So......What types of medical cases do you see in Africa?? ...A day in the life at ELWA.

People often ask this question and we typically say "malaria, HIV, TB, parasites, high blood pressure, diabetes, etc".   Friday January 29 was an interesting day and I thought that I would share brief glimpses of some cases that I saw.............I will do my best to limit the medical jargon.

1. A 50 year old man with recently diagnosed HIV had come in 3 days prior with weakness, weight loss, and some cough. He had started his HIV meds elsewhere and did not bring them in with him. He was severely wasted and appeared moribund. He was anemic and his chest X ray showed cavities in his lungs highly suggestive for TB.  We asked for the nurse who oversees TB diagnostic testing and treatment to see him and begin treatment as soon as possible. ......he died later that day.

COMMENT:  About two-thirds of the world's cases of HIV are in sub-Saharan Africa.  Unfortunately, many patients are diagnosed late in their disease.  In Liberia, some of the testing that is helpful for following the progress of their treatment is rarely available so we just do the best we can. Getting patients to faithfully take their HIV drugs every day is a challenge; without such compliance, resistance to treatment develops and "backup" or second line regimens are often not available. Also, people sometimes get their treatment one place and then present somewhere else for a problem - continuity of care is compromised! At ELWA, there are several dedicated nurses who monitor and follow the HIV patients - sadly, they tell me that government-provided supplies of critical HIV drugs are sometimes not available for variable periods of time.


2. A 17 year old boy came to the hospital with trouble breathing.  Last year, he had had a lower leg amputation for bone cancer. Sadly, his chest X ray showed large tumor masses of metastatic disease. There is no chemotherapy available here or anywhere else in Liberia, I have been told. All we could do is try to make him comfortable with pain meds, have the chaplain visit him, and send him home.

COMMENT: In developing countries, cancers are often not diagnosed early - people either ignore their problem or take ineffective treatments. Last week in clinic, I saw a middle aged lady who had had a breast mass for over a year and finally came in to get it looked at - it was the size of an orange and past the point where surgery had any chance of curing her.

Favor

3. Favor is a 15 month boy who has been brought to the hospital a week earlier by his grandmother. He presented with a swollen belly and "failure to thrive". His exam showed him to be clearly malnourished.  He was treated with antibiotics, given a "worm treatment", started on zinc supplements, and given a dose of vitamin A, all of which are standard treatments of malnutrition. His grandmother was told about the need for nutritious food such as milk and eggs in addition to rice, cereal, and beans.

COMMENT: While antibiotics, worm treatment, and vitamins are important in treating typical cases of malnutrition, patient and family education is  critical. Favor's grandmother seemed to understand our nutritional advice and repeated it back to us the next day so we are hopeful for this child! By the way, the child was negative for HIV.

Sarah and her happy mama

4. Sarah is a beautiful 3 month old baby who came in with breathing troubles. Her lung exam showed evidence of pneumonia and she was started on two powerful IV antibiotics. Within a couple days, she seemed to be breathing easier and was nursing better.

Rebecca

5. Rebecca is an 87 year old lady who came in with wheezing. Her exam showed evidence of inadequate oxygen in her bloodstream, too much fluid in her lungs, and possible pneumonia. She also had a heart murmur. Her chest X ray showed a large heart, excess fluid and also unusual shadows in her right lung that suggested the possibility of TB. She was started on meds for heart failure, oxygen was administered and sputum testing for TB was requested. She is improving slowly.

COMMENT:  There are many cases of heart failure in developing countries. Sometimes this is due to many years of undiagnosed high blood pressure and sometimes due to the long term complications of untreated rheumatic fever. (which can injure heart valves leading to chronic problems).
                        TB is common in developing countries. If we strongly suspect this diagnosis, we often treat the patient with or without confirmatory testing. However, in Rebecca's case, we will be cautious and wait for the test results since TB drugs have a high chance of causing side effects in the elderly.


6. Mietta is a 38 year old lady who had been in for about 2 weeks. She was a new patient to ELWA and had presented with unconsciousness, a blood pressure that was sky high (240/120), and was paralyzed on the left side of her body. She had a history of high blood pressure during pregnancies but had not been on any regular treatment.  She was treated aggressively to lower her BP to a safer range and then placed on oral blood pressure meds with good results.  Her consciousness level improved to the point where she could greet me every day, follow commands, and interact with her family who were very attentive. Sadly, she remained paralyzed on the left side of her body, indicating damage on the right side of her brain. There are no CAT scans in Monrovia so a more detailed diagnosis could not be given.
.....I explained to the family that Mietta had had a stroke due to her high blood pressure and that I was concerned that her paralysis might well be permanent; they were instructed in basic bedside physical therapy for her. Her husband Abraham worked for the government and was of some means- he explored options of taking her to another country for further evaluation and settled upon a hospital in Delhi, India.  I had the privilege of praying with Mietta and her family right before her transfer to the airport and asked Abraham to let me know how things turned out.