Malnutrition & Dehydration

Today was slightly less busy at the clinic. We saw a ton of patients, but fewer that were critically ill. The one exception was a 8 month old little boy who was brought in by his mother looking very sick and undernourished. Apparently he was being cared for by his grandmother because his mother had taken a job as a live-in nanny in a town far away from where they live. While living with his mother during his first few months of life he was breastfeeding and growing well. Since he has lived with the grandmother he has been formula fed, but apparently not enough. The cause is likely due to poverty, but there may be a social component too with the grandmother not really being able to care for the baby...but who reallly knows.

Anyway, the grandmother called the mother today and told her that the baby was very ill and she would have to come bring him to the clinic. He had lost several pounds since his last visit and looked visibly small for a child his age. Worse than that though was that he couldn't close his eyes because he was too dehydrated to produce tears and his eyeballs had developed a white film over them. He was too weak to cry or even really move. His neck was stiff, but his limbs were floppy -- not good. Definitely could be meningitis, encephalitis or various causes of sepsis. He perked up quite a bit once we loaded him with IV fluids. He then was transferred to the hospital...I hope he makes it. Will hopefully get to check in on him I go to the hospital with one of the docs on Thursday. Fingers crossed.

Neonatal HSV, Verruca Plantis and Epidermolysis Bullosa - oh my!

Today was our first day in clinic. It was very nice to go out our door and walk 100 feet to work. I could get used to this commute! Kate and I were each paired with a doctor and saw patients from about 8am - 5pm. There were 4 doctors working today who saw over 100 patients total. It was a busy day not only because all of our patients have HIV, but also because at least 10 of them were REALLY sick -- I think more than 5 ended up getting admitted to the government hospital in Mbabane. The little emergency/urgent care room was overflowing most of the day. If you think your Monday clinic days are busy...you should check out this place.

The first patient I saw with the doctor I was working with had a rip roaring case of pneumonia and was breathing 60+ times a minute - that's a lot for a 10 year old who probably breaths 15 times per minute usually. Her family lives 2 hours away and started their trip at 5am to get her to the Baylor clinic. She was so weak that she couldn't walk. And that was just the beginning...

Kate saw a 10 day old baby with HSV (herpes simplex virus). She had tight, raised vesicles all over her forehead, around her eyes and one in her mouth. She most likely got it from her mom when she passed through the birth canal and it's possible that it could go everywhere in her body -- bad news.

I saw one of the leaders of the teen club, which is held once a month for teens living with HIV. He is usually very smiley but today was feeling badly. It was an upper respiratory/sore throat type deal so probably just your run-of-the-mill bronchitis or mononucleosis case. He has been on ARVs (anti-retroviral drugs) for years and has a relatively strong immune system, so this was just like a primary care doctor visit for him. But...he has verruca plantis (flat warts) all over his face, especially around his mouth. It is caused by an HPV virus, and the reason we don't all walk around with it is that most of us have fully functional immune systems. His constant low-level immune suppression allow this virus to stick around and cause what looks like a white-ish, flat rash.

Kate and I both saw these two ADORABLE kids - one 3 and the other 5 years old - with what we think is Epidermolysis Bullosa on the soles of their little feet. It is a blistering disease with a genetic component which gets worse with trauma - a.k.a. little kids running around barefoot. I gave the 5 year old a book and she read it to her little brother in a combination of English and Siswati (so cute!).

Here is what it looks like on light-colored skin. We didn't think it was kosher to start snapping pictures on our first day...but maybe once we get to know some of the patients and families.

So, all and all a very busy and interesting first day. I'm excited for a very infectious disease filled month! :)

Pictures of the trip & day 1

Getting ready for the long haul in the Atlanta airport:

Welcome to Swaziland:

 

Our humble abode (living room, kitchen, & Carter's bedroom):

No, we haven't used the TV (tried for the sake of some noise but couldn't figure it out)

Yes, we have used the kitchen - spaghetti for our first dinner

Carter liked the orange bedspread the best

The Baylor Center of Excellence / Clinic

Not complete without a dedication from the King

Swaziland activity number 1: walk/hike to "the Pinnacle" (a trek pioneered by our classmate's brother who worked here as a pediatrician a year or two ago....though he ran it which is crazy!)

Local guy who wanted his picture taken

The view along the way

Finally made it to the top of "the pinnacle"

Pictures above courtesy of the one and only Carter Denny....here are one or two more that I thought were worth including from the day: 

The road/path ahead as we walked (periodically passed by trucks or motorbikes - one guy actually came back to check on us because he passed us in both directions & wanted to make sure we were okay and not stranded......or he just wanted to come find out who those 4 women were)

Not quite at the end of the journey but at the last big outcropping of rocks was this one - just like a nose!

