HIV, TB, and Parasites. Oh MY!

Trip Start Mar 21, 2012
Trip End May 11, 2012

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Flag of Zambia  ,
Monday, March 26, 2012

First day at the hospital, Bria and I head over for the daily 7:30am meeting with Dr. Spurrier and four Zambian physcians. The meeting is very much an update on overnight events, occasionally used as an opportunity to give educational talks. After the meeting he gives me a great orientation with lots of info. I'm still a little foggy about how rounds work in the mornings because we don’t pre-round and we don’t necessarily know the patients.  I’ll figure it out. 

Im starting off on the Pediatric ward with Dr. Thuma for one week and he is awesome. He takes loads of time at each patient to explain to me what is going on and how we treat it in this low resource setting. He was born and raised in this area and returned again to work here in 1976 (Dr. Spurrier was here in 1975) and has done lots of public health interventions in the surrounding villages.  I learn that Macha Mission is perhaps the first place to realize that asymptomatic malaria carriers in the community are contributing to malaria prevalence. By screening and treating this carriers they have drastically decreased malaria incidence and now people have started taking notice.
The pediatric ward houses children 6 and younger only and they are very sick.  It is not unusual, he said, that one will die during morning rounds. Every child is malnourished.  The question we have to answer seems to be is simple protein energy deficiency (unusual) or a combination of that with another disease (HIV, TB, Dysentery).  One is so sick, he tells me that she is not going to make it but we are giving her the full court press.  You’ve seen the pictures of the starving African kids on the fundraising commercials.  The swollen bellies and faces.  The rail like arms and legs, reddish hair, peeling skin. But what gets me is the leathery, wrinkled skin in their groin and joints. It looks like turtle skin.  What took their mothers so long to bring them in!!? Dr. Thuma tells me that some of the religions around here don’t believe in medical care and nearly everyone believes that when your children begin to get the look we know to be due to malnutrition it is a curse of marital infidelity.  Witchdoctors are used frequently here. The little girl that is not going to make it has little line tattoos from the witchdoctor on her face and abdomen.  Some children have AST/ALT labs throught the roof, which Dr. Thuma believes to be due to herbal medicine from the witchdoctors.

At lunch, Bria and I walk along the red dirt roads for 15 min to buy internet vouchers from the restaurant here. They are $30 for 1 gigabyte of download. Something I think only us foreigners buy.   Dr. Thuma says that 50% of the population lives on $10/month. No wonder they can’t buy protein for their kids to eat. (THough I learn that you can get pretty much all the nutrients a child needs to avoid kwashiokor malnutrition with Nsima and peanuts).  We run home before afternoon clinic starts. Lunch is from 1-3pm here. I meet Priscilla our housekeeper who is super sweet and made us luch of Nsima and meat with sauce. Then she baked some scones that were really very good for just having flour and one egg.

In the afternoon, I am in the outpatient clinic and start to see patients by myself. The first one is advanced HIV, not on anteretrovirals, with a large white plaque growing over the outside of her eye.  The Zambian doctors haven’t seen it before and wonder if I now that it is. I don’t.  But I surmise it might be a fungal infection. At lunch I google it and now I think it may be squamous cell carcinoma of the eye in HIV.  Nothing to be done about it. Next patient had suspected advanced cervical cancer though she has not gone back to get the results of her biopsy from Lusaka.  She is having abdominal pain and thinks it may be due to constipation, I think it’s due to metastatic cervical cancer but give her laxative and pain meds.  Nothing to be done about it. Then there is a healthy child with transient edema and then a women with conjunctivitis. Finally something I can do something about. And then the clinic is empty and we get to go home at 4:30pm. I’m eager to do it over again tomorrow.
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