Dr. Hardison is in the U.S., and Dr. Morrison left this morning; Silus will be leaving for advanced medical training in less than a week. He and I made rounds today and found 6-year-old Whitney suffering from repetitive seizures. She was admitted yesterday after having received outpatient treatment at another clinic two weeks prior, following an unwitnessed "fall from a height."
Whitney's thigh wound, a nasty 10 cm slice, ended in a 3 cm hole which had been (sorry) inappropriately sutured closed. We opened, drained and wicked the wound, then prescribed IV fluids and antibiotics -- after we removed a 5 cm stick from the incision. Whitney was listless, and her verbal responses were limited, but her pupils were equal and reactive to light.
We kept her overnight for observation, in the hope that infection and fever were the causes. When she began suffering seizures this morning, however, we transferred Whitney to Kisumu's Provincial General Hospital. We can only pray she will be properly evaluated via CT scan for a subdural hematoma. There is no follow-up between hospitals, however, so we will never know.
In the midst of rounds, we were called to Maternity, where we determined that a 23-year-old multipara also needed to be transferred. Millicent was 28 weeks pregnant, bleeding and in pain. She had expelled a 13 cm "clot" after admission. We have no surgeon at Maseno Hospital, and Millicent's pregnancy is too advanced for a manual vacuum extraction.
On Ward II, 25-year-old HIV-positive Alice is tolerating IV Amphotericin B for cryptococcal meningitis remarkably well. However, she is weak and has begun spiking fevers, although she has also been on anti-TB medications for several months. Alice may not be able to withstand the necessary course of treatment; her caregivers are worried, and so are we.
Charles, 28, is still languishing on Ward I as a "discharge in," pending payment. He was ready to go home four days ago after recovering remarkably well from PCP pneumonia, but he could not afford the (minimal) mission hospital costs. Charles' employer agreed to lend his family the money. Charles' brother promptly disappeared with it -- a sad, but not uncommon, problem in a country where too many people are too hungry.
The good news? When we stopped by his bed, Charles was reading a small, well-worn Bible, open to the Gospel according to St. John. Silus asked Charles if that was his favorite book. "Yes," he nodded. Reminiscent of yesterday's ruminations, I exclaimed, "My confirmation verse was John 3:16!" Charles began to recite it in unison with me: "For God so loved the world that He gave his only begotten son, that whosoever believeth in Him shall not perish, but shall have everlasting life."It is Easter Monday, after all.
And it is my own beloved son's birthday, besides. Blessings, Rex! (There's that candle again...)