And one last picture, courtesy of Carter again, is a shout-out for the Denny family...did y'all know that your family is (apparently) responsible for the best creamed cheese mushrooms in Swaziland?

Swaziland at last

Greetings everyone - just wanted to post a quick update that we are safe & secure in Swaziland.  We will attempt to post pictures a bit later (maybe even tonight after dinner), but all is well at our little cottage home for the next month.  We are staying on the clinic/Baylor Center of Excellence property inside a massive gate with a 24 hour security guard.  We got unpacked today, went on a long walk/hike with Stephanie (our supervising physician) and another visiting pediatrics resident, & then we bought groceries. 

After these quick email updates at the clinic building, we will walk back over to our cottage (just across the playground) to make dinner & have a go at uploading some pictures.  The internet connection on my little computer is a little bit spotty depending on where I am seated (currently using it in the clinic lobby while Carter is upstairs on one of the clinic computers), but we're told that bedroom closest to the clinic usually gets reasonable access to the web....so we'll give it a try.

Oh, and I promise Carter will post some too soon.....I've just happened to be on my little computer more on the trip than has she....and she's probably been better about sending emails to folks so far too. 

Are you a doctor?

Do you ever wonder whether the security people actually watch the monitor as your carry-on luggage goes through the scanner?  Well, in Johannesburg they apparently do....and they don't care about what size your shampoo is or how full your water bottle is.....instead, they key-in on the stethoscope. 

That's right, medical vignette number one of this trip resulted because the security lady saw the stethoscope show up when her backpack was scanned.  Then, after confirming to whom the bag belonged, she asked if we were doctors.  I believe "yes" was the simplest answer at the time though I don't really recall exactly how it was explained.  Instead of asking what we were doing here, where we were going, etc, she wanted to know what caused dizziness.

It's a good thing Carter wasn't feeling super-talkative because asking a budding neurologist about dizziness could open up a book of causes.....in fact, I'm sure there are (several) books on that topic alone.  Unphased when Carter gave her standard answer of dehydration (which very often is the case of folks' dizziness), the security lady asked if that would even cause dizziness at night in bed.  Really, it quite possibly could - and she probably doesn't drink enough water, but in order to calm her a little further we explained very quickly about the crystals of the inner ear & how they float in fluid in the ear.  If they get moved out of their normal place, dizziness can result.  So then we explained a brief maneuver she could try at home to reposition the crystals - and Carter imitated said maneuver on one of the security tables (without actually lying down - which is probably good because who knows what security would have thought about that!).

In any case, that's medical vignette number one....I imagine that a good number will follow.  In the meantime, we're in the airport in Johannesburg waiting for our flight to Swaziland in an hour or so.  We will update again once we're settled (hopefully tonight but perhaps tomorrow).

Hope everyone back home is enjoying a nice weekend!

Stop 1 complete

Just a quick note to anyone following back home, we made it safely to Johannesburg this evening.

Our flight left Atlanta at 7pm local time and we wound up here about 4pm local time....quite the flight.  During the boarding process I was sure that I would need something to help me relax for the 15 hours, but it actually went by very reasonably.  We had personal tv/movie devices at each seat which kept us entertained (as well as the pre-K kids behind us....thankfully!), so the flight wasn't actually so bad.  2 movies, 1 book, 2 meals, & 6-7 hours of sleep and continent number 5 is checked off my list.

We'll get a little R&R time now, freshen up from the long travels, & get dinner here in the hotel.  After a good night's sleep, we'll be back at the airport around 8 in the morning to head up to Swaziland. 

No crazy or particularly funny stories yet, but I'm sure they'll come.

Let the adventure begin...

Our trip is finally here!  Time has flown by, today is the day....we start our travels in just a few short hours from New Orleans to Atlanta, and then Atlanta right into Johannesburg (South Africa).  That last one will be a monster of a flight (15 hours)!  We'll spend the night in Johannesburg & get on a plan the next morning for Swaziland.  We are actually anticipating meeting our supervising physician on that flight as she will be returning to the clinic from a conference in Libya.  We will likely also be greeted on arrival by our Swaziland-experts, Mac & Nancy, who are graciously going to be sure we see the best of their country when we have free time away from the clinic.

We will most likely be updating the blog a few times a week between the both of us, so check back as often as you wish.  Pictures will also hopefully be forthcoming but probably a little less rapidly than the text.

Oh! And the other big news, yesterday was Match Day.  For those of you unfamiliar with that, it is the day where all graduating medical students across the country find out where they will be doing their residency training for the next few years.  Carter & I will both be sticking around New Orleans for a little longer.  She for 1 year of internal medicine before going off to Washington DC to complete her training in neurology at Georgetown, and I for 3 years of training here at Tulane in internal medicine.  It will be an exciting time!