KCH and Bright Vision

Well, I had planned on Monday at KCH Casualty, but I was exhausted after all the wedding 'going-ons' so pretty much took the day off. Tuesday Anne and the kids left, but I didn't see them- there was a death of an orphan at Pothawira village, so they were dropped early by Maggie, who then stopped by here, and a funeral was held for the child down at Pothawira. I spent Wednesday at KCH in the Casualty. If you are not my friend on Facebook, you should be, as it is always sometime going on there. The interns and I had an issue with a radiology tech, but hopefully that is straightened out. We saw lots of urology problems - suprapubic catheters specifically, along with some RTAs (road traffic accidents), admitted kids with spinal bifida for surgery (apparently a common problem here). One poor little guy had gotten caught in a grass fire with major burns and was transferred from another hospital to the KCH ''burn unit". A youngish guy with an immense scrotal swelling, diagnosed with 'hydrocele' but I was concerned it might be testicular cancer. Lump, bumps, swellings and growths that I have not idea what there were / are. The interns are such hard working young doctors! I am always impressed by what they do with such limited resources. That night I had Charles Msukwa and his sweet family, along with Clifford over for dinner. It was very pleasant!
Maggie came Wednesday night, so Thursday morning we did ward rounds at Partners in Hope. They have some very, very sick people. At least they have more resources that most places here, but still they are limited. The doctors I had the privilege of making the rounds with are just flat out SMART! I mean, these guys have to deal with all the 'usual' problems of sick people - strokes, sepsis, newly discovered cancers, congestive heart failure, renal failure, Stephen Johnson Syndrome AND add on top of that, many (but not all) of their patients have HIV/AIDs, some who have defaulted (quit taking their meds) or were just diagnosed, so that have the overlying problems of miliary TB, metastatic Kaposi's sarcoma, etc. Obviously some of the meds for the different problems interact poorly. They have a real balancing act trying to treat their patients. Dr. Perry Jansen has put together an awesome team at Partners in Hope!
In the afternoon, Maggie and I went to the Children of Blessing Trust seizure clinic again. These patients can be challenging. And I get the easy ones! When they are doing well, no seizures, no side effects, no big weight changes, it is an easy refill. However, when things go back, it can get confusing. Are the new 'startles' in a child break through seizures or does he have malaria and fever? Is the medication causing the aggressive behavior, or is it part of the spectrum of the disorder the patient has? Should be change meds - risking uptick in seizures but maybe improved overall behavior? All this without any drug levels, liver function tests, and most of the time, without a clear idea of why the patient has seizures. Dr. Young, Dr. Hodges and Kathy Bowler are doing amazing work there and I feel privileged to be able to help in some small way.
Friday we all went to Bright Vision orphan care. We saw more adults than kids, and I have no idea how many but I think it was pushing 200. The nurse, Maxwell, was taking BPs but when he identified a straight forward patient (general body pain or just needed BP meds) he wrote the prescription and skipped over me. He did the same with the kids with malaria. It was wild, disorganized and just plain crazy. Fortunately, we had a strong team and managed to somehow pull it off, but I didn't drink, eat, or go to the toilet from before 8 AM until sometime after 3 PM. I figure I can sleep 8 hours without that, so I should be able to work 8 hours like that, right? However, I think next year we will work on our organizational skills with these village clinics. I realize we don't really make patients with hypertension, diabetes, or heart problems better in the long run. However, my translator and I spent some time with these chronic patients to explain the chronicity of their disease. I would like to start basic education in diseases as a regular part of these clinics (but I need more people!). I think we do make a difference to the people with acute infections, including malaria and infected wounds.  We also found a very small 2 year old with cerebral palsy (diagnosed in her health passport) whose Mom seemed totally unaware of the diagnosis and what that meant for this child's life. The baby apparently 'cries all the time' and 'startles'. We referred them to Children of Blessing - Maxwell lives in area 25 and was able to give them directions and I was able to give them the clinic dates. Hopefully the Mom will take this child, it is the best (and maybe only) chance this kiddo has! I leave Monday. I have no more clinics planned. I did treat one of the guard's little ones early this morning (in the living room clinic), but otherwise, packing, distributing left over medications, seeing people for the last time for a year. It is a melancholy time for me, especially with Whiskas and his wife.  They are precious people and this country can be hard on the older people. Enjoy the photos. Prayerfully consider whether YOU are called to this mission. Thanks for all of the support and prayers.

Bright Vision orphan care is set up next to this huge ? granite dome. The main building is on the right of the photo.

The people are gathering for the clinic

Maxwell is checking blood pressures. The small white cap is the pinkish pills - albendazone. We worm everyone who comes to these clinics.

Amy, my translator, trying to get a history from this gentleman. It was a challenge. You can see the crowds starting to gather in the back

Pharmacy staff hard at work, Annualitta Motope, Larry Brown, and others worked hard all day!

This lady had eruptions  on her foot. She gave the story that they would spread all over her body, itch, and then disappear but always stayed on her foot. I have no clue!

This was the smiling-est (if that is a word) baby I had seen in a long time! He looks much happier than Mom!

Again, trying to get a history from an elderly woman, fortunately she had her health passport with her, and it documented CHF and cardiomegaly. She had medications, but they were 'finished' and she was sick again and didn't understand why. We need some basic medical education here! Also note how the crowd continues to grow in the background. And it is very, very loud!

Pharmacy still hard at work, and the crowd grows!

At the end, we all had to pitch in to get the patient's prescriptions filled. I am not a  very good pharmacist!

The team (except for Charles, who was taking the photo). Do we look exhausted?  Well, we are!

This morning my guard, Grey, brought his little son, Samuel, by the house to be checked. Fortunately I had not packed up all the meds, and had some liquid antibiotics for him.