Sunday, May 8, 2011

#43 Patient Updates

One Month Out

The lady that had the curettage after having a retained placenta for one month recovered.  She was on IV antibiotics for several days.  She was discharged home a couple days later with a shot for birth control.  She went home with her father’s family.  Her husband abandoned her because she hasn’t given him a child.  All of her pregnancies have ended in loss.  

The 5 weeks postpartum patient with a ruptured appendix is recovering as well.  She is ready to go home now.  She lives very far away, so is waiting to go until her stitches come out on Monday.  Her malnourished baby though is far from “healthy.”  He is now nursing quite well directly from her, but it’s hard to change the culture.  DON’T give WATER to your little baby!  He is 6 weeks old and less than 2 KG.  His birth weight was probably the same by the looks of his body.  He had a fever the other day and so is now on antibiotics.  


She ended up being my 6th mother who died as a result of pregnancy.  I had originally thought her drastic hypoglycemia was a result of quinine, which was weird because she had been eating and drinking and only on oral quinine.  

The same thing happened 3  or 4 times over the next 2 days.  She was given IV dextrose each time and recovered.  We started her on an IV sugar water drip.  We wondered if her liver was shot.  

Then she didn’t recover.  She stayed unconscious.  We were able to get a glucose level at that point which was normal.  She started having a high and frequently recurrent fevers.  

The family demanded to take her home.  They said they didn’t have any money.  We explained that we were ALREADY giving her free care.  We reasoned with them that the funeral costs would be more expensive.  (People here are never ready to pay for hospital costs, but it is expected to use every last dime they have for funeral costs to feed the visiting family).  They agreed to stay a little longer.

We started her on Ceftriaxone, an IV antibiotic.  Maybe she had meningitis now.  Maybe it was cerebral malaria.  Maybe I had no idea what it was (yes, this is true).  

The family kept insisting to take her home.  We explained she would for sure die at home.  She may live if she stayed in the hospital, but we could not guarantee it.  They stayed.  

Then Friday night at midnight (of all hours) the nurse came to the door saying the family insisted that they leave with her.  They filled out a paper saying it was against medical advice and left with her and the small baby.  

This last week the family came back.  They wanted help with milk for the baby.  The mother had lived until the following Monday and then died.  This small baby actually looked healthy.  He had been nursing from a family member (I thought the sister-in-law, but now I think the grandmother???).  

For those who haven’t lived in a place like this, the following may be hard to understand.  But... if I gave the family formula, they would just run out.  It is 3,000 F (about 8 dollars) per can, which may last 1 week for the first little while.  They would thin out the formula or give it with non-boiled water.  It just doesn’t work well here.  The baby would become malnourished and die.  If there is any possibility for breast milk here, it is the best solution.  I explained that they must continue with the same family member who is willing to donate breast milk at least for 1 more month.  They will come back in 1 month to discuss the milk situation further.  They live over 20 km away.  In a car, it can take over an hour on these roads just to go 10 km.  People don’t have cars here either.  

I still don’t know what the mother’s diagnosis was.  If I had liver function tests, I might have known if her liver had been failing.  It wouldn’t have changed the outcome though.  Maybe it was acute fatty liver of pregnancy, but it doesn’t quite fit.  Maybe she had multiple diagnoses.  Maybe it was malaria and then changed to cerebral malaria.  Maybe she was just too anemic to fight off the malaria, even with the quinine.  We never did get more O negative blood.  

Josephine is still here.  She is the lady who had the ruptured uterus and cesarean-hysterectomy.  Three weeks postoperatively I discovered I had cut her right ureter.  This gave her a huge infection, which I believe was the cause for her vesico-vaginal fistula also.  

She is 5 weeks out from the repair of her ureter.  The right ureteral stent is still in place.  I had to leave the foley in to keep the stent in place because the stent didn’t have a loop at the end.  

Several weeks ago she developed a postoperative ileus (when the bowel goes to sleep).  She recovered from this with bowel rest and an NG tube (an awful tube that goes from your nose to your stomach to keep the stomach empty).  Afterwards she was doing great.  Just malnourished.  I started giving her a yummy protein supplementation drink that someone had left with us.  

Then she developed a wound infection.  Her skin had to be opened and is now being packed with dilute bleach water compresses.  It’s looking better.  

This last week she got malaria again.  She has been vomiting and now looks awful.  She is too skinny.  I asked her what she missed from N’DJamena.  She said milk.  So we brought her some powdered milk.  She needs nutrition!  I just want her to get better!

I plan to take her stent out next week.  She will eventually need a repair of her fistula, but that will have to wait until she is healthy again.  For now she is still recovering.  Please keep her in your daily prayers.  

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1 comment:

  1. May God bless you and your family! You are truly doing his work!!