Tough Week

In some ways, this has been a tough week.  We have had more deaths at the hospital, especially in the pediatrics ward and the newborn nursery.  Many of the babies and children are brought to the hospital too late and are already too sick.  We try to take comfort in knowing that we are doing all we can for the patients that come to Mbingo and even when we can't heal them, we try to treat them and their families with dignity and love.

This is Angela leading rounds on the pediatrics ward.  She is working this month with Comfort (next to Angela) and Stephanie (across the bed with the chart).  They have seen some tough cases this week from  disseminated TB, massive ascites, and osteomyelitis to severe burns, Wilm's tumors, and sickle cell disease.  Angela diagnosed the sickle cell child at 8 years old (this is found at birth in the US on the newborn screen).  One child in particular made a big impact.  Her name was Grace and she was being treated for PCP pneumonia and was only 4 months old.  Angela, Lindsay, and JR had gotten to know her family while she was admitted.  She died this AM.  Situations like this are rare in the US and common here, but it is never something you want to get "used to".

Chuck continues to round daily with the residents on the busy female ward.  It seems that no matter how many patients are discharged one day, the beds are all full the next day.  During rounds just one morning, Chuck had 3 patient's results come back positive for active TB.  The rate of TB is higher with HIV infection and about 1/2 of the admitted adult patients have HIV.  This picture is a chest x-ray of one of the patients with active TB with positive sputum stains for AFB.  One of the other patients had TB diagnosed from a lymph node biopsy in the axilla.  TB can be a difficult diagnosis to make and is almost always on our differential.  Fortunately, we have a great pathologist here who helps with the diagnosis and an HIV and TB treatment team called M+ that follow the patients after they leave the hospital to give them medications.

Chuck is doing EGDs now.  This picture shows him working with Immanuel who keeps the EGD room running.  Chuck started about 2 weeks ago and has already done 25 solo EGDs.  Dennis Palmer has been teaching him, but he mostly operates on his own at this point.  He has seen many gastric and duodenal ulcers.  He has biopsied masses and has evaluated acute bleeding.  Probably 1/2 of the EGDs have significant findings which is much higher than in the US.  By the end of the month, he will be in charge of teaching this procedure to residents so he is trying to get plenty of practice!

We are excited to introduce you all to Helen. Helen works at our house to help with cooking and cleaning during the week.  She is one of the main reasons that our transition has gone as well as it has.  She is an amazing cook and makes everything from scratch.  This includes baking, killing and plucking the chickens, bleaching and scrubbing the vegetables, and even making salad dressing. Cooking here is definitely a full time job.  You have to try her chocolate cake, it is delicious!  She has also started to become part of our family and we could not be happier.

This picture shows the bottom part of "Paradise Falls".  We hiked there from our house last weekend with the plan to actually get in the water and swim up to the base of the waterfall through the opening in the rocks.  However, just as we arrived the rains came and it got a little too cold.  We can't wait to do this so we will try again soon.

Isaac continues to be a hit with the local kids.  This was just after church and everyone wanted to lead Isaac around by the hand.  We have been so proud of how he has adapted to life here, especially all the attention that he tends to get.  We are thankful each day for him and all the joy he brings to our lives and the lives of those around him.  Thanks again to all of you for the prayers and support that you send our way.