Africa Vision 17

Africa Vision 17

Bebedja, December 6, 2007

Early end.

“Ashis take a look at the uterus. There is something wrong there. The echo shows a mass, which should not be there! Perhaps a extra uterine pregnancy or some of the intestines that have kitted together with the uterus due to a sexual transmitted disease together” The girl Dr Gusto and I are talking about is 17 years old has had 2 previous spontaneous abortions at 5 and 6 months. Now she came with some vague complaints of abdominal pain. An operation (laparotomy) to check out her abdominal organs was proposed to the family and they agreed. During the operation done by our senior nurse it became clear that there was a massive infection of the peritoneum and that as a consequence both her ovaries were tangled up in a mass stuck to the uterus. There was no way out but to take out both ovaries effectively rendering her into surgical menopause at this young age. Also making it impossible for her to get children in the future. If the operation had not been done she could have died at any moment due to an infection of the abdominal cavity (peritonitis)

Imagine coming for some abdominal pain and leaving the hospital no longer having menstrual periods or the chance to get a child at the age of seventeen. It shows that sexual transmitted disease is rampant her as is child brides. She must have gotten married at 15. Her story reminds me of other women I met in Africa who had similar problems. Infertility when there are also many women with a football team of kids. Not a position to envy. I sincerely wish that her husband does not abandon her. It is something that happens all too often unfortunately.

Then at night I am doing a late night round of the pediatric ward. One of the young girls (3 years) is anemic and we are giving a blood transfusion. To assure she is ok I check her heart and lungs trying to assure the transfusion does not go to fast for the febrile and weakened young girl. As I move on to check another new patient 3 minutes after my checking the girl the nurse comes to me and says the child has expired. Cerebral malaria kills fast. Even under treatment with anti-malarial drugs. Her parents had walked 11 kilometers to make sure that their child was all right. The girl had only been sick for les than a morning when they visited their local health post. It shows how lethal malaria is even today.

A third patient with a third story. At the young age of eight she cannot walk far, is easily tired and has difficulty breathing while lying down. She has been having these problems for several years but it is now she comes to the clinic. On examination you can hear a murmur over the heart. You can see and palpate. Her heart is enlarged. It is what the echo and the ECG show. One of her heart valves, likely the mitral one has been well destructed. Children get a skin infection or a throat infection and during that episode of illness the bacteria passes on to the valve of the heart and there nestles and destroys part of the valve. In Europe she would have been to her general physician in an early stage who would have treated her original infection thereby prevention damage to the valve. Even with damage there would be the option for valvular surgery and replacement by an artificial one. Also she would have received prophylactic antibiotics to minimize further damage to the valve. Here in Chad it remains to be seen if there is an opportunity for an operation (likely not) or even if the family would have enough financial resources to sponsor an operation (unlikely).

One patient has died early, one has become menopausal and one has a reduced life span. All three had preventable or at least in the beginning curable disease.

Namaskar,

Ashis