Storm Clouds

It has been wonderfully exciting these last few weeks to see people cured or treated, returning to their lives and family, in a setting of resource-limited medicine. 

There are sobering times to balance this happiness, though.  When a patient at home is failing to respond to treatment for their illness, it is often only after a prolonged effort involving multiple specialists, extensive tests, and multiple attempted treatments.  There is a point in illnesses which are not responding to treatment where both patients and healthcare providers begin to understand that the attempted treatments are not working and that good additional treatment options are not available.

Those "storm clouds on the horizon" appear sooner in the setting of resource-limited medicine.  There are often few or no second-line treatments available if the first treatments of an illness are not effective.  It is one thing to see such a patient for whom no effective treatments are available anywhere in the world.  The real sadness comes when you are sitting looking at a patient and thinking that if you only had "this or that", that the patient could well recover from the illness which is taking their life.

Snakes in the Grass

I recently asked Dr. Hake about the local snakes and the best treatments available for these bites.  Dr. Hake answered my questions and noted that it had been a while since he saw any snake bites.  We must have been talking louder than we thought; either that or the local snakes have good hearing.  

Anyway, we have been admitting one person per day with snake bites for the last three days.   All have been in young-to-middle-aged women, and all are doing well with treatment.  We must learn to talk softer.

Stayed in my Mind

It has been great to be at St. Martin de Porres Hospital for the last several days with the Hakes.   It has been hard, though, to see the burden of diseases born by people here, particularly Malaria, Tuberculosis, and HIV.

There were two patient's this week who stayed in my mind.  The first was a young man who had recently been admitted with all of malaria, tuberculosis, and HIV.  He had a prolonged hospitalization during which his malaria was treated, his tuberculosis begun on treatment which allowed him to return safely to his home, and his HIV begun on treatment.  He looked happy and strong.  The total cost for this hospitalization was about $110.  The second patient was a young infant who was admitted to pediatrics with pneumonia and a severe congenital liver problem.  The pneumonia was treated, but there are not the medical resources available to evaluate or treat his liver problem.  
 
The young man is a joyful reminder of how much can be done with so little to help people.  The young infant was a sobering reminder of the inequities of the distribution of healthcare in the world.