It has been some time since I last
wrote. Partly because we were so busy, partly because there was no Internet
connection. It was a busy four days in Kangundo. We saw over 780 patients in
2&1/2 days, but let me start with the setting. Kangundo is a rural
community, about 4 hours east of Nairobi. The only electricity is from a power
generator that they run at night for about 3 hours. The food is prepared over a
gas stove and our cooks did an amazing job. Miriam’s parents had built an
extension on their home that could accommodate the team, so it turns into a
college dorm situation. The evenings
would cool a little, with the terraced hills acting as a backdrop. This is
really Africa. The jog in the evenings was amazing. Soon joined by a group of
10 or so young boys keeping pace in worn down sandals. Bad for the ego, but a
lot of fun otherwise. Their hospitality was also fantastic. Imagine opening up
your home to a bunch of foreigners, bit that is exactly what Monica and Isaac
do every year.
The clinical cases that we see are
also remarkable. There are a number of people with blood pressures over 220 /
140, yet they don’t see the number of strokes that we would see in our
population. There must be some genetic component, both to drive the pressures
up, but also to provide some protection. I will have to read on
pseudo-hypertension as to one answer. Diabetes is in a similar vein, however.
We saw a number of prople over 400 blood sugars, some over 800. No signs of
diabetic ketoacidosis either.
There are a number of cases that
stand out. The first was a woman in her 90’s who presented with a massive
thyroid goiter. It was so large it cut off her esophagus and she couldn’t eat
at this time. It was starting to affect her breathing as well. She had already
been to the national hospital, and they had advised her that she was too old to
operate on. I could only offer her thyroid replacement, as well as an Albuterol
inhaler to minimize any airway spastic disease that was affecting her
breathing. She will probably not live too long, something thst she and her
grandson tok with grace. The other memorable thing was that she had collapsed
while walking to the clinic. Her grandson came to her aid when he found out
about that.
We really are missing our surgical
colleagues. Basma, my medical student, found a woman with a pelvic mass right
up to her lower liver margin. It was freely mobile and not rock hard, so I
suspect either a large uterine fibroid or a benign tumor of the ovary called a
serouscystadenoma.
Another case was a 9 year old boy
severely affected by cerebral palsy. He had poor head control, it sort of
flopped to the lowest point depending on how his mother was holding him. He had
early contractures on the left side, prominently affecting the hand and aknkle.
His right side was more flaccid. Not much to offer other than teaching mom some
exercises to minimize the hand contractures.
My final case (there are many more)
was a 22 year old woman that was suffering from a severe post-partum
depression. She is currently living with her aunt, who initially did all the
talking. Finally the young woman opened up herself, and we were able to make some
head-way. She had developed severe symptoms at about 2 months of the child’s
age. Often in rage, other times totally withdrawn. She was having what sounded
like some psychotic symptoms as well with at least delusions, if not paranoid
ideation. I never did determine if she had been sexually abuse and this child
was the product of that abuse, but I suspect that is the case. There are no resources
available for her, however we could have gotten some help in the village for at
least other women in the church could have come alongside her.
The thing I want to leave you with
is a idea of the Kangundo hospital. We visited one morning, particularly the
maternity unit. There are 6 bed wards, with women taken back to a small room
for delivery. In that room are 3 delivery beds that the US donated in the
1950’s. They don’t breakdown, hence the deliveries are a challenge. They have a
small warmer, that doesn’t quite function. They have to have a side space
heater to keep the infant warm. The suction devices are foot pedal operated,
which may be a good thi since the electricity is not always running. I didn’t
see the other delivery equipment, but was told they do a lot of vacuum
extractions. (This is where a large suction cup is placed on the infant’s head
and they assist the delivery). They also deliver breech presentation (where the
feet or buttocks presents first, rather than the head). They have close to 300
deliveries per month. They average about 3 stillbirths, 2 prolonged
stillbirths, 1 maternal and 2 to 3 fetal deaths per month. They clearly need
some help. They were desperate for fetal monitors, better delivery beds, some
infant resuscitation equipment, as well as antibiotics. (I left our
Ceftriaxone, Amoxicillin, and Septra with them).
The NICU (neonatal intensive care
unit), consisted of two small rooms with two premature babies in isolette
warmers in the first room, and four babies in the second. Two of the babies had
bilirubin metabolism disorders and were in light therapy. The other two babies,
one had a birth trauma and was recovering (though cerebral palsy is probably in
his future), and the other was a normal newborn whose mother had died giving
birth.
I am considering forming a group
called Friends of Kangundo. The idea would be to raise some support for both
minimal treatment of totally out of control blood pressure, diabetes, and some
symptomatic relief (eye drops – liquid tears) on the out-patient side, while
connecting difficult to control patients to the hospital outpatient services
(they run blood pressure and diabetic clinics on a regular basis), as well as
seeing what we can generate in terms of support for the local hospital.
Sorry for the long read, but that is
the news from Kangundo.
Patients waiting outside the clinic - old church outbuilding
Basma at work
Karen at work
Community Greeting - not everyone sings when you come over
Procession in the field to the new clinic site
Hospital grounds - Kangundo Hospital
6 bed wards all pretty much open
Infant resuscitation table with side warmer - the overhead warmer does not work
Their best delivery bed
