Week 3/4 Daktari cases

Week 3 out of 4: a little late, but this is Africa...

The medical ward team from this month- includes 1 resident from home, 1 med student from TX, and the Kenyan staff here alongside myself...a sample of what we've seen:

Patient group 1: Sodium: little old ladies come into the hospital GBW (general body weakness) with a sodium of 106.  normal sodium 135-145, Tenwek normal 120-130.  Why?  I believe every Kenyan coming into the hospital is dehydrated by at least 2 liters. 1) Sodium and water have a nice balancing relationship in the human body and when one is missing, the other will follow. If there is no water, the sodium flows out, leaving one hyponatremic.  2) Clean drinking water has not been easy to come by historically and thus not part of normal daily meals. Chai is.  We once heard of an Kenyan man who was in his 90’s and never drank a glass of water in his whole life! 

Patient 2: Meningitis: 26 year old Massai man self-referred from Narok county hospital, headache and fever, treated for malaria without improvement.  Had bacterial meningitis with 1200 WBC in his Cerebral Spinal Fluid. Treated for streptococcus pneumoniae meningitis, improved on therapy and discharged home.  Praise God!

Patient 3: Pulmonary Embolism (blood clot in the lung): 32 year-old woman, post-partum 21 days, admitted to nearby hospital with chest pain, fever, treated for pneumonia without improvement, underwent CT scan (new to outlying hospital), found to have a large pulmonary embolism, transferred to Tenwek for higher level care.  We were able to acquire one dose of a rare clot-busting drug, streptokinase, from the pharmacy.  A newly available medicine for our services here, could revolutionize the treatment options for pulmonary emboli, ischemic stroke, and heart attacks. Thankfully for her, we did not have to give this med because she was able to keep her blood pressure up, but what a new opportunity for therapy.

-Highlights: In the  journal club with family medicine residents last week we discussed the recommendation to  get people to reduce their NaCl (salt) intake to 2 grams daily, which could save 33 million lives over 25 years!  How much sodium do you take each day?  Remember to drink your clean water with gratitude too.  Circulation article 2018.  Journal clubs here are great.  There are 100% eager learners among the residents with a challenging situation in which they practice medicine, but they really work so hard and are such pleasant people to be around.

-14 days on medical ward in a row, covering for some gaps here and there, sustained by grace and not taking myself too seriously.  One that I was helping cover for was on a mission outreach to a remote island in the middle of Lake Victoria, Western Kenya, where they were seeing 1000 patients in 4 days. I was glad to be here, not there.  We are also delighted that the hospital has hired a Kenyan consultant for medical wards since we were here last year.  Carrying one another’s burdens is much easier to shoulder when there are two or three shoulders to help.  

Sustained by grace,

Daktari Davis