Boys wait in line for food at
one of the refugee camps
This past Friday, Emily and I had the opportunity to go on an outreach here in Jos with our neighbor Dr. Don Sampson (an American pediatrician), a Nigerian doctor, and five other people. Our patients were displaced residents of Jos who are in a refugee camp about 20 minutes from our house. On our way to the camp, we passed a burned out mosque and another intact mosque with armored cars and soldiers actively guarding it.
For three hours that morning patients streamed in, the first ones being very tired-looking soldiers with their automatic rifles still slung over their shoulder inside the clinic. Their complaints were insomnia, chest pain, malaria … no wonder after what they have gone through the last couple of weeks. The patients that followed were a mixture of men and women, Christian and Muslim all living together in the same camp.
In all, we saw almost 60 patients: everything from hypertension to malaria, dizziness and a possible broken hand on a toddler. Emily and I are now quite proficient at filling prescriptions in a very makeshift set up. Dr. Sampson and Dr. Dennis were able to keep us busy with a steady stream of patients needing medicines.
As a side note, Emily escaped yet another marriage proposal … and the clinic escaped yet another escalation of violence as one young man grew very frustrated with the other man’s interest towards Emily. Mama had to step in on all accounts and squelch advances as well as rising tempers. All in a day’s work in Jos, Nigeria ….
Dr. Michael Mitchell, SIM missionary and ENT surgeon at Evangel. See the Mitchells' Blog
We now have four patients in the hospital who have a condition called enterocutaneous fistula. They all had surgery at other hospitals for various problems but developed a leak in their intestines so now they have stool leaking out their abdominal wounds or their vaginas. Most come to us very sick, dehydrated, severely malnourished and anemic and some near death.
Our approach in helping them is pretty simple; they need food – protein – so we put them on a regimented schedule of taking a soy bean and peanut formula called “kwash pap” because it is used to help malnourished children with kwashiorkor. It is remarkable how well most of these patients do after a few weeks of a high protein diet. Some actually close their fistulas spontaneously without need for surgery. At least they are in better shape to have the surgery so their outcome is better.
I feel so badly for these dear people who have suffered so much at the expense of other “healers” and how desperate they are. Several are from the other main religion so we pray for both spiritual and physical healing. Without the benefit of expensive intravenous nutritional support, we rely on simple foods and prayer.
--Dr. Bill Ardill, SIM Missionary and chief surgeon at Evangel
This Lancet article reports an important observational study from South Africa. The authors investigated 358 children aged 1–59 months, regardless of HIV status, who presented with WHO-defined severe or very severe pneumonia. Sixty-eight percent of the children were HIV infected. The empiric treatment used was benzylpenicillin, gentamicin and, for those less than a year old, high-dose trimethoprim-sulfamethoxazole.
FIndings included the fact that in the infants, 42% failed therapy by 48 hours and 6% subsequently. Many of those failing had polymicrobial infections (more than one organism). M. tuberculosis,S. aureus and, in infants, PCP were common among those failing treatment. The authors conclude that (in this HIV-prevalent area) existing empiric treatment recommendations for children with severe pneumonia are inadequate, since nearly half the children failed treatment.
Read moreto see a table of organisms isolated from those failing treatment, then see the original article as well.
"Results Primary outcome data were available for 311 (98.4%) people, 77% of whom were thought to have a psychotic illness. Patients allocated haloperidol plus promethazine were more likely to be tranquil or asleep by 20 minutes than those who received intramuscular haloperidol alone (relative risk 1.30, 95% confidence interval 1.10 to 1.55; number needed to treat 6, 95% confidence interval 4 to 16; P=0.002). No differences were found after 20 minutes. However, 10 cases of acute dystonia occurred, all in the haloperidol alone group. "
The two day old baby looked so tiny in the middle of the full-size ICU bed. The whole left side of her head and her left eye were swollen and bruised, with scratches here and there. Now and then she would stiffen and shake—convulsions probably due to her head injury.
Little Hannah was born on a Saturday night in "Blind Town," the area in Jos where many of the blind people, mostly beggars, live. It's a regular community of its own, with customs, rules, and its own chief. Though Hannah's seventeen-year-old single mother was not blind, she did live there. ...continued
"The reported incidence of indigenous cholera in sub-Saharan Africa in 2005 ... was 95 times higher than the reported incidence in Asia ... and 16,600 times higher than the reported incidence in Latin America .... In that same year, the cholera case fatality rate in sub-Saharan Africa (1.8%) was 3 times higher than that in Asia (0.6%); no cholera deaths were reported in Latin America. The persistence or control of cholera in Africa will be a key indicator of global efforts to reach the Millennium Development Goals and of recent commitments by leaders of the G-8 countries to increase development aid to the region."
Evangel hospital last week unveiled its brand new digital x-ray machine. For some time we have been struggling with our old machines, and the last one was starting to give images of rather poor quality. The new machine represents our commitment to quality of care and is a big improvement in our ability to diagnose patients. Not only are the images of high quality, but they can be stored and transmitted digitally anywhere in the world. Click on photos for larger view.
This is a short, sobering article that all of us in Africa should read. Perhaps the pandemic will never develop, but the signs are still worrisome. Maybe there is still time to correct some of the deficiencies in policy and practice that are highlighted in this article.
An entire issue (supplement) of Journal of Infectious Diseases is devoted to a look at the "rollout" or scaling up of antiretroviral treatment in developing countries, mainly South Africa. See the full table of contents for articles including
The two day old baby looked so tiny in the middle of the full-size ICU bed. The whole left side of her head and her left eye were swollen and bruised, with scratches here and there. Now and then she would stiffen and shake—convulsions probably due to her head injury.
"The reported incidence of indigenous cholera in sub-Saharan Africa in 2005 ... was 95 times higher than the reported incidence in Asia ... and 16,600 times higher than the reported incidence in Latin America .... In that same year, the cholera case fatality rate in sub-Saharan Africa (1.8%) was 3 times higher than that in Asia (0.6%); no cholera deaths were reported in Latin America. The persistence or control of cholera in Africa will be a key indicator of global efforts to reach the Millennium Development Goals and of recent commitments by leaders of the G-8 countries to increase development aid to the region."
