Jungle Fever

another picture taken just outside of my house...

a positive PPD

Another interesting case today -- a 13 year old girl who came in two weeks ago with vague complaints of abdominal pain, persistent fever, lack of appetite, some vaginal discharge, and general malaise. She had no pulmonary complaints, her lung exam was clear as a bell, and she had no history of TB contact, but we placed a Mantoux (ppd) at the same time as doing several other tests. She didn't come back two days later to have the test read, but came today complaining of persistent abdominal pain and fatigue. While doing her exam, I noticed something strange on her arm. Thinking it was a bizarre skin infection (i'm terrible with derm, especially here!), I asked Dr. Bonito to have a look. It is a very, very, very positive PPD!

The doc's hypothesis: some type of pelvic TB?!? Fascinating. We'll find out more in the next few days.

this weekend's soccer match

was the HAS pelican team (our home team) against "les maliens" - a group of people of malian descent who live in lambarene (and some gabonese too.) it was a great game, and we won 6-0! here's a kinda crazy shot of the game.

almost there...

and the sign letting us know there's only one more hill before we get home.

The road to Schweitzer

A photo of the jungle-y road from the main "highway" to the hospital, our standard running route where we dodge taxis and goats and hooting men!

A serious bump on the head

This little girl came in yesterday with a bump on her head. OUCH. It's been there for FOUR MONTHS.
More on this later.

Wildo again

Here's the latest pic of my peds assistant. Found out a little more about his story yesterday - the "severe anemia" with which he was admitted -- he had a hemoglobin of TWO. yes, folks, 2.0. He has also gained more than 50% of his admission body weight in the past four months! He's still significantly growth-retarded for his age (he's a six year old and looks the age of a 3 or 4 year old), but he is doing fantabulously!

life in the jungle

Time for a few pretty scenery shots

First is a pic of the sunset from above the stade municipale last week:



And then a pic of the Oguee river from the road at the base of the stade hill:

a crazy skin infection

And another picture from PMI - this was an infant that the mother brought in with "a rash." We explained to her that it was very important to get the infant to a hospital as soon as possible, but she was concerned about the cost, and maintained that the child was happy and eating well and it couldn't be a very serious problem... couldn't we just give her some medicine? We prescribed some meds for a staph impetigo, but Dr Diallo made it as clear as she could to the poor mom that her child faced a real risk of the infection progressing to a lung infection...

craziness.

une pericardite

I wanted to share an exciting "success story" from this week (and a pretty crazy xray). We had a 9 year old boy come in about two weeks ago in respiratory distress and with a high fever, and his chest xray looked like this -- a massive heart. Based on the CXR, an echo, and the clinical presentation he was diagnosed with pericarditis and the surgeons inserted a drain. (there is no capacity for bacterial cultures here, no radiologists - the docs read the xrays, and the "echocardiographer" is actually the internal med doc who happens to know how to do echos)

After the drain was inserted, he improved rapidly, his fevers diminished, and within about a week or so he was hopping around the peds ward happily playing with the other kids. We sent him home yesterday.

(At first we suspected TB, but it turned out to be a viral pericarditis)

more pics from dinner

the table of food

Sabine, Major Sophie, me, Judith, and Johannes at dinner (front to back)

Fete chez nous

One of the Austrian women working in the labo de recherches is leaving soon, so the peds nurses decided to throw a going away party / welcome to visiting parents party last night. Only complication -- it was at our house! (they informed us of this monday morning =)

Despite the short notice, though, we had an absolutely fabulous African feast, including crocodile, every possible permutation of the manioc plant, tarot, yams, chicken, beef, poisson au chocolat (yes, fish in chocolate sauce!!), cucumbers stuffed with some sort of fish creation, fresh pineapples out the wazoo, and lots of dancing to african music. It was fantastic.

Here's a picture of me with some of the ladies who cooked.

Soccer madness

As in pretty much every country I've been in except the US of A, people here are absolutely obsessed with "le fut." We spent last Thursday night at a bar in town with the rest of the Gabonese population (or so it seemed) screaming their heads off throughout the entire game!

On Saturday, though, Negar, Judith and I went to the stade municipal to watch the Schweitzer Hospital soccer team (Pelican) play the team from General Hospital. It was hysterical -- we watched the "vieux poumons" team, which is the older peeps, who range from 20 or so year olds to the 45 or so year old doc for whom Negar works. What a fantastic crowd!

Here's a pic from the match.

driving to oyenano

a scene from the roadside en route to oyenano



and here's a logging truck about to ram us head-on during that drive to oyenano... couldn't get this to upload with the rest of that part of the blog.

PMI encore une fois

PMI this Thursday was even more of an adventure than usual -- the 2nd half of our 1.5hr drive took us down winding bumpy dirt roads through the jungle! We finally reached the village of Oyenano, where 100 children and their mothers were waiting to be weighed and vaccinated, about 15 sick kiddos were waiting to be seen, and several pregnant women were waiting for prenatal visits. We sat down to start att about 10:30 am and didn't move from our chairs until 5:00, when we inhaled our lunches like we'd never seen food before.

Chef de la pediatrie

Here's my new friend Wildo - he was hospitalized about three months ago with severe malaria, severe anemia, convulsions, severe malnutrition... the gamut. He's been here since, gaining weight and health and running the ward with us!

Dora's Confirmation Party

Today was Dora Bernadette's confirmation - the daughter of the pediatrician I work with. They live next door, so the party was literally in our backyard, and it was a raging success. The church service was apparently all morning, lasting from 9 am to about 1 pm, and guests started drifting in around 2 or so. There was a giant tent, and a great deal of delicious traditional African food, and wine, beer, and other beverages flowed freely. The music got louder and the dancing and talking crazier and crazier and when I finally left at 7 pm, the party was just starting to wind down!

The first picture is of (left to right) Dr. Gregoire (surgeon), Dr Benito (peds and dad of confirmee), Damien (white guy - the soon-to-retire directeur of the hospital), Dr Diallo (sante communautaire), and Dr Kaba (surgical resident). They are all fantastic. And yes, that comprises the ENTIRE community of MDs at the hospital. =)

The second picture is of the not-so-slightly inebriated peds nursing staff dancing. They are absolutely fantastic and a blast!

Home, sweet buggy home...

I'm living smack in the middle of the jungle. Check out the picture of the river from the front porch of our little treehouse! Everything is just beautiful - lush, deep green foliage with vibrant flowers everywhere. With the beauty, though, come the animals... I already sent out an email about the cockroach that slept on my forehead the other night. Sweeeeet. After a bit more extermination and a nightly pre-bedtime cockroach check, though, I've managed to sleep roach-free for the past few nights! Here's a picture of Negar decked out in extermination gear as we attacked the roach-ful kitchen the first day we were here.

Out into the villages

I've been spending every Weds and Thursday travelling to rural villages with a program called PMI (protection maternelle et infantile) which essentially consists of a doctor, me, and three nurses who travel on a 6 week rotation into the brush in order to vaccinate, give medical consultations and nutritional guidance to children under 5, and offer inital prenatal screens, vaccines, and referrals to pregnant mothers. Each visit also involves a "presentation" and discussion withthe mothers on a topic of public health interest, e.g. child nutrition, TB prevention, HIV prevention, etc etc etc. It's a fantastic program and I love heading out into the villages!!

Here's a pic of the nurses weighing the babies.