Sunday, 23 October 2011

Balla (colon cancer)

Because the family cannot afford to go back and forth from their village to the hospital, Balla and his aunt have been living at the hospital for the last 4 months. They only have 5 weeks to go!

Balla is a trip. Everyone says he spends the entire day with them so I don't know if he has clones or what but he can be everywhere at once. Though this at times can be trying, we've also started taking advantage of this. When we need someone to find someone- ask Balla. When someone needs to be shown the lab- ask Balla. When this or that needs to go to another building- ask Balla. He is always happy to help! (:

Here he is working with Doug, our maintenance guy.

Doug was trying to work on piping for the peds buildings so he was looking at stuff and measuring. Balla didn't know what he was supposed to be looking at but he would look regardless.

Taking our diabetic daughter to college

So we didn't really take Elizabethi (type 1 diabetic) off to college but this week we did take her to a village where she will start at a girls' school. Elizabethi arrived at the hospital in March very sick and has been a part of the family every since. She has been living with a lady who sells food outside the gate so that she could remain in Koutiala for better treatment. She had never attended school and is too old now to be attend any regular schools so we have used visitors and other teammates to help teach her how to read.

Our organization started a school for uneducated girls in a nearby village many years ago. We also have a clinic there. We thought this would be a great option for her. So we took her two weeks ago to see it and see if she would like going there. She liked it a lot, especially since she is a village girl and doesn't like all the motor scooters and the few cars in Koutiala, so then this past Sunday we took her to her home village to ask permission from her parents for her to attend the school. All agreed.

So on Friday, we got ready to go. Here she is with Jessica, the nursing director, and Saran, a Malian nurse who became very close to Elizabethi. When Saran came to say goodbye, Elizabethi buried her head against the car to try to hide her tears.

In Baramba, walking to her new home with all her belongings. Amazing that all she owns is in that little travel suitcase that one of our teammates gave her for the move. I had to buy her blankets and sheets since she didn't have any. I also gave her some clothes and shoes I no longer wear. It did really feel like I was sending my child off to school.

In front of her new dorm. There are some shelves and mattresses on the floor for them.

With Anna, who is teaching missionary kids in Koutiala, but who also worked with Elizabethi some to learn to read.

With her "mommas" as we said goodbye. I told the workers there that she is our daughter, the hospital's daughter, and that we will do whatever we need to do for her. She is definitely in the hospital family. Carol, a dental assistant, helped Elizabethi a lot also learning to read and taking her to church weekly.

Last hug before leaving. I know that Malians aren't normally huggers but I couldn't resist. She has learned to hug back as well.
To see how far she has come, see the original blog post about her...

Yanoussa (Wilm's tumor)

Thought I should add a picture of Yanoussa. He came in this week for treatment. He is doing very well and has gone back to his village for school. He comes in every three weeks for treatment. He will be finished with everything at the end of November (so will Balla (colon cancer) and Mamadou (Hodgkin's lymphoma)). My work load is about to get a lot lighter!

Moussa, Retroperitoneal Duodenal Perforation

Moussa came from about an hour away with severe abdominal pain and vomiting. A few days prior he had a bicycle accident and the end of the handle bar stabbed his abdomen (You can see the circular mark left from the handle bar midway between his belly-button and bottom of the ribs, a little on his right).

The impact of the handle bar caused a retroperitoneal duodenal perforation (an intestinal tear deep in the abdomen near the spine). Of your entire intestinal tract, this is the worst location to have a perforation.

He was in so much pain at arrival that Brett had to be his transport from one place to another.

Post surgery. Yet another time we are thankful to be serving in this day and age with internet, skype, and cell phones. We called Atlanta-based pediatric surgeon Dan Kim, who talked our 2 OBs through the case since it was such a complex surgery and nowhere near the uterus like they are used to. :) Lord willing. Dan Kim and his family will be joining our team full time in summer 2013 after studying French.

Here is Moussa, above, hooked up to some donated IV nutrition. We were so thankful to provide that IV protein and fat which we normally would never have here in Mali. Despite this he lost 15 pounds early on.

But after 4 weeks of healing he regained weight quickly. Here he is on the day he left the hospital.

Nephrotic Syndrome

About once or twice a week we get a new case of nephrotic syndrome. It's easy to diagnose as the kids come in looking like this with even their eyes so puffy they can hardly see.

Simply amazing.

Thankfully this is often curable with prednisone pills. Within a few weeks they are looking quite good. This boy has already had a lot of improvement. I'll post pictures of him the next time I see him come in.

Bele, wasting disease and Tuberculosis

Bele, believe it or not, is 8 or 9 years old. He is the oldest of 4 kids. When he came to the hospital he could no longer walk he was so weak as he weighed only 16 kilos (35 lbs). We began treating his severe malnutrition as well as the cause of his wasting.

Within a week he was up walking around and soon after he looked like this! Amazing what a little treatment can do.

Here he is about a month after his initial treatment. He is looking great. However, we realized this past week that he also has Tuberculosis and we have started treatment for that as well. Looking forward to the day when he is healed and full of energy and strength.

Wednesday, 12 October 2011

Issa, dialysis patient

Sadly, tonight Issa died. He has been having some hard days but today his body gave out. Brett found him this morning with a heart rate in the 30s and was able to revive him with blood, dopamine and various other treatments. Unfortunately it just didn't last. He was slowly dying all afternoon. It seems he died of septic shock from chronic peritonitis as a result of the peritoneal dialysis that we couldn't stop because of the fluid overload that occurred when we did before.

