As you know, we have to practice medicine far beyond our level of formal training here at Mbingo. We have told you about difficult tropical medicine cases, making diagnoses with limited testing, and even giving chemotherapy to both children and adults. Chuck continues to do and teach EGDs and colonoscopies daily, but lately he has been doing more pediatric gastroenterology. Here are a couple cases...
This is an 8 year old boy who presented with intussusception (the bowel telescopes on itself). The cause was seen on ultrasound to be a mass in the colon. Chuck did a colonoscopy on him and found multiple polyps, the largest being over 2 cm and this was the cause of the intussusception. The polyps were juvenile polyps, but needed to be removed. At first the plan was for the surgeons to operate. Then Chuck and Jim Brown (missionary surgeon) decided to try to snare the polyps, even the large one. This was the first time cautery has been used for an endoscopic procedure at Mbingo and it was a huge success. All the polyps were removed including the large one and the young boy did not need surgery and was able to keep all of his colon.
In the past month, we have had three children with caustic ingestions that injure the esophagus. These injuries require multiple EGDs with Chuck needing to dilate the esophagus due to strictures. The kids have been young too (the youngest is 8 months). In addition to the caustic injuries, this photo shows Chuck and Jim Brown finding a coin in the esophagus of a child. It was removed without any complications.
This CT scan shows neurocysticercosis. This man presented with vision changes and seizures. He had the CT scan done in another town a few hours away that has a CT scanner. Neurocysticercosis is a disease in which a parasite (worm) is ingested in the egg form and then migrates to body tissues including the brain to cause cysts to form. It can take many years to develop, but is felt to be the leading cause of epilepsy in adults in the developing world. You can see on this CT scan the multiple cysts in the brain tissue and even in the ventricles. This man was treated with albendazole (worm medicine) and steroids and has improved significantly.
This is Kaye Streatfeild walking on a hike with Isaac. You can see how brown the grass is from no rain in months.
Despite no rain, we have been able to water our plants due to the hard work of Thom Shotanus. He is the missionary engineer and general contractor at Mbingo. Many of you know that last year we ran out of water for most of a month at the end of dry season. Thom assures us that the improvements he has made to the water supply will allow us to even water our plants throughout the dry season. This is currently one of Isaac's favorite activities.
Having enough water has also allowed the kids to play in our inflatable pool. Mostly Isaac just dumps the water out, but he and Cathen enjoy it and it keeps them cool during this warm month.
Yes, Isaac is going down the hill on a homemade slip-and-slide in our backyard. We bought the tarp in town and put the kids in their bathing suits. We then put some soap and water on the tarp and sent them down. They had a blast.
And finally to the big news...Angela is pregnant. Many of you have already heard this, but we wanted to make it blog official. She is now 20 weeks and this shows her getting an ultrasound from Christy Lee, our good friend and missionary OB/GYN here at Mbingo. We are excited and Isaac is already talking about how he is going to help with the baby. We appreciate your prayers for Angela and the health of the baby over the next few months.