I think Courtney and I might have saved a small child! This is highly exciting for many reasons. The problem with medical TV shows is that it makes you think that being a doctor is running around saving people on the brink of death; that after one, giant, heroic measure they are all cured and you celebrate with tearful eyes, everyone gives hugs all around, and the curtain comes down. The truth is that a large portion of medicine is a very drawn out process, recoveries are slow, paperwork is extensive, and they usually ride off on a wheelchair into a rehab center rather than a white horse into a sunset. So to be able to see a quick and huge improvement in someone because of something you did is an awesome feeling, especially for med students still so new in our career. We were having clinic in our typical mudhut with tin roof and Courtney and I were in the back room. A mother came in carrying a toddler…a toddler that when you looked at them your brain sent a danger message; this child looked very ill. She was lying listlessly in her mother’s arms with her head just lolling loosely. She had no appetite, vomiting and diarrhea, and fevers. Her mom said she had been treated multiple times for malaria and she would get better for a small amount of time before becoming very ill again. We went over to examine her and the first thing you noticed when you touched her was that this child was hot. Her temperature was above 39 degrees Celsius (above 102 for us Yanks). But what was REALLY concerning was that when you tried to sit the kid up she still kept her head kind of leaning back. And when you tried to bend her head forward, it didn’t really bend. If you tried to force it, she cried. This is about when Courtney’s eyes got REAL big and both our little medical student brains exploded. For those not in the medical lingo know, a rigid neck is one of the first medical scary signs they ever teach you in medical school. It is a classic sign of meningitis, which is infection of the coverings of your brain. That qualifies as a bad thing. It kills people even in the States and even if you are a previously healthy adult. This was a probably chronically ill and malnourished child. The rest of her exam was actually pretty normal; nothing leaking out of her ears or oozed on the back of the throat and no rashes anywhere. She was very pale but she didn’t seem too dehydrated. The most concerning thing about the rest of it was that she didn’t fight. If you have ever tried to stick anything in a toddler’s ear, then you know you are fighting an uphill, loud, angry battle. In contrast, this child flailed its hand a little bit weakly. We went and conferred with our big, full-fledged doctor for help deciding on a battle plan. In the U.S. the child would be admitted for many days with IV drugs. Here the hospital is a place to be avoided at all costs, where children are crammed side by side into a long room with nothing separating them from their neighbor and with little treatment available. We gave the child a full gram of Ceftriaxone (one of the more powerful antibiotics and a meningitis staple) via 2 shots in the butt. She cried a pretty good bit on the shots, which was a good sign. We also treated for malaria. It sounded as though this kid had a chronic case that requires more extensive, longer treatment. Malaria is not something you want to miss in a child this sick, especially under the age of 5. If it doesn’t kill them, which is unlikely, there is a good chance it will do permanent brain damage. So she got another shot in the thigh for super malaria treatment. Then we had her mom stay and give her rehydration salts on the lawn in front of the clinic so we could see how she was looking in a bit and to make sure she got some fluids in her. A lot of times it isn’t the illness that kills people so much as it is things like dehydration. Dr. Hodges helped the mom give 1 tsp of water with rehydration salts in it every 1-2 minutes. After about 1-2 hours the child looked moderately better and we decided we could probably get by without sending her to the hospital. Instead we gave the mother money to take the bus back to our home base clinic the next morning so we could see her before driving off to our next mobile clinic locale. When the mom brought the child in the next day she said that baby had seemed to do better for most of the evening but had started looking ill and vomited again that morning. So we repeated all the shots. This child will never trust white people. Ever. We then gave the mom enough meds to get through the weekend and enough money to come back and see us again 2 days from then on Monday. On Monday the child was doing much better. The mom said there were no more fevers, no more vomiting, nothing. The child was of course crying because by that time she had figured out that white people= butt shots but she looked much better. We gave her enough antibiotic for another 10 days or so and enough malaria medicine for a total of 10 days. Normal malaria treatment is about 3 days but since we were thinking chronic, relapsing malaria we needed to treat longer. So we are going to chalk this one up in the win pile and have a group hug.
-Erin Barnes
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