Friday, January 29th--Fonds Parisien, Love a Child, Jimani

The internet was broken yesterday, so I couldn't post.  We again saw many, many patients.  One that sticks out to me is an 18 month old who had been sick last summer with a fever and had an "attack", which probably means a seizure.  He was very sick, his mother said.  Then he stopped walking, and he hasn't walked since.  When I see him, he has contractures of his legs and hands.  Seeing him, I think of all the opportunities he would have had, would still have, if he were in the US.  We would have been immunized against the most common forms of meningtitis.  If he got it anyway, he could have seen prompt and appropriate care.  If he developed, as he has, problems arising from having meningitis, he would have recieved developmental evaluation and intervention. Each day we see between 200 to 400 patients.
Yesterday, I also see a 12 month old whose belly had swollen up at home and has been vomiting everything he eats.  When I see him, his belly wasn't swollen, but he looks pretty punky, so I admit him to our mini-hopital for some IV fluids.  He does pretty well overnight, and we were going to discharge him, then his belly blows up again, he is very lethargic.  He develops a mass on the right side of his abdomen and passes a bloody stool.  For those of you playing along at home, the answer is a condition called intussuseption, a condition where the small intestine telescopes into the large intestine.  To fix it, you need radiology, and if that section of intestine starts to die, you need a surgeon. 

So we call the USS Comfort, who say to take him to the LZ at the Love a Child field hospital and they will pick him up by chopper.  We race there,and the chopper never comes.

  We sit there for 3-4 hours trying to get the comfort to come, but they never do, so we pile into an ambulance for Jimani, Dominican Republic, where thankfully, there is a pediatric intensivist and a general surgeon.

  Also thankfully, in this time, the intussuseption has reduced itself..
So we get to go home, but the border had closed, and the DR border guards were having none of it.  Fortunately in our travels, we had met Jose Quinones,  a special attache to the US Embassy from the Coast Guard who had all kinds of juice with those border guys, and he got us across, then took us home.  On the way, he has to check out a group of orphans from a Haitian orpahnage who were being shepherded by a mission group who was now trying to go across the border without the right papers.  It turns out, they need some medical care, and are not allowedto cross the border, so they will be coming to see us tomorrow.