Patience with Patients
We are having a BLAST with the medical team here—a mixture of pediatricians, family doctors, infectious disease doctors, MSF doctors, Swazi doctors, South African doctors, residents, medical students, nurses, and “expert clients” (openly HIV positive translators and counselors). In the midst of our projects, we have had a chance to spend a few hours a day in the clinic with the doctors. We have encountered some really cool cases—some of them, “unheard of” in the US:
1. The first of the hidden gems was a patient with epilepsy, MDR (Multi Drug Resistant) TB, and HIV. She had an ENORMOUS pleural effusion caused by her TB. A pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation. So, needless to say, she was having serious trouble breathing and could barely stand up straight. Pleural effusions can be easily drained, a standard protocol in the US. However, this woman refused to go to the hospital to get it drained.
“Patients believe that you go to the government hospital to die. It’s mostly true—we send patients there as a last resort. Whenever we tell a patient that they must go to the hospital, they always begin crying hysterically.”
Needless to say, this patient was no different. The doctor examined her chest to reveal a scar where a traditional healer had attempted to treat her condition. The woman was unphased by the fact that her x-ray showed no function of her left lung—a cloudy white haze. She refused treatment, claiming that draining the lung would cause it to harden, and that she would surely die from the wound. After an hour of convincing her that she needed to have it drained, the doctor agreed to drain the effusion at the clinic. Yiwen and I watched as they drained 250+mL of fluid, teeming with TB.
2. There is only one oncologist in all of Swaziland—he’s from Cuba, and he only does mastectomies. There is no chemotherapy or radiation in the entire country, and there is little to be done at the clinic for patients with Kaposi’s sarcoma (often, an AIDS defining viral cancer).
“This is a serious issue that goes beyond HIV related cancers.”
They need an oncologist. Currently, there is only one oncologist on the PAC (Pediatric AIDS Corps) team, and he is located in Botswana. The cancer scene is quite a contrast to the 14th floor of the Texas Children’s Hospital.
We have identified several potential sites for the bililights and/or incubators:
1. Orphanages: The clinic does outreach trips to several orphanages that may require neonatal care. We will be visiting the orphanage (hopefully) once a week.
2. The two government hospitals (Mbabane Government and Manzini Government): The hospital in Manzini has just set up a neonatal care facility and will likely be able to make use of the projects.
3. Outreach clinics: The Baylor clinic sends about 5 of its 10 doctors to outreach clinics every day. We will be traveling with one of the outreach doctors once a week.
We are finishing up the resource library, and are beginning a few other projects around the hospital this week. This afternoon, we will be presenting the Lab-in-a-backpack and the bililights to the hospital staff. We spent Sunday evening desperately holding the bililights together as we waited for the Epoxy glue to dry. Yiwen’s worst fear had come true—the side boards began to crack off on the flight over.