Amazing Day

This is the view over looking the hospital.  How would you like to see this everyday?

  It was a very good day today here at Kibogora.  Since being here I have hoped that I am doing some good and making a difference, but today I really felt it.  The first patient I saw this morning on rounds was an 18 year old student studying pre-medicine who was admitted last night with fever and headaches.  I took one look at the kid and said this kid looks like he has meningitis.  I gave him a dose of ceftaxime (that is the only cephalosporin we have) and a dose of dexamethsone.  Sure enough his lumbar puncture was positive for gram-negative intracellular diplococcus.  For those of you that don’t know, that is nesseria meningitis, which is one of the most contagious and if not caught in the first 24-36 hours deadly bacteria there is.  He is doing well now.  Unfortunately, now we are concerned because these kids live in dorm room of like 50 kids to one big room.  I am praying we don’t have the start of an epidemic. 

 One of the missionary nurses just left, and this Saturday the nurses from the hospital threw her a party at one of their homes.  This would be a tradition Rwandan meal.  It has fish, notice cooked head, scales, and all; noodles, fried bananas, rice, some kind of beef, and a soup/gravy.

  

Later on I saw a patient that I had been trying to convince the other doctors here to start TB treatment since I arrived.  See even though she was a 20 year old with fever, weight loss, and hemoptysis and was still spiking fevers despite 4 different antibiotic trials, she was not able to produce any sputum.  Their national protocols do not let them start TB treatment without positive sputum.  However, last week after my continue persistence we started treatment.  She has been fever free for 3 days and is starting to look a little better.

Just another view of the beautiful Rwanda countryside.

  Finally one of the last patients I rounded on today was a young female who was 6 weeks post partum.  She came in complaining of fever, throat pain, and weight loss.  She had been tried on antibiotics for strep throat as well as anti-fungals.  The doctors had demised her as a psychiatric problem because they felt she was faking because she didn’t want to go home because she had no father to support her and her new baby (not that is completely unheard of here).  However, when I looked at her chart I saw she was still spiking fevers up to 40 C.  I felt that something just wasn’t right.  I ended checking a chest x-ray just because of the fever even though her physical exam was normal except for her being very thin and having a slightly enlarge liver.  However, after 3 weeks here I am convinced almost all of Rwanda has enlarged livers.  Her chest x-ray looked exactly like miliary TB.  This is a very aggressive form of tuberculosis for those who have never seen it.  She is now on TB treatment, and her six week old baby is on INH prophylaxis to hopefully keep him from getting it.

View of sunrise through the rain forest where we saw the chimps.

  As if this wasn’t enough, I gave a lecture yesterday on EKG and common heart problems.  I was trying to correct some of the improper treatments I had seen of patient with hypertension and congestive heart failure.  Today one of the doctors called me into the emergency room to help him look at an EKG.  He had correctly diagnosed the patient as having decompensated heart failure.  He had already given Lasix with potassium.  He had already talked about starting her on an ACE Inhibitor and then a beta blocker when she was feeling better.  He never even once mentioned giving her digoxin, and he had read her EKG complete right.  I was so excited.

  So all in all, it was an amazing day today.  I really felt like that work I am doing is helping people.  Hopefully, I am able to make some changes that will last even after I am gone.  I am so glad that God has given me this amazing opportunity.