A few more patients

As I was on my way out for a walk along the river I decided to stop by and see what was going in the hospital. Jorge was on call and a 15 year old had just arrived who had been shot in the foot by a animal trap! It's some kind of contraption that is rigged to a bb-gun and he had accidentally walked into the trap. There was a small chunk of the right side of his foot missing, you could clearly see a few of his tendons, but bone wasn't immediately visible. I put on a pair of gloves and started to help Jorge. Once we were sure he was stable we decided to irrigate the wound and take a good luck. As you can imagine, it was pretty painful, so Jorge decided to sedate the kid with Ketamine, the wonder drug. While he did that the nurse and I cleaned the wound to try and get a better idea of what had been damaged and to control the bleeding. Once we did that we put a pressure dressing on his leg and started working at setting up a transfer to Iquitos. The wound continued to bleed so about an hour later, we took him back to the OR and Jorge ligated one of the veins that was bleeding and was able to find one of the bb pellets. He continued to ooze, but there was nothing else we could find to ligate. So we dressed the wound again and hoped for the best. He left for Iquitos the next morning with one of the nurses and there they were able to do an xray and said his foot is full of bb-pellets. They were planning on taking him to the OR to see what they could do.

We have two other patients in the hospital I wanted to make sure and mention. One is Holbert, a 11 year old boy with aplastic anemia. Aplastic anemia is a pretty serious condition where your bone marrow doesn't produce enough of the blood cells you need. It can be life threatening. He was diagnosed a few years ago and was on immunosuppressive therapy for a year and did well for a while, but then relapsed this year and has been at the hospital for the last four months getting occasional blood transfusions and antibiotics. He is from a community that is far from Santa Clotilde so it is safer for him to stay at the hospital than to go home. He is in need of a bone marrow transplant and so he waits with us.

On Thursday afternoon, in clinic, a mother brought her 8 month old son because of a fever and cough for 3 days. When I looked at him I had to double check the date of birth, because he looked like a 3 month old, weighing only 4.2kilos (9lbs). I have delivered babies in the states that weigh 9lbs! The mother told me that for 3 days he had had fever, cough, some vomiting, and diarrhea. She said that he had stopped breastfeeding at 5 months and she was supposed to be getting milk from the nutrition program at the health center, but hadn't received it steadily and the child ate very little other food. She has 5 other living children, one child died at the age of 6 months from pneumonia. She is a single mother and her only income is from what she raises on her chacra. As I examined the child he was truly lethargic (something you rarely see in the states) and had all the classic signs of severe dehydration and an awful fungal rash that had gotten super infected. It broke my heart. This mom clearly cares for her child, but she just does not have the resources to take care of him well. I admitted him for IV hydration, antibiotics, and feeding. So far he's doing well and eating like a champ, not sure how long we'll keep him, but the nurses have already set up extra food supplies for the mom and baby.