Mene atoukou (blood is spilled)




 Ok, the tachycardia I can deal with.  Our transfusion threshold is 4, or 6 if you are "intolerant."  Hypoglycemia, sure.  Coma, seizures, fine.  But the bleeding!  I want to know - DIC?  Fulminant liver failure?  Simple malaria thrombocytopenia?  Viral hemorrhagic fever?  No one seems to get petechiae, or maybe I'm missing it.  Not that this differential helps me treat in any way.  I have vitamin K, I have whole blood.  I have antimalarials, I have antibacterials.  I can run a bedside hemoglobin.  I can pretend I'm doing coags with a dry glass vial waiting for clot to form (there are actually published norms for that).  I've run into a string of upper GI bleeds from what?  (Ok, one of them was a battery acid ingestion.)

     Diagnosis is elusive.  Miraculously, kids often survive.  Serious brain damage on the other side is sadly common.  A nurse asks me, what does enlarged liver or spleen mean?  My reply doesn't seem to help: just about everything one runs into here.  

     We are building an ambition to get an antigen detection kit for common CSF pathogens, maybe cell counts on CSF or even gram stain!  I will not hold my breath.  But I can hope.

     The young general surgeon, from Mexico, is impresive.  Courtesy of my NGO he has trained in Ob/Gyn and ortho procedures. OMG the C-sections, hysts, flaps and grafts, and external fixations he does are impressive!  And gunshot wound mortality is gratifyingly low (bandits and militias in the countryside.)  I've heard the blood bank has in past run out, but hasn't been a problem since I've been here.  Malaria positive donor?  No problem!  Transfuse, and treat!  God bless artesunate.

     A quick look at one of the two bar/restaurants in town authorized for us.  Am I a geezer, because generic autotuned Afro-Pop with a reggaeton undertone doesn't do it for me?  Still thankfully true classic Soukous (style 80s/90s) is still around especially at the ExPat house where Congolese of that age make up the biggest single group.  Sorry for the blurry pictures, and yes Jeanne I did think of you with my Kota Castel.  Maman Chantou by day, and by night.




By the way, for those of you from back then, the owner of the original, Bar Etoile, I am told passed away in Bangui recently (the Bar is long gone, as are Ouaka Stars) but his adult kids are all in "business."



Comments

  1. AnonymousAugust 4, 2022 at 4:01 PM

    Hi Jeff Speaking of the Bar Etoile, here is my journal entry for July 6 1985 which was our first night in Bambari: "I went to the Bar Etoile with Caryn, Babette, Sharon Hall and Jeanne. We danced a lot, the bar was fun. The band played non-stop. No 20 minute breaks like in the USA. Everyone dances, even men dance with men. I wonder how I will respond if a man asked me to dance. I ordered a beer and was given water. I need to improve my French!" Brian Collins

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