Monday, 29 October 2012

Soumaila, squamous cell carcinoma

This cute kiddo came in with a wound all over his head. I am in fact not going to show the picture since it is a little much. (It may not seem like I don't use discretion when posting pics but believe me there are a lot of pictures I do not post).

Soumaila had been burned several years before and then the wound area has actually formed into squamous cell carcinoma. This is a somewhat common occurrence in adults but not in kids. If the cancer has already spread to his lymph nodes then he is unlikely to be medically cured. His best chance is complete resection of the mass and any affected lymph nodes. This week Tim, our facial surgeon, will try to remove the nodes and do some reconstruction of his head.

It is sad to look at this sweet kid because aside from the head wrap he looks healthy and he is so cute. It's hard knowing that his chances of survival are slim.

Cleft lip and encephalocele, pictures are somewhat disturbing

We give out formula to many babies each week. Most are orphans, some of the mother's have special medical conditions that cause us to give milk and others have medical issues like this child that prevent them from nursing. 

This baby has a cleft lip and palate along with an encephalocele. She is now gaining weight and doing fairly well. At six months, Tim, the maxillofacial surgeon at our hospital, will be able to operate on her and correct these problems. I can't wait to see the difference!

Lassine, perinephric abcess

Lassine came in with this huge, foul smelling abcess that orignated in his kidney. As you can see the skin was necrotic from the infection. Working in medicine, especially in Africa, you get used to smells. This, however, was one of the worst. For days the smell permeated all the rooms around where he was staying.  He had surgery to remove the abcess and dead tissue, which included part of his 12th rib, and has remained in the hospital for dressing changes and antibiotic treatment. 

He is doing well, healing nicely and gaining weight. It's hard to see in the picture above but he was quite malnourished at the time of his arrival. Thankfully he is doing well now! Isn't he precious?

Elizabethi, again

Since the last post had a slight negative spin on the differences here in our work, here is a difference that I love: getting your hair done is part of the care of the hospital. :)

Elizabethi has returned to the girls' school in a village about 30 minutes from here. It is for older girls who have never been to school to teach them how to read and write. She enjoyed it last year and learned a lot so she was excited to return, but not without looking nice. :) So I had to find someone who could braid her hair for her before she left. I even had to get "meche" which is the hair extensions so the style could be extra special. 

I must admit this makes me happy. I love that we get to be involved, really involved, in our patients' lives. When we care for those with chronic illnesses they become like our children and we are culturally responsible for their well-being even as the years go on. Sure sometimes this can be a heavy weight when many people are in need of us but most of the time it's great. I mean, what women doesn't want hair appointments to be included in their hospital stay? :)

Things are never as easy as they seem

In the US we take for granted that most all children are in school and that the majority of 15 year olds could follow simple commands. As I've mentioned before, that is not the case here. There are many bright Malians, no doubt, I in no way mean to say that is untrue. The vast majority, though, of the patients we see come from uneducated families where we are lucky if one person in the household can read, especially when these families are from villages around Koutiala.

I've written about Elizabethi, one of our diabetics, many times. She is a sweet girl whose smile can light up a room. She, however, is not smart, as she herself would admit and does frequently. This struggle is only magnified because she never attended school. Trying to teach her about her medicines and keeping records of her blood sugar is a task.

We decided to start a new sheet to keep better records of her glucose. The picture is hard to see but basically it is separated into four sections (7am, 1pm, 5pm, 9pm) where she is to note her sugars. There are 7 columns so that this sheet could be used for one week. There are three places to write within each time slot of the day: glucose in the urine, protein in urine, and glucose on the glucometer. I didn't have the urine strips to give her on the first day so I told her how to use the glucometer and showed her where to fill in her sugars. I decided to highlight where she was supposed to write so she wouldn't get confused, or so I hoped. I went ahead and highlighted for the whole week which I questioned even as I did it and which did in fact prove to be a mistake. She wanted to get credit to call her mom and I told her if she could fill out the sheet correctly for two days I would give her money (20 cents) to call her mom. 

