In the last few days, we students have been both recuperating from our miserable illnesses of last weekend and working in the hospital, operating room and clinic. Not too many exciting things going on this week, but here are the highlights.
Some of my favorite cases of the week: There was a case of chorioamnionitis (an infection of the membranes around a baby inside the mother) in which the woman (on her 7th pregnancy, woof!) presented at 35 weeks gestation with labor pains and was found to have an elevated white blood cell count and elevated fetal heart rate. This condition necessitates delivery and the woman was taken for a c-section, but unfortunately the baby did not survive.
We also had our second case of cerebral malaria. As you may know, malaria is caused by a protozoan that enters the body through a mosquito bite and invades first human liver cells and then red blood cells. Common symptoms are fatigue, vomiting, headaches, fevers, and occasionally jaundice, seizures or an altered mental status. Because the spleen (the body's blood purifying machine) happily destroys malaria-infected blood cells, the bug causes the red blood cells to produce an adhesive protein on the surface of the cell, so it can stay as far from the spleen as possible . This causes the cells to get stuck in the body's small blood vessels, such as in the placenta causing placental malaria or in the brain causing cerebral malaria. Cerebral malaria can cause a variety of neurological abnormalities ranging from confusion to coma, seizures, difficulty speaking or walking. The patients with cerebral malaria seen here at CHM are often at fairly advanced stages and thus often have poor prognoses. Our patient presented with high fevers for 2 weeks and recent loss of consciousness, minimally responsive to stimuli. She is now awake and improving slowly after multiple days of treatment with quinine.
I've also been hanging out with the orthopedic surgeon some this week because he's a fantastic teacher. He sees a wide range of interesting pathology, a lot of road traffic accident victims and many more long-untreated traumatic injuries than one would in the US.
His x-ray
This gentleman fell on a slick surface at his house, landing on the fourth finger of his left hand. He's been shopping around for the best price for surgery... for 6 weeks. He's decided we're the best option and he's coming in a few days for what sounds to be a challenging procedure to repair his joint.
We also took a walk into town this week to run a few errands. Mostly we bought some bland foods for our recovering stomachs.
We also took a walk into town this week to run a few errands. Mostly we bought some bland foods for our recovering stomachs.
Steena and Lindsey made us french fries last night! It was very exciting to have a little American food for a night. This is Geeta (chopping papaya), one of our cooks, rolling her eyes at our silliness perpetually.
We also took a tour of the government hospital in town. It sounds like it operates very similarly to the VA hospitals in the US, less than stellar, not very efficient, but fairly dependable.
The operating room
It was a functional hospital but not nearly as beautiful as CHM (shall I give you a blog tour of our hospital in the next few days?)
xoxo,
Lily
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