The Hopeful Trip to Mbingo

Lots of new patients today. One little girl came in today, minimally responsive aside from occasional vomiting. No fever per mother. WBC normal. On exam her fontanelle is tense and her left pupil is sluggishly reactive compared to the right. I don’t want to tap her, for fear of herniation, so we are treating her with meningitic doses of antibiotics and treating for cerebral malaria. Without a fever, however, my main concern is that she has a space-occupying lesion (brain tumor) for which we can do nothing. For now we will add on some steroids and pray.

Since I’ve gotten here, I’ve been seeing more and more patients in the outpatient clinic, although I have been assigned to the inpatient wards. It usually goes like “…but the parents heard that there was a pediatrician in Mbingo and they traveled many hours to get here…” No pressure or anything. So as the news spread, I’ve been seeing more and more patients in between more and more patients. It’s mostly a sea of hopeless diagnoses that have been seen by many doctors before me. I wish I had something more to offer, but my hands are tied as much as everyone elses.

Today a mother brought in a 3mos baby girl for a “rash” which has been present since birth, but recently has been getting worse. Now with fevers. I undressed the baby and the skin was peeling off with her clothing. She has what is known as epidermolysis bullosa, a congenital deformity of the skin. I confirmed with my stateside consults that bone marrow transplant is the only cure; so again, there is nothing much we can do aside from hydration, antibiotics, and education. Apparently the skin breakdown of the fingers can get so bad that the fingers can fuse together (“mitten deformity”), so at least we can try to prevent that. The overall prognosis is not so good.

The baby in a coma for 4 days took a couple sips of water today. A little blessing! Rudolf may be able to go home tomorrow if he is able to start walking on his own. We have another new girl name Ntoh who came in with a spleen that was so big that it was protruding through her shirt. Everyone here has at least one enlarged organ, I swear. Sure enough on CXR she had some pretty impressive cardiomegaly. So, correction, everyone here has AT LEAST one enlarged organ. You just hope it’s not the brain.

And so life goes on after death. We salvage what we can and have to let go of what we cannot. It’s not that we shouldn’t lose sleep over the ones we could not save, it’s just that we need enough sleep to think clearly for the ones that we can.

A sister and her baby brother <3