Today I went rounding with Dr. Benjamin. He had already begun his work. Others of the
team were distributed amongst the various other ILH functions so I was with him
by myself. I heard there was a child
with a substantial burn that I was anxious to see. He had basically finished with the little
girl. I decided to take a peek. The 3 1/2 year old girl had somehow splashed
boing water on herself. This is a very
common problem in TZ. The wood or
charcoal stoves are low to the ground and sometimes the pots tip. There was an infant that died of an extensive
burn a week or so ago. Fortunately, this
little girl has mostly superficial second-degree burns with some deep second
degree, about 18% body surface. Of
course, the important concept in treatment is to keep the second degree burns
from becoming third degree, i.e. full thickness burns. They know what they are doing here. If only
there were fewer of them to know about.
I tried to make myself helpful and saw a couple kids with
respiratory problems. Both were stable;
both had pneumonia. Both should do fine.
We moved on.
 | |
| The Growth Chart |
In the next room we went to, there was a baby, an eight
month-old who was sick. The mama was
young – I do not know how young at the moment – and accompanied by bibi
(grandmother). I am not even sure why
mama brought the child in now and not last week or last month. The baby has
marasmus.
About 38% of children under-five years of age in Tanzania
are stunted, i.e. short for age.
Stunting is a surrogate or indirect measure of chronic under-nutrition. Wasting, low weight-for-height, is a measure
of acute under-nutrition. (Remember that obesity is also malnutrition.) Marasmus is the extreme case of wasting.
The mother had never breastfed the infant. Dr. Benjamin speculated lack of counseling on
discharge from the hospital. Did she leave early? Did she just get missed? She
had told someone that her milk did not come in.
A wives’ tale, or should I say “Bibi’s tale,” is that colostrum is
harmful. Was she discouraged in this
fashion? Attempted and persistent
nursing is what stimulates milk production.
What happened? Perhaps we will
find out as a few days roll by, but my language barrier will obstruct me from
finding out easily.
I do not know what he has been fed. Possibly only dilute
ugali.
Marasmus kids look like little old men or women. The face is drawn, Adonis’ face is drawn and
tiny. Their ribs stick out. My colleagues noted, “You can count his
ribs.” His arms and legs are sticks. His
lips are dry and cracked. A rash is peeling the skin away on his posterior
thighs.
The last case of marasmus I saw, a two year-old girl, died
within two hours of admission. Kelsey
Watt, do you remember her? I know you do! Her picture, which has haunted me for
several years, is now replaced by that of Adonis. Yes, I am using his real name
and no apologies. If he survives and I
see him again in a year, perhaps I will apologize. Or just hug him.
Ashura, one of our nurses, is the local authority on
malnutrition and knows just what to do.
We recruited the nursing students for round-the-clock attendance to help
with feeding and to watch for re-feeding syndrome, intolerance of formula. I went back to the room this evening. The nurses have washed him and lubricated his
lips. I got to hold him for a few minutes. I told him, “I am Babu,”
grandfather. I will be on edge until I
know he has started improving. This
morning, my actual birthday, I am relieved and happy to report that he looks
qualitatively better. This afternoon, no diarrhea and no vomiting, the latter
the important sign of re-feeding syndrome.
This morning we heard the second year Nursing Students
report out on their field experiences.
The three teams each went to a separate communities where they lived for
4 weeks, assessing the community’s health needs. They all did a marvelous job – in English.
On a further happy note, we are having a get-together for
the entire staff tomorrow (now today). I
volunteered for our group to pay for the sodas and water. That was before I
knew there are close to 180 people, including nurses, doctors, aids,
volunteers, housecleaning staff, guards, nursing students and tutors and us. It was also before Kikoti suggested two
bottles each. Originally I coined it a
“Soda Party.” I had not connected it with my birthday. Still it is more apt as a going-away party,
since Jon and Mahveen will leave Saturday and the remainder will leave Tuesday
next. I will stay on in Iringa with Birdie for another 10 days.
An update on the Soda Party. I am pretty sure it was the
biggest thing at ILH since Saga’s wedding, which was BIG! OK, so that was at the church, not the
hospital, but anyway, it was BIG.
There won’t be any photos of Adonis. You may look at the growth chart, however. Note that his weight had crossed many
lines. I am not sure why the baby was
not sent for consultation at any point in the past. Possibly he was. There could be a myriad reasons why nothing
happened. Perhaps I will find out. Maybe
not.
 |
| Tanzanian line dance |
I have a party crowd photo from my birthday party – I mean,
the “Soda Party.” You can pick out what you see as blessings above. You should
include the birthday present I got from the nursing students, kobe in Kiswahili
or turtle in Kingereza. I am contacting
Mr. Magafuli for special dispensation to bring him (kobe) home. I am tweeting Mr. Trump.
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