Saturday, 17 December 2011

Elective 42. Sodomy

A five year old boy comes into the hospital after being raped, and while while most cases keep confusing us, others are eventually solved. I give a gift to a patient, which makes them cry, and I get given a gift from Tim. In the evening, Kiwi, Dolittle and I walk to the lake where our shower water comes from.

In the morning meeting, another two babies have died during birth, but as well as the worrying fact there are so many deaths, I am worried that I am getting used to this, becoming more accepting of why they died (Oh. Prolonged second stage of labour. I see), rather than asking why they died (shouldn't she have had a c-section?). Perhaps this is what happens to doctors who come here from other areas of Tanzania. An insidious eroding of expectations and general acceptance of death that shouldn't have happened.

On the ward round with Eggs, we visit the man who had the abscess in his neck, which has been surgically drained. Eggs wears some very... interesting... T-shirts while on the ward. My favourite is one which I have seen him wearing a number of times, proclaiming "If I said you had a beautiful body, would you hold it against me". I am serious, this man wears this T-shirt for ward rounds!

On the ward round with Dr Bike, we review a 5 year old boy who was admitted yesterday after being raped. On examination, he still had a significant amount of blood around his anus and on his buttocks. It was very hard to get any history from the parents, as they spoke a tribal dialect  rather than Swahili. It seemed they said it had happened while he was playing with other boys. Not really too sure what to do at the moment, we gave pain relief and antibiotics as prophylaxis against infection, and instructed the parents to clean the area (I have no idea why they didn't do this yesterday). An HIV test follow up would be a wise idea. In the evening, we tell one of the nurses who are staying with us about this, as he is a psychiatric educator, in the hope he can try and offer the boy some counselling or something. He tells us that witch doctors give people a medicine, which needs to be taken after raping a male child. This 'medicine' should then make them wealthy. I knew that there was a reason not to trust rich people! In all seriousness, although this hospital has many faults, at least if doesn't advocate the harm of others and genuinely seems to care about people rather than making itself money.

At other stops on the ward round, the baby with hypopigmented patches, who has been in hospital for weeks, is finally ready to be discharged. A few days ago, we guessed it could be excema (after all the guesses at strange fungal infections and so on), and prescribed topical steroids. While we were told these were out of stock, a few days ago I looked through the pharmacy stocks and found some Daktacort, a mixed anti-fungal and hydrocortisone cream. Perfect for a possibly fungal possibly autoimmune infection. After a weekend on this, the baby is a lot less itchy and a lot less red and flaky, though she still has many patches of  hypopigmentation. I never knew that eczema could cause changes in skin pigment, but the girls from New Zealand have taught me this. Having people smarter than you on elective is really very useful! 

The full blood count for the complex case of the horse voiced girl with oedema in her legs and the inability to walk is finally done (the lab is closed over the weekend). And what a strange result! Microcytic anaemia, but that's par for the course in Tanzania. What's most interesting is that the break down of the white blood cell count has produced an 'error' in the results. The lab people have both tested the machine on another blood sample (which was fine) and then a different sample of the girls blood (error again) [this is very efficient for Tanzania, my guess is that Choc was in the lab yesterday]. The error that is coming up shows a code (T2) written in a box, rather than the numerical result for all of the break downs of blood cells. We visit Choc at the lab to inquire about this error. The lab book tells us that this error is something to do with cell counts being outside of normal ranges. Or unable to differentiate cells. It is kind of confusing and neither Kiwi, Dolittle, Choc or I really understand what this means. My guess is that this is some kind of leukemia, creating strange looking immature cells in the blood, which are confusing the machine, but really I don't know, and we don't have any way of finding out, so us three students try to petition Dr Bike to let us refer the girl to the big hospital, which is quite far away. Dr Bike doesn't really like referrals, but doesn't put up much of a fight this time, probably because he has no idea what to do next (but does suggest a fun cocktail of antibiotics which he thinks might help). I now feel justified in pushing for that full blood count, and eventually paying for it, as it has shown something. We think. I still feel robbed, though, as I still don't know what the diagnosis is!

The baby who was admitted with marasmus, and diarrhoea, who was bought in by his sister some weeks ago and fed up by Doctor bike is being discharged tomorrow. The IHPUK drug pack I bought had a doll in it, and I decided that this baby and sister are the best people to have it. If they cannot afford food, I doubt they have any toys! I bring the doll to the ward, with some pens, pencils and an exercise books for the older sister, so they can both have presents. I find them sitting outside the ward, and hand the doll and stationary to them. The older sisters eyes light up, and she gives a massive smile, but the ill child just starts bawling. He is clearly even more terrified of this doll than a mzungu! This is definitely not the response I was expecting at all! Perhaps he has never seen a doll before? There is not much I can do about it though, so I leave them, hoping that he will get used to it in the end. Or perhaps they will just sell it for some food. so much for a good deed!

The malnourished child flinches away from the terrifying doll from IHPUK, held by her happy older sister

In the evening, Tim comes by the house to deliver me a present, I assume this is to pay me back for the BMJs and pen torch I have given him so far. Yesterday he was in a large city, visiting his gold mining, broken arm-suffering dad, and decided to get me some Carrots as a present. What a star! This sounds trivial, but it is an amazing present. It adds some much needed variety to our meals. Its not as though we don't want to buy more interesting ingredients while here. They are just not available in this village. He clearly had remembered me complaining about the simple food, and had decided to bring me something fun back! While our new carrot based dinner is created by the cook, Kiwi, Dolittle and I walk to the lake, where the villages water comes from. This has some beautiful views, and many villagers washing or swimming in it while others collect buckets for home or let their animals drink and splash around. The water for our cooking and tea comes from here. Urgh. Well, what can you do. It seems that the level is very low compared to where the banks suggest it normally is. I guess we are towards the end of the dry season, with rain expected soon, so it is to be expected.

The lake where the water is collected for the village is drying up. The wonderful scenery is ruined by the phone mast stuck on the cliff, to try and cover some of the rift valley. I shouldn't be complaining, this was my one way to communicate with everyone!

In the evening, after our meal of carrots in spagetti (better than plain spaghetti, but still mouth-curlingly sweet) we do some water colours and drawings with the drawing materials we have for the kids to use. Kiwi and I are just doing it for fun, but Dolittle turns out to be good. Really, very good. Don't you just hate those medical students who have all these hidden talents like drawing and talking to animals. At least she isn't perfect. She loves glee.

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