Day 21-24 Back at Daeyang Luke

The last week was spent at Daeyang Luke in the Casualty department.

 

The interesting cases of the week included a chronic traumatic knee

effusion, drained of course with a catheter. A older woman with a ulcerated left breast came in after 5

years! Previously diagnosed as eczema with a biopsy that was negative for Pagets, but likely very superficial. We had a post-op patient fistulotomy patient with an ileus vs. volvulus. The surgeon was quick to want to go to the OR but luckily was convinced to try to scope the patient first. On the ward the patient made a full recovery, but as per his wife was dying of hunger. The Malawians can't even go two days without their nsima!

 

Typical Solution at Daeyang, drain it with a catheter

 

Chronic traumatic knee effusion

Ileus vs. Volvulus? Post fistulotomy

Sadly we had one child this week with suspected cerebral malaria. She had be diagnosed the previous day with malaria, started on LA, but continued to have fever, and became progressively more altered. She responded only to pain on exam, and had periodic episodes where she would shake her arms and legs. It wasn't a typical seizure, and even after her fever came down, she continued to have periodic episodes of shaking, mainly with tactile stimulation. it was quite a feat to find some rectal Tylenol as it is not routinely given! I couldn't find an answer to whether PO could be used in the rectum on google! She was started on Quinine, and then treatment for suspected meningitis infection. Many children with cerebral have a very poor outcome, and live with long term seizure disorders, as well as physical and mental incapacities.  



Transferring a pediatric trauma patient,
Malawian ambulance driving is quite an
experience!



Writing admission orders, hard at work!

The other pediatric case of the week which was very disheartening was an auto vs. ped. The young boy was hearding cattle when he tried to get his cows across a street and was struck at 50kph. He had a GCS of 8 on  arrival and a large laceration on his forehead. He was taken to the CT scanner, and was not found to have a bleed, by our radiology scan. The boy was stable to be transferred to KCH, the community hospital which does have a neurosurgeon on staff. Granted, this hospital is frequently out of medications, anesthesia drugs, and even water!! The ambulance drive was a bit scary, I was hoping not to become a trauma patient myself!! 

The COGRATULATE cake! For Sister
Beak (Mission Director of Daeyang Luke)
 who earned the Florence Nightengale
award.

Thursday afternoon, was spent helping to run a seizure clinic.
Many of the children had been afflicted by malaria, meningitis, or complications during birth, and are now suffering from the sequelae. Trying to come up with combinations of carbamazepine, phenytoin, and phenobarb is definitely beyond my scope! I am not envious of neurologists!!