighs 7 kg. (A kilogram is 2.2 pounds; you can do the calculations.) Phoebe suffers from oral thrush and Kaposi's sarcoma; she also has KS lesions on her swollen right leg. The only treatment we have for KS is vincristine IV. She needs to be stronger before we administer it. Zedekiah is not walking, not talking and not smiling. His healthy 7-year old brother is being cared for by a grandmother. A middle child died three years ago. Because Zedekiah and his mother have AIDS, they were turned out of the house by his grandmother and his (HIV-positive) father -- who has another wife. Phoebe Leah and her youngest live in a shed on the edge of the property. She is too sick to work; whatever Phoebe is given to eat, she gives to her son. It isn't enough.
Benson, 10 years old, presented almost two weeks ago with a fever and pancytopenia. He cannot hear or speak, and his father is dead, so his mama spends most of her days at the hospital with him. She agreed to have her son tested for HIV since Benson had had a transfusion as a baby. He is HIV-positive. Since he is the middle child of three and his father had died, we needed to err on the side of caution: Mama and her other children were advised they should be tested. Sadly, all of them are HIV-positive. Fortunately, the CCC here offers excellent counseling and free anti-retroviral medications. But Benson is still spiking temperatures, and we cannot determine the cause. Pneumonias, aplastic anemia and malaria have been ruled out; he has been started on anti-TB meds. Perhaps he has an empyema?

Philip, 17, was brought by his mother to the Outpatient Department in the middle of the morning. He had fallen, hard, two days ago on a playing field at school and was complaining of abdominal pain. Ultrasound examination revealed a lacerated liver; we sent him by ambulance to Provincial Hospital in Kisumu where there is a surgeon.

Grace, 26, was admitted via the CCC this afternoon in a psychotic state. After 200 mg. of Thorazine and an injection of Valium, she was still combative. I foolishly forgot I was wearing my glasses while assisting with her examination. Grace managed to yank them off my face and crumple them with one bare hand. That's not quite the reason I anticipated I'd need a second pair, but I'm glad I packed both. Grace will be transferred to a psychiatric hospital tomorrow.

Tomorrow Kwan Kew Lai, an infectious disease physician from Boston, and I will go with Dr. Hardison and the mobile medical van to Ekwanda between morning and afternoon rounds. Our housemates Ralph (a UConn medical student) and Sue (a Boston EMT) will be leaving the hospital early to go on safari to the Maasai Mara. We may find our rambunctious pediatrics unit is somewhat more subdued by the time we all return.