Rooftop (highs) and pediatric (lows)

The heavy rains started a few days ago but no tornadoes. Two nights ago it was raining lightly and I heard a “thud” on my roof. I live in a house with concrete walls and a corrugated steel roof. Shortly after the “thud” I heard a scratching sound and then the sound moved across the roof. Since a tree branch hangs about a foot over the edge of my roof, I figured something fell off (i.e. branch, fruit). As I waited to see something hit the ground out of my window, nothing came. I realized then that something alive was on my roof, likely a monkey. I proceeded to close the windows and go to bed, praying I wouldn’t encounter whatever was on the roof. J I survived.

Medicine here in Africa is very different and challenging. Several labs I’m used to checking are not available here. In the midst of malaria season we have several anemic patients, with hematocrit down to 15% or lower. We normally transfuse if they are <16%, but today we were made aware we had three units of blood left in the hospital until a new supply comes in a few days. This makes us seriously consider whether or not to use the blood in case of a postpartum hemorrhage or need for it during surgery.

One other challenge here is the lack of advanced medical care. In the US, basically any necessary treatment can be obtained. That is not the case here because specialists and resources are not available. We have a 5 year-old boy named Nelson on the pediatric ward. Every day I see him it is sad because he has developed untreatable congestive heart failure. We are not sure if it is congenital or acquired (rheumatic heart disease) but regardless his heart isn’t pumping correctly. Because of this, he is retaining too much fluid which is collecting in his lungs and abdominal area. He has difficulty breathing because of the fluid in his lungs and his stomach skin is tight due to the distention caused by intra-abdominal fluid. He leans backward to compensate.  We are giving him diuretics, trying to help his kidneys eliminate the fluid, but it isn’t working too well. If he were in the US, he’d be a candidate for a heart transplant and have a much better prognosis. In his current state, he will be lucky to last a few months. He can barely walk 15 feet without being short of breath. Regardless of changes to our healthcare system, it’s meeting patients like Nelson that makes me grateful for the access to healthcare we have in the US. We’d appreciate your prayers for Nelson.

On a brighter note, we discharged Mata, the girl with cerebral malaria, on Monday. She went home with her whole family! Thanks for your prayers!

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