Africa Vision 16

Africa Vision 16

Bebedja, December 5, 2007

Hospital St Joseph.

The morning brings burning leaves. Outside by little bungalow they are being burned in heaps. I slept like a little baby. It is strange with no electricity after 21.00 the village and the hospital terrain get really quiet. Being a newbie I managed to miss out on the daily ward rounds. What to do? Tomorrow I have been asked to do the ward rounds for the adults (and join our part time doctor, in other words he is also the chief medical officer for the district and he has a lot of different tasks besides working in the hospital). Dr Gusto is the doctor who has been doing his best to keep the hospital floating. There is a Mexican nun who is also a doctor who works 2 days a week with the HIV sero-positive patients. And apparently a Chadian surgeon has just been hired but he is off to take care of family business in the center. We are hoping he will come back soon. As it is the senior nurse in the hospital is doing all the emergency surgery in the house. The only knife one should give me is to carve a chicken and our other colleagues are also minor surgeons also. It is clear that women requiring a caesarean are blessed with our dedicated senior nurse.

As the things are moving and shaking in Chad I shall be spending one week per two weeks in this missionary hospital. Remember the nearest hospital is a two-hour drive and the official district hospital at 23 kilometers is closed. The red earthen road makes the air very dusty. As if one is playing tennis on a gravel court. At the end of the day I went for a small walk to the village to see what is available and to reflect on the findings of today.

What did I do?

Well at first I joined a nurse in the health center and together we saw about 30 patients. The most memorable were an 18 year old who was convinced he had lung cancer. This is an easy entry to make him stop smoking. Another young man in state of confusion (a typical case of malaria). A young lady with a sexual transmitted disease. Her newborn had an eye infection and as her husband has 2 wives (yes polygamy exist in the South even among Christians) all 4 needed treatment.

Then I went through all the files of the patient to see what kinds of diseases/operations were frequent at the different departments. There is the maternity (today 2 deliveries), surgical department, pediatrics and internal medicine. There should be about 70 patients in the hospital today. It seems 80% has malaria and then typhoid fever. The big but however is that the test (Widal) for deciding it is typhoid fever or not is not available due to lack of reagents. What to do common things are common so treat as if.

I shared a chicken and boul the local dish with some nurses and talked about how they view their work.

And finally in the afternoon as a good student I did my first dilation and curettage under guidance of Dr Gusto of a lady who had gone through an intra uterine death of the embryo.

This after we had done a punction of the pericardium as to remove 220 ml of fluid for a young 30 year-old male patient suspected of tuberculosis. It means that around the heart there is a strong bag like structure called the pericardium. In his case for some reason (suspected TB) that bag fills up with fluid every 3-4 days. As a consequence his heart cannot beat easily and fluid pools everywhere; his liver, jugular veins, abdomen, legs and lungs. He has difficulty breathing when he lies down. Even if under guidance of an echo it looks pretty intense sticking a needle about 10 centimeters under his sternum towards his heart. Even more impressive is when the patient tells you after removing the first 100 ml of fluid that he feels as if he can breath easily again.

The most impressive realization however was the fact that out of two deliveries today one of the ladies was sero-positive and her baby had to receive anti retro viral drugs to reduce his chance of becoming HIV positive. AIDS is rampant in Bebedja the nuns estimate looking at their sentinel voluntary tests of pregnant women that up to 30% of the population may be HIV positive. Something to think about…

Tomorrow more about the nuns/nurses working here.

Love and peace,

Ashis