The Casualty/Clinic continues to occupy my time. Kids continue to come in who are sick and at times confusing. A sick newborn came in recently who had been home from the hospital for 7 days. The parents took him to a nearby clinic on day 6 after noticing that the child was febrile, not feeding well, and generally acting sick. They were sent home with a bottle of amoxicillin and came to the hospital the next day after the child continued to decline. The child required a lot of work after it was determined that the accucheck was 1 (that’s around 18 in our lingo). IV access was difficult but an intraosseus line was helpful. Intubation, glucose, fluids, femoral blood stick, CSF, antibiotics and a carry up to the ICU, where I placed the baby on a little German baby vent, all went pretty smoothly. I took out the IO after about an hour when we had another peripheral line. The line had been in the right tibia just below the tubercle and the skin of the lower leg remained loose with no evidence of extravasation, but the leg from the level of the IO down to the foot became very purplish with delayed cap refill. This puzzled me. After removing the line the leg improved, with better color and warmth (what was that about?). However, sometime later in the night the poor child suffered a rather sudden decline leading to a code that ended in the baby’s demise. I was sad for the family and couldn’t help think how unfortunate it was that they had gone to that clinic instead of coming immediately back to the hospital.
On a brighter note, there are twin preemies in the neonatal unit who are 29-30 weeker’s. They came in with bilirubins in the mid twenties shortly after delivery and underwent exchange transfusions through their umbilical veins. They looked pretty terrible with little chests that looked like little birds...all retracting. That was last week and now they are still alive, on NGT feeds and they look like they will make it.
I’m into day 14 of treatment for rabies on a 10 year old boy who was bit by a crazy dog on his porch. The dog subsequently died the next day. I was told that it is possible to collect the dogs head and with the help of the pathologist (which we do have), cut the brain up in the morgue and look for those things you see in rabies; some bodies of something. It all sounded a bit farfetched so I elected to just treat as if the crazy dog did have rabies. Finding the immunoglobulin was difficult; it was found in the Nairobi National Hospital and brought out to Kijabe the next day. This kid is looking great.
Sandra is writing a grant proposal for a new building for outpatient care, which will subsequently allow for expansion of the ER. This seems like a worthwhile endeavor and would provide an opportunity for us to provide care for more people and with more efficiency.
Today we had the privilege of attending our first Kenyan wedding. Two of the young doctors I am working with married each other. We were 3 of the 5 white faces in the crowd. It was great fun.