The medical post

Patient 1- 20 yr old female from somewhere far away was able to get to the hospital barely whispering in English "Please help me".  She presents with a blood pressure of 70/40, much to low to keep the body working. Heart rate 140 bpm, meaning the heart is working very hard and hardly pumping any blood.  

Ultrasound and ECHO reveals aortic stenosis (tightening of the valve through which the heart delivers the blood to the body).  The tightness of the aortic valve is so tight, that the blood squirts through it in a weak little squirt gun manner.  The valve is the problem.  It has been bad for such a long time that the muscle of the left ventricle has grown incredibly large.  It has been striving so hard to push blood out of this bad valve that it is now constricting the ventricle further.  The blood is now partially moving up through the mitral valve back into the left atrium. 

The patient has too much fluid gathering in some places and not enough in others.  The lack of blood supply to the rest of the body is causing the liver and kidneys damage, which means she is in the end stages of heart failure.  

The cause of this terrible situation is called RHD.  Rheumatic Heart Disease is a preventable illness of poverty.  It affects far too many people who are now hospitalized for their condition, about 10% maybe.

Back in the medical ward, it is now a matter of fine tuning the treatment for the patient with heart rate control and volume of fluid as a bridge to try and get her renal and liver function back.  She needs valve replacement surgery rather soon. That could cost about 11,000 USD that a family has to come up with.  The outcomes are bleak.  Thankfully, a new RHD screening program has started early treatment and prevention education in area schools.  The simple solution of penicillin for strep throat infections and even for infected heart valves will save so many lives in the future.

Patient 2-  18 yr old male presents in emergency room with upper GI bleeding, vomiting blood.  History of sickle cell anemia (meaning his red blood cells are sickle shaped instead of round).  Faster than he can make the misshapen blood cells which are pouring into his stomach, he is throwing them up.  The source is a stomach ulcer due to bacteria called H. Pylori which is common in any low- middle income country.  Again, another disease of poverty is unfurling.

Hemoglobin was 4, bp 80/40, heart rate 120 bpm.  He was first given 3 units of blood, then sent to endoscopy and the ulcers were not actively bleeding.  He intermittently bled and stopped for several days from the deterioration of the stomach lining.  Medical team decided to give transfusions, acid suppression, and treatment for the bacterial infection.  The sickle cell disease got worse due to the lack of available blood flowing in his body, developed what is called acute chest syndrome.  

Acute chest syndrome is when the sickle shaped blood cells clog up the alveoli (part of the lungs where oxygen is attached to the blood cell).   This causes severe chest pain, hypoxia, loss of oxygen to the body overall. It is a pretty bad state to be in.  Treatment needed is called exchange transfusion, meaning all the blood in the body needs to be replaced.  Then he started bleeding profusely in the ulcers again. 

60/30bp, Hgb 2

He is sent to emergency surgery for resecting the section of his duodenum where the bleeding is coming from. The blood bank in the hospital gives 12 units of blood to him over 24 hours.  (An average person might contain 12 units in a normal healthy body)  The gift of the new and normal shaped blood cells in all of these donated pints was that they flowed properly and cleared the clogged up alveoli in his chest, opening oxygenation to the blood stream again.  It is called an exchange transfusion but was done in a very unconventional manner.

He was recovering in ICU today. Pray for Boniface when you read this, please!

The medical ward nowadays is being run by some very fine Kenyan team members.  They have a good dynamic and genuinely want to help people.  Michael is enjoying working with them and seeing their growth and development as medical professionals not only over these 3 weeks, but also over the past 11 years since he's been coming here.  They see about 60 patients a day but it is divided up quite well among the team so no one is overwhelmed.

We are also hosting 2 residents (and their dear spouses) from UT with us this time at Tenwek.  We eat lunch and dinner together in a guest house with lots of other volunteer physicians and spouses.  They show each other x-rays and pictures of things like a black lung that they helped remove earlier in the day.  The table talk can get colorful you might say.  This is a typical day in the typical life here.  

                                                    blood donation center inside the hospital

                                                        Katie's type 0+ matches our patient!

                                                        into the blood fridge it goes for Boniface