This has been a typically atypical week in casualty. We have had some of our standard medical and trauma patients but the past couple days have been pretty interesting. Here is a very brief overview.
We typically see open fractures in casualty from a variety of traumatic mechanisms. This week though we saw a middle aged woman who came in after a small fall onto a hillside in which she rolled her ankle. Typically this would case a severe sprain or maybe a minor fracture. Amazingly, this woman came in with an open fracture-dislocation. My clinical officer and I quickly attempted a reduction but due to severe pain we had to postpone and perform an ankle block first. Thankfully with an extra set of hands and the analgesia we were able to effectively reduce it and have her admitted for surgery and antibiotics.
Seeing advanced cancers is also pretty common. A combination of lack of funds, poor access to care, and sometimes minimal knowledge of what is happening contribute to the late presentations. This week we saw a fourteen-year-old present to casualty pulseless. To look at him, you would never know he was so young. He was severely wasted from his chronic malnutrition. Sadly, he had died prior to arrival in casualty and there was nothing we could do for him. Upon further questioning, we discovered that last year he was diagnosed with advanced esophageal cancer at Tenwