16 year old with swollen lymph nodes from Tuberculosis (TB) This is my second visit to Kenya this year and I'm learning more and more about his country, its people, and its medical care each day. I want to preface my remarks by saying that I am far from an expert on this subject, but I’m far from being totally ignorant (as I was just 10 months ago)! So, if you have knowledge that differs from mine, please share!
My first visit to Africa was in February where I traveled with Bruce Steffes, MD, the CEO of PAACS. He has spent 25+ years in and out of the mission field and is, without doubt, an expert. PAACS runs 8 residency programs scattered over the African continent. He referred to Tenwek, the hospital I’m serving at now, as the Mayo clinic of mission hospitals. I correctly assumed that it is an advanced hospital offering the highest level of care among mission hospitals. What I didn’t realize until this trip, is that Tenwek provides higher level care than the big government hospitals. During this trip I have encountered many patients who have had poor or inadequate care at these hospitals and present to Tenwek for improved care. One such patient presented last Thursday. The problem was simple enough – she had fallen while running with a stick and it had poked into her right neck just below the jaw line. The government hospital had stitched her up, but the family was concerned that after several days she wasn’t getting any better. After a brief evaluation at Tenwek ER, she was sent to theatre (the operating room) where I assisted a resident in a surgical exploration.
This is no small stick!What we found shocked us all! We cut the stitches loose to drain what we assumed was an abscess only to find that a 2 inch piece of the stick was still embedded in her neck! The government hospital hadn’t even washed out the wound – they just sewed the skin closed! Now for those of you who may not be medical, it doesn’t take much training to realize that when a stick makes a cut anywhere on your body that washing out the wound would be the very first thing to do! We removed the stick, cleaned up the wound, and closed her up over a drain that stayed a couple of days. Unfortunately, this young lady will be left with an ugly scar that didn’t have to be that way.
Kaposi's Sarcoma in a 6 year old with AIDS Another young lady presented after being seen at the government hospital where a biopsy was take of her upper gums and the family was told that they couldn’t tell what the problem was. So, months later, the family came to Tenwek, where in one afternoon period covering about 4 hours, we diagnosed her with HIV, a lung infection that was most certainly from TB, and the gum lesion was a Kaposi’s sarcoma. She had three conditions – all which should have been diagnosed months ago when she presented to the outside hospital. She is six years old and likely in her last year of life. Sadly, this child is in full blown AIDS with an AIDS related cancer that is not curable. After informing the clinical officer of the findings, I walked away thankful that I didn’t speak the family’s language.
Giving bad news is the worst part of my job, but this would have been especially difficult. Her HIV certainly came from her parents, who were both in attendance. How do you tell a mother and father who are clearly concerned about their child that the end is near? How do you answer the question that’s bound to arise – could the outcome have been any different if the first hospital hadn’t missed the diagnosis? How do you look the mother in the eye when she asks if it’s her fault?
The sad part of the HIV/AIDS epidemic here in Africa isthat it doesn’t have to be this way. Education, includingsex education and teaching about sexually transmitted disease is critically lacking. Testing and preventionmeasures will do more than anti-retrovirals and improved treatments ever will. But, there are so many cultural barriers to overcome. Male promiscuity is an accepted way of life. Prostitution, evenRight lung TB pneumonia with a cavitary lesion evident on this chest x-ray
among young teenage girls, is also way too common here. In a country that surveys show to be 80% Christian, there is a true disconnect between the true message of the gospel
and the behavior of large segments of the population. I pray for my patient’s family, that they will find
forgiveness in Christ. I pray that they will be comforted by a God who loves them despite their circumstances. I pray that they will find peace in Jesus who can lift them from their deepest sorrow. I pray that there is someone who speaks their language who has comforting and guiding words for them. I pray that Tenwek stands as the shining example of medical excellence and compassionate care that this family needs in the days ahead. I pray that next time I can find some better way to help. Finally, I offer my prayers of thanksgiving that my family, safely back in America, has been so abundantly blessed.