Saturday, November 8, 2008


Her mother brought her to the hospital three days ago. Leah's chief complaint was a headache. She said her husband had died in 1996, and she asked us to let her die, too. Leah, 36, was thin and somewhat listless, but her conversations (in Kiswahili) were animated. She had no pain except the headache, her vital signs were normal, and her chest and abdomen were clear. HIV positive with a CD4 count of 238, her malaria smear was negative, and her FHG (full hemogram/CBC) was normal; there are no chem screen panels in Maseno. With not much to go on, but given the host of infectious possibilities here, Dr. Hardison started her on the antibiotic Ceftriaxone. We watched and waited.

Yesterday her mother reported that Leah had diarrhea. Her chest was still clear. At the same time, her temperature began to spike, and she quickly became unresponsive. Within two hours, she was comatose. We weren't sure why, but Leah was slipping away in front of our eyes. Ralph, a visiting med student from U.Conn, performed his first lumbar puncture to perfection; Leah's spinal fluid came out clear and without undue pressure -- although we have no gauge here. It was sent to our lab and the results were returned quickly: no cryptococcus, but Leah's glucose level was less than 1/4 of normal. With no previous history, she had lapsed into a hypoglycemic coma!

I sat next to Leah's mama while Dr. Hardison administered a bolus of IV dextrose and ordered D50. Leah roused and was responsive within minutes. Her previously frightened mother hugged and kissed me: "Thank you, thank you, thank you, Sister." Equally joyous, I replied, "We need to thank Dr. Hardison. And God." Since Leah is still febrile, there is certainly more going on than "just" hypoglycemia -- which Dr. Hardison says he sees surprisingly often here. But at least we can now begin to tackle that problem... and then head for the weekly orphan feeding program and mobile medical clinic in Esiandumba.

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