Today was the day I got to go with Sarah Spear into the community and see how the people live, the conditions they deal with, how severe some of their medical problems are, and how some of them don't come to the hospital for various reasons. I was getting ready to leave when she texted me and asked if I could check on a patient on the way over. This patient has a sad story really, as she's only 18 and has terrible tuberculosis that has caused a host of other problems. Basically destroyed her lungs, backed up fluid throughout her cardiovascular system and into the portal system (liver stuff), and now she has lots of fluid that we drain out of her belly. She's super sick. She's the one we built the mud house for, I think I mentioned her in the past. Anyway, I had Sephora take me there since I couldn't remember quite where it was, and she was able to translate. We had to find someone else who spoke French who could then translate into Lingala for us. But, she's feeling pretty good. Not a lot of pain and is just hungry, though Sarah had arranged for some food to come. Her family recently returned to the village I guess, and isn't the most functional. Her uncle drinks a lot and even the other night tried to get her to get off the bed so he could lie down. Considering how sick she is, it's a pretty horrendous request and it just makes you mad. But, there's a lot of people around here involved in her life, so hopefully that will keep her family backed off a bit so she can live out the remainder of her days with some level of comfort.
I finished up there and rode my bike to Sarah's house. We spent some time going through her daily devotional with one of the nurses, who was translating it into Lingala and looking up the verses. She wanted him to pick a verse to share with our patients throughout the day, and he picked a few from Romans 8. Then we headed out on our bikes to see our patients in the community.
The first patient we saw was an older woman and man, who were related to the nurse with us (think aunt/uncle). She had previously been treated for some chronic ulcers on her left leg secondary to poor venous flow, or peripheral vascular disease, or something like that. They had finally skin grafted her and got that to heal up pretty nicely, though now the problem was that she had limited range of motion because the skin graft crossed the anterior portion of her ankle. She probably didn't go to physical therapy :) Anyway, she didn't have much motion and also was having some very pinpoint pain on the lateral surface of her foot. I looked at her shoes and saw that the lateral part of her sandals were almost worn down completely in comparison to the rest of the shoe. I asked her to walk for me so I could assess her gait, and saw that she was majorly everting her left foot as she walked, putting all the pressure onto that one spot. So, first I explained everything I saw to her and Sarah translated for me. Then, I talked about the possibility of creating a make-shift orthotic for her to shift the weight a bit more medially, taking some of the pressure off the area of pain and starting to correct her gait. One of our other patients we were going to see later was actually a shoe repair guy, and has a lot of tools and equipment, so once I explained how I would create the orthotic, they were like oh yeah we can have him make that for us. Sweet. I then walked her through some range of motion exercises and talked about some very specific exercises she could do to try and start adjusting her gait. Otherwise the graft looked great and she didn't have any other areas of skin breakdown. After explaining everything her husband seemed impressed and asked Sarah who I was. She told them I was a doctor from the US who was going to be training in Urgences, and so he was like oh, well then, since you're here check my hernia, doctor. Sure why not. He had a hernia repair back in November but then was lifting some water in March and felt a tear. I checked and he definitely had a reducible bulge, so I advised him to go back to the hospital and follow up with Dr. Wegner and look into getting it fixed. They do the primary repairs here (no mesh), mainly because of lack of supplies (big surprise, right), which have a higher rate of recurrence/failure. So, not entirely surprised, but it was causing him a lot of discomfort so I told him to go back and have the surgeons check it out.
We then headed to our shoe-repair man. He has sickle cell trait I believe they said, but he was overall doing ok. He had some chronic wounds on his lower legs that had been there for years and just weren't healing. When we got there too he had just cut his hand, but insisted it was ok and didn't want me to look at it. I had him show me the movement just to make sure the tendons were all in tact, which they were, and then I explained to please please please just keep it clean so it doesn't get infected. He's in the process of rebuilding his house, so lots of mudding and sticks and such -- perfect for infecting a fresh wound. I see pus in his future......
He has a bunch of kids (11), so he was pretty much like I have to work and don't have time to think about any of my problems. Which, hey, I get it. Glad he's at least committed to his family. Hard to see though when his medical problems could kill him if things get infected enough.
The next patient we saw was an elderly woman, who they believe is around 90. They aren't great with the ages of really old people here, so they just ball park. She has this pretty awful skin condition that wraps across her chest. Sarah first described it to me as keloids, but I was skeptical when I saw it. Normally, from what I've seen and learned anyway, keloids grow aggressively if there's like a wound that is scarring over and there is excessive skin growth. Like getting your ears pierced and then having keloids grow around the ear for instance. This case was a bit different in that it was pretty much spontaneous, and spread across a really big area (all the way across her chest). Maybe I just don't know much about keloids, which is completely true, but it still looked like something different. I suggested maybe a fungal condition. You know, like that guy who looks like he has a tree growing on him.....kind of looked like that to me. Bizarre fungal conditions that grow all over your skin, maybe? I need to do some research when I get back and see if I can identify it. Maybe talk to a few dermatologists. I don't know much about skin conditions other than what I've read in a textbook. I talked to Wegner though and he seems to think that it is probably keloids. He said she probably had a small burn or something years back that stimulated the process. I've never seen them quite so painful and itchy, but hey, I'm not a dermatologist!
We also stopped by to visit with a teenage girl has some type of cancer we think, which caused a really bad sore to develop on her leg leading to amputation. However, the sores are back, and worse this time around. It doesn't look good for her. We aren't even entirely sure what's going on, but she had just changed the bandages and didn't want me to take a look at it for whatever reason. She is very malnourished and looked really sick. I think she knows she's dying and wasn't super excited about talking about it. We left it at that.
We rode our bikes around a bit more and stopped along the way to talk to people, buy some avocados, check out some minor medical conditions, and so on. It was really amazing to be able to see the community and the people who are too sick to even make it to the hospital, or the ones who are really too poor to even pay the hospital's cheap fees. Seeing where people dump their garbage, where they get their food, where they get their water, where they store their water, the conditions of their housing, the mosquito nets or lack thereof, the mode of their transportation (walking usually), etc. is all part of the public health experience that helps me to assess what I might do to impact their health, and helps me plan for the future.
That was really all the excitement for the day. Otherwise just a team meeting (my last one) and a pretty chill night. Tomorrow is my last day working in the hospital, so here's to hoping it's a good one.
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