This past weekend included ward rounds and some outpatient visits on Saturday followed by a trip to the local market, and then a hike to a beautiful waterfall with Danny, Emiley (my roommate), and Rebecca (wife of a US surgeon).
We got ripped off at the market, paying double what we should have for a pineapple, but bought a papaya and some passion fruit for a reasonable price (about $1.75 for pineapple, 45 cents for papaya, 20 cents for 4 passion fruit).
The hike to the waterfall took a couple of hours, and on the way we passed a Fulani compound (Fulani are a separate ethnic group of people and their livelihood is based on cattle) and saw people hearding cows up the mountain, both on foot and on horseback. The waterfall was breathtaking. We are lucky to be in Cameroon during the transition from rainy to dry seasons as there is still enough water around that everything is lush and green and the waterfalls are flowing, but with little enough rain that we can enjoy the outdoors.
Sunday included church, with an extra-long service due to a baptism of multiple secondary school children, and violin. Who knew that daily Baptist church services would be trying for a half-Jew half-Unitarian athiest? Live and learn. Anyhow, turns out that one of the missionary families (Rebecca’s family) has three children who play violin, so I went over some Suzuki pieces with each child, and then Emiley and I played duets, which turned into trios when the oldest girl joined in. Ended up being a lot of fun, especially because I was playing a 1/8th size violin by the time we gave a little concert for the rest of the family!
Medically, more interesting and very sad cases role in each day. We have been diagnosing many people with HIV, and have seen many others with HIV-related illnesses. For example, we recently discharged a young woman with HIV and ascites of unclear etiology (possibly Budd-Chiari but we can’t check dopplers or get a CT to look for thrombus) and Kaposi’s Sarcoma on the tongue, a 30-year-old with HIV and invasive cervical cancer who cannot be treated with surgery or chemo because she does not have the money, a 29-year-old lady with HIV and a likely-Tb pleural effusion who keeps spiking fevers despite chest tube drainage and treatment for bacterial superinfection, a 60-year-old with HIV and lower extremity weakness found to have positive PPD and likely Pott’s Disease (spinal Tb), a young lady with HIV who is 9 weeks pregnant whom we are treating with bactrim for presumed CNS toxo as we have none of the first line toxo treatments at this time (giving a lot of folate given anti-folate properties of bactrim in the first trimester, yikes), a number of HIV positive people we are treating for presumed crypto infection of the GI tract, and the list goes on. On rounds it feels as if everyone has HIV, and it is actually not too far from the truth.
The Cameroonian government’s ARV program is frustrating. One cannot simply write for HIV meds for inpatients as people are only allowed to get ARVs from one treatment center. If a patient’s primary center is not our hospital and they do not have extra medications with them, HIV treatment is put on hold while they receive acute care.
Outside the realm of HIV, the female ward includes is a 30-year-old female with acute psychosis who continues to insist that I am her spiritual grandmother, and a very sweet elderly woman coming in with a COPD exacerbation who happens to have a huge goiter that displaces her trachea rather dramatically.
This week I am going to be giving a lecture on acid-base status, ABG interpretation, and ventilator management (topic requested by some of the residents). Even though we cannot check electrolytes or ABGs here and do not have ventilators, the Cameroonian residents are still tested on the same subjects we are tested on in the
US. The things we take for granted every day are taught in a purely theoretical sense here. Unbelievable.
Anyhow, please check back shortly for some pictures, including the goiter and the resulting tracheal deviation.
See you back in the US soon!
-Karen
85yo male seen in outpatient clinic with very large goiter causing venous compression, presenting with nocturnal dyspnea, nocturnal cough, and intermittent LE edema. Also with epigastric pain on exam. Apparently the goiter is so deep that it is inoperable. All labs and an echo were normal. Hopefully some omeprazole and lasix will help.
Elderly woman admitted with several month history of dysphagia and epigastric pain, found to have white count of 38, hemoglobin of 5, and creatinine of 5. Took about a week to get a chest x-ray because she was persistently hypoxic (people can’t get x-rays on supplemental oxygen), but after treatment for presumed pneumonia we got this CXR showing a mediastinal mass vs huge aortic aneurysm probably compressing the esophagus (and trachea). She was discharged today, poor prognosis.
