Thursday's cases...

Here’s a peak into my world. I know this is a long entry but my clinic days are long. Stick with me and read about some of the patients I saw last week Thursday…

Clinic opens.

I picked my first patient out of the waiting room as soon as the patients found their seats because I knew I would have to refer him. 3 year old Solomon had a very swollen painful right eye. Apparently he had fallen down a few days earlier and dad thought it was time to take him to the clinic. Because of the possibility of a fracture I referred the child to the Surgical Center.

Next was a child my nurses prioritized…a 3 week old boy with fever and labored breathing. This plus mom saying the child was not breast feeding well, again ushered me to refer the child. He was too young to take any chances.

My next patient was 1 ½ years old. However, he could not sit, he could not crawl, he could not walk. His mother told me that this child’s development was definitely different than that of her first two children. A pediatrician told her 6 months ago that her child was fine. I soon found out that the child was born 2 months premature and that since birth his milestones had been delayed. He couldn’t even hold his head up. It seemed to me that this child had cerebral palsy. It was difficult to explain this to his mom and tell her that there is no cure. Her response was that it was okay, God gave her this child and she would take care of him. She said ‘nothing is impossible for God’. All I could do was encourage the mom and refer the child for physiotherapy. I was amazed by her optimism and dedication to her child.

9:15 am.

A few patients later it was 5 year old Mukeh’s turn. A very cute kid who was quick to tell me he wasn’t feeling well. This was quickly confirmed after he threw up in my office. He had been sick for 3 days with a fever, vomiting and abdominal pain. Besides the vomiting and a palpable spleen on examination he seemed alright. An hour after sending him to the lab I got his results back – malaria. Not a surprise. Fortunately while waiting, he managed to drink oral rehydration solution and when we gave him his first dose of antimalarial medicine, he was able to keep it down. I’m sure within a few days he’ll be feeling a lot better.

Nannah came in with a high fever, swelling of her limbs and a drop foot. The drop foot was a bit unusual, but made sense in the end. Nannah had been sick for 4 days. 3 days ago she went to a nurse who gave her an injection in her buttocks. Now Nannah has a drop foot due to the poor technique that was used. Besides the drop foot, I diagnosed Nannah with malaria and anemia (Hb 5.3g/dl). Many of the patients that come to the clinic have been elsewhere first (usually someone’s house) and gotten a number of injections. No one ever knows what kind of injections or what for…but they all seem to believe in them! Unfortunately in my opinion, they usually seem to do more harm than good.

Noon…

A mom came in carrying her 1 ½ year old girl. For three months now she has had a rash. The poor child had severely infected scabies- her feet were covered with open sores, lots of pus and crusts and just moving the feet made the child miserable. Needless to say, the child was not walking. Why the mom waited so long to come, I don’t know. Hopefully an anti-scabicide and course of antibiotics will help her feel a lot better.

More children with ear infections, coughs, fever, etc.

6 month old Memunata came in with her mom. Because the main symptom was diarrhea I drilled the mom about the child’s intake and was surprised to hear that she wasn’t breastfed. When asking why, her mom said the child was never breastfed because mom was trying to get a visa to go to America. The plan was to leave her child behind. I told her I was surprised and she just smiled. I asked her if she was married, she said no. I asked her if the pregnancy was planned, she said no. I told her that if she wasn’t planning on taking care of this sweet little girl, she better think twice about have more children. She smiled again. The focus quickly turned from Memunata’s illness (she was actually very happy and well) to mom’s social problems. In the end it turns out that mom is going to America to see her own mother, who left her when she was 4 years old. I asked her how she felt about growing up without her mother. She said she didn’t like it. I pointed out that her daughter would grow up without knowing her. She didn’t answer. In the end mom left with nutritional advice, vitamins and ORS for her child. And I was left wondering if little Memunata would ever get to know her mom.

I ended the day with a couple of follow-up cases…a 1 ½ year old boy who was malnourished but is slowly starting to gain weight…a 4 year old with chronic ear infections who still has discharge coming out of her ears but also ended up having malaria which I could treat…a very adorable 3 year old who I diagnosed with malaria and anemia a week ago and is slowly getting better.

5pm. 45 patients later. An early finish compared to the rest of the week. Time for a run on the beach and to reflect on the day’s interactions.