The next day we found the sheet filled out like the above. She checked her blood sugar SIXTEEN times in ONE day because she thought she was to fill out the whole sheet! She really wanted to talk to her mom! :)

Another day she was given the opposite of her insulin doses (40 units of her fast acting insulin instead of the 5U she should have gotten and 5U of the slow acting instead of the 40U). Quite a big difference. Completely different than every other day for the last few years. Brett asked her if she noticed that it was different. She said yes. He then asked why she didn't say something. She hesitated but said that if she questioned the nurses their response would have been, "What? Are you the doctor now?" She has learned not to question those over her, even if it doesn't make sense. Now I don't think our nurses would have responded that way (though they most definitely would at another hospital) but still it is sad to see that she is not able to be in control of her own health. We in the West try to empower our patients but that is rarely done here.

This is often the case in Mali, that a "simple" task turns out to not be so simple but ends up being days of learning for both the patient and me. 

Alou, facial swelling update

It has been quite some time since I updated on Alou. see here

His swelling continued to improve and then while we were on home assignment the prednisone wasn't having any good effect anymore and he even had a stroke as a complication of his nephrotic syndrome. He was in very critical condition with frequent seizures and we didn't expect him to recover. He was started on newer severe immune suppression medicines and he has recovered tremendously. He continues to take these medicines daily to prevent a relapse. Thank you for your donations to the MacLean Work Fund which pays for his medications.

Thursday, 18 October 2012

Habi, ovarian Burkitt's lymphoma

This beautiful girl is Habi. She has been diagnosed with ovarian Burkitt's lymphoma. Burkitt's, thankfully, is a treatable cancer with a good prognosis. She is about three weeks into her treatment and actually doing quite well. We arranged for her to stay in the hospital for the first 6 weeks of treatment just so that we could watch her closely and keep her away from lots of infections. Our previous kids with Burkitt's have had a hard time with nausea and vomited quite a bit. Habi hasn't really so that is a huge blessing.

One negative of the Burkitt's treatment is the number of intrathecal doses (medicine into the spinal column)  that the patient receives, 9 in all. We often give medicine for them to sleep through the procedure but for the other kids the often choose to have them without ketamine. We tried ketamine with her and she didn't do so well with that but she also didn't like them without pain medicine. We finally struck a deal. I put on numbing cream for an hr before the injection and if she sits still then she gets three pieces of candy. :) The first day of this was kind of funny as it went something like this... "If you sit through this I'll give you two pieces of candy"
-Habi: "No, three"  -Me: "Three pieces?" -Habi: "Yes" and we shook on it. So that is now the deal. I can stick her back without her being put to sleep and she gets three pieces of candy. And not just any candy. She doesn't like Butterfingers. She gave that back. Reese's peanut butter cups and tooties rolls are her candy of choice. :)

Saturday, 13 October 2012


This little girl is Awa. I met her mother while she was hospitalized before giving birth to triplets. Her mother also has an illness that can be passed in childbirth or breastfeeding to the kids so I worked with her a lot to make sure she had enough milk. We actually decided she would breastfeed two of the girls and the other would exclusively get formula. Because the case was somewhat difficult, we saw these girls a lot. It was sweet to watch them grow. Unfortunately, after one of our furloughs we came back to find out that Founé had passed away. This was very sad to find out. As the girls have gotten older I haven't seen them as much. This past week, Wassa, was sick with malaria. She has been treated and is doing well. It was great to see the girls and how much they have grown. This is Awa. She had lots of energy and giggles to share. So fun to see!

Oldie Goldies

We have been back for a month now and time has flown by. Soon after our arrival it was great to see our "oldie goldies," Francois and Kadia, who have been with us for years now. They are both doing well.

Showing off her new dress that I brought back for her. I tell you, this girl could be a model...if we could clean off her teeth a bit. :) She is so precious. Love her spunk.