Though we enjoy all the patients and form some bond with them, there are certain kids that really grab our hearts. For Brett, Issa was this kid. For the last month Brett has worked so hard on his case. Issa would call him the "toubabou ce" (white man) until Brett told him he had to call him by name. So Issa started calling him Tonton Brett (uncle Brett). One night when Brett was still at the hospital, I got a call from him. Instead of it being Brett, it was Issa. He called me Tanti (aunt) and asked if Brett could spend the night beside him that night. Thinking he was doing much better and would recover, I joked with him and told him no, I didn't accept that.

He was a sweet kid. He was loved by his family and friends. Sad that he is no longer with us. I just keep thinking that I hope he can be a case like our first cancer patients. Those who literally gave their lives for those who came after them. I do hope that we can learn from his case and take that knowledge to improve on the care in order that the next child in need of dialysis will receive it and live.

Mamadou (Hodgkin's Lymphoma)

I continue to be amazed at how quickly Mamadou's lymphoma has shrunk. There are now no palpable nodes in his neck. Simply amazing.

Poor kid looks terrible. He hates his chemo. Throws up the entire time.

But look at that lovely neck!

Only two more cycles left!

Thursday, 6 October 2011

Update on Issa (dialysis)

I don't have any pictures of Issa but wanted to write an update. The short of it is that he is better but still has a long way to go.

His creatinine dropped steadily, yesterday it was "only" 3.8. Over the weekend he had a scare with his sodium being 110 (normal 135-145). We say Malians are always testing the limits of the human body and what you can really live with. :) Thankfully, that was relatively quickly resolved.

The drain came out yesterday so he is no longer on dialysis. Unfortunately, his swelling has returned to his hands and face. His creatinine also increased to 4.8. We are giving Lasix in hopes to decrease the fluid load without having to start dialysis again. Hopefully that will help.

Once again, I must say thanks to Jesse who has helped Brett tremendously. So glad we can be working overseas with skype and cell phones. It makes treating patients so much easier!

Saturday, 1 October 2011

Issa, our first dialysis patient

Issa came into the hospital a couple weeks ago with severe malaria which caused ATN (acute tubular necrosis). He had stopped urinating despite lots of treatment we gave him. Then we thought that perhaps he was getting better since he started urinating again. However, when we checked his creatinine it was 14 (normal 0,8 - 1.4).

We had heard that dialysis was done at one big hospital in Bamako so we prepared the family to go there, only to then find out from their head nephrologist (kidney doctor) that neither they nor anyone in Mali could do dialysis on kids.

In order to try to save his life, we decided to try peritoneal dailysis where a catheter is put into the abdomen and fluid is regular put in to allow waste to be pulled out of the blood in hourly cycles.

We just used local anesthesia to put the catheter in so we gave him special treatment with a movie to watch.

Since this was the first time we had ever done dialysis all the ex-pats were around to help and see how it would work.

Here is Issa after his first dialysis. The fluid goes in clear but comes out dark, evidence of the waste that it is removing.

Brett talked to his friend from residency who is a pediatric nephrologist (thanks Jesse!) to get a lot of guidance on how to proceed. Jesse hopes that is kidneys will heal over the next 2 weeks and that they will start working appropriately again. Praying that Issa does well and that the first pediatric peritoneal dialysis can be called a success! As I told Brett yesterday while I was doing the dialysis, I felt like I did the first day he put me in charge of chemo. TOTALLY out of my scope of practice and knowledge. Thankful that God can use anyone. His creatinine has come down now to 11. We have a long way to go, but at least we are moving in the right direction.

Yohana (type 1 diabetic)

Yohana went home on Friday. He "only" stayed in the hospital 40 days which was considerably less than the other two girls. Amazing what a little education can do. He picked up on things very quickly and I think he will do well in his village. He knows when his sugar is low which the two girls have not really picked up on.

He starts school on Monday with the rest of Malian kids. Thankful this happened during the summer so he didn't have to repeat a year of school. He was excited to go home and even became brave enough to ask for some shoes for school. He wanted $5 so he didn't have to wear flip flops, his only shoes, to school. I couldn't resist and gave him $10 so he could buy two pairs.

He will come back in a month unless he has problems beforehand.

Update Mamine (incurable osteosarcoma)

******I have added a picture that some might not like to see. I put it on for medical people. If you prefer not to see the growth of the tumor, just read the message and disregard the picture.*********

Thought I should give an update on Mamine. She has declined quite rapidly. About a week ago, she fell as she went to the bathroom and was actually stuck between the door and the toilet for awhile before two nurses came and got her. She can no longer walk. She now lays on a mattress on the floor all the time. She doesn't even sit up. She cannot urinate unless someone presses on her belly. The mass is just so large. She sleeps most of the time. She isn't eating much. I do hope for her sake that she quickly passes. She is miserable. It is horrible to see her suffering. Thankfully her pain has been under control. Her poor mother cannot move her now because her leg is so heavy. We are still praying for a miracle but if God chooses not to heal her, I'm praying that she will go quickly. I've been telling her that soon she will have no pain. Soon she will be able to walk and run and dance. Soon she will be free.

This is the size of the mass as of this past week. She is wasted away from her waste up. From the waste down is the tumor and subsequent swelling. The tumor now is well across the midline and at least halfway down her thigh. Her head is propped up on two cushions and is at equal height with the top of her hip.