Kobela ti susu? [The fish disease?], and kunja ti mbi akono! [my rug grows]

Sorry to all for the long gap in posts!  I am now on a brief, asymptomatic COVID + isolation so stuck in my room and internet is cooperating.  Some odds and ends:

     Just had a 5 month old reasonably well-nourished kid sign out against medical advice, which I can't fault because in 5 days of escalating care I got nowhere with her pneumonia, and her persistent severe respiratory distress.  I asked parents why now and they explained the diagnosis of "Fish Disease" which entails respiratory distress including skin retractions between the ribs, much like the gasping and gill slits of a landed fish.  The treatment, which was successful in the child's older sibling in the past, entails tying pieces of fish around child's neck and chest.  I offered to add the fish treatment to existing hospital-based care but parents declined.

     The rag-rug is progressing.  I will probably call it quits in December and give it away.  It is becoming quite heavy and will be very hard to clean for whoever wins it (I plan a lottery amongst the staff of Peds ICU and Malnutrition wards).  Doing the little pieces during the day helps me find the tranquility to accept that which I cannot change, particularly when it entails a meeting (of which there are many.)

     

We are expecting, today, the start of a visit from our Medical Coordinator (Bangui) and our Health Advisor (Europe-based) for not-really-sure-what goals; I have been told that I will be informed at the proper time.  I don't know what those guys are supposed to do, although I have previously met them both.  In order to follow protocol I have requested permission from my boss (who so doesn't care as long as no labor is required of him) and my boss's boss (who will likely evaluate my request for its risk of exposing problems and distracting from vital hierarchy-pleasing report drafting and box-checking) to speak to them about multiple opportunities for improvement, that have been kicking around un-acted upon for years (everyone with my job has had the same laptop passed from one to the next - a weird way to time travel by opening up all the files and reading.)

Sorry for medical jargon:

I think I found a case of leukemia, terribly malnourished septic etc etc but oddly covered in bruises which is the first time I've seen that amongst hundreds of life-threateningly malnourished kids.  We had a special day, when WBC count was possible (no other cell lines) and so I got a white count - 51,000.  There is no oncologic treatment in this country.  I asked to see the slide, but lab friend forgot and chucked it; maybe true, maybe not.  I was thinking of adding doxy to cover Rickettsia but these were not petechiae - I did manage to get her signed up for TB treatment (she makes criteria based on a Keith-Edwards score) and was planning to add the doxy today, but locked up in isolation, we'll see if my coverage read my note (not optimistic; but then again probably doesn't matter). 

     Generally when kids pass the one month mark in ICU they survive to discharge.  A kid on hospital day 35 with plan to discharge next day.  Plan interrupted by status epilepticus then coma.  I am not optimistic.  Hopefully it was just a stroke (sickler) or electrolyte disturbance (can't measure here) because if it's infectious he is already on every anti-infective we have so nowhere to go with that.  At 12 years old he is the oldest sickler alive I have ever seen here, and only one person claims to have seen an older one.  Family has been very patient with a month of ups and downs, very sad.  On the bright side, when he went into status the nurses tried to reach any doctor, and failing that did everything right - oxygen, glucose check, hemoglobin check, ordered blood for transfusion, gave diazepam.  Perfect.  I ended up using 2 of the hospital's 10 remaining vials of Keppra after diazepam, phenobarb fails.  He deserves it.

     Definitely better to be lucky than good.  I had a week of ZERO deaths and thought I had everything figured out.  Then, massive patient overload (two kids and their moms per bed) and a blizzard of deaths (6 in 2 days).  Many I didn't get to see (admitted at night, dead by morning) but a couple were the "really?  couldn't be" cases.  One I thought was on her way to a miracle cure, after 2 weeks of continuous improvement went from sudden onset distress to death in 30 minutes.

     Jolly Englishman facilities engineer - with that accent he is not easy to understand, in any language - asks why I'm here.  How can I explain how exhilirating, and devastating, every day is?  Such a privilege to be here amidst extreme misery and death with opportunity to lessen it.  And, goof around in Sango.  Joy and tragedy every day, fun and frustration, gratifying victories and painfully missed opportunities.  Plus, room and board!  I would like more sun, though; clouds and rain through November.  Tropical downpour (a view of the Rehab NGO, "Humanity and Inclusion" from porch of the PICU - feel free to imagine accompanying deafening rain on corrugated metal roof ):