Take this case for example. On
Mondays and Thursdays, the doctor comes by to do round with the MD intern who
is in charge of the ward. The patient in question is a previously healthy 22
year old male with bilateral lower extremity 2+ pitting edema to the knees that
has now been present for 7 days despite treatment at the hospital. I suspect it
is not improving because he is being treated for the wrong condition. He was
diagnosed as having “DVT/cellulitis.” Bilaterally? In a healthy 22 year old?
With no predisposing conditions? I
didn’t think so.
Anyway during rounds yesterday, the
physician mentioned that the diagnosis that this patient had been assigned was
probably incorrect and the cause was probably more systemic to cause bilateral
symptoms. I wrongfully assumed that this would steer the patient’s care in a
more appropriate direction. Today the chart still reads “Dx: DVT/cellulitis,”
and he got antibiotics and Lasix for 7th day. It isn’t a surprise to
me that his condition is not improved.
We are drastically limited in what
we can do and test for by the patient’s finances. I would have liked a
urinalysis, CMP, CXR, etc. There are very few tests that the patients can
afford, if any at all. Plus, I was told that even a hospital bed for a day cost
about 700 Kenyan shillings (Ksh) which is just shy of $10 US dollars in a place
where the majority of people live on less than $1/day. It was on my insisting
that I would be willing to do the ultrasound myself if I could just have a
little time with the machine – one of the few tests that might offer some tiny
bit of information that I know we could do for “free” if I could just get my
hands on an US. (I know that I am no expert with the US, but my thinking was that
it would be in the best interest of the patient to get an US done rather than
just sit and wait through another day of antibiotics.)
Keep in mind that none of this
happened particularly quickly because it took the better part of the morning.
My estimate would be that it took like 2 hours.) The guy working the ultrasound
was more preoccupied with some “dilated loops of bowel” (which I admit I didn’t
appreciate, nor would have it explained the edema well) than the patient’s
heart, liver and kidneys. The ultrasound seemed grossly normal to me. So I
doubt the ultrasound will be of great help in the long run. More frustrating
news because I doubt we will be able to do any further testing. I felt like I
was doing the right thing in advocating for the patient but I don’t know if it
helped at all.
At least 5 of the patients on wards
have been diagnosed with “chronic kidney disease” (which I also admit that I
doubt to some degree because only 1 of the patients has a documented elevation
in creatinine). They all need dialysis but can’t get it because of the cost.
Sooo… they, like the patent with the edema, are just sitting in the hospital
without anything of substance being done for them. It is becoming apparent to
me why there are at least a handful of casket makers right outside of the
hospital.
Plus, 2 of the patients that I was
most concerned about yesterday (1 with
severe pancytopenia and 1 who had a R sided ischemic stroke with resulting
edema causing a midline shift) were discharged sometime yesterday after I left.
Maybe they were discharged because we were unable to do more for them. Not sure
but still concerned.
Overall, crummy day at the hospital.
I feel I’m doing nothing useful. I will talk to the coordinator to see if there
is more that I can do elsewhere.
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| Benson and Frank, respectively |
I also went on a
walk with Benson and Frank (2 of Elective Africa’s employees) this afternoon to
one of the poor areas of town, a village called Shaurioko. (I highly doubt that I
am spelling it correctly). He wanted to show me how most people in Kenya live. And
the conditions were probably the worst I have seen, including the visit to the
internally displaced people’s camp in northern Uganda. I know that millions of people
live in conditions like this, but somehow it is still shocking when you walk
through the middle of it. There were tons of dark little alley ways and a truly
incredible amount of trash. Sanitation and clean water are clearly huge
problems for areas like this. We also walked to a local open air market which
somehow smelled 10x worse than the slums. I think the smell of discarded
rotting fruits and vegetables is what made the market smell so unappealing.
Despite the grim surroundings, I
still heard calls of “Mzungu, how are you?” from the kids in the streets and
market. I don’t know that they understand my response when I offer it in
return, but the kids beam at being acknowledged. For those of you who didn’t go
to Uganda with us, Mzungu is the Swahili word for “traveler” which over time
has morphed into the slang term for a “white person”. I also kept hearing “picha”
which fortunately sounds like its English equivalent “picture” as I walked with
a camera hanging around my neck. Not very many words in Swahili are easy so I'll take as many easy ones as I can get.
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| Just a glimpse at all of the trash that surrounds these people's living space |
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| Walking into the market |
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| "Picha" of some really cute kids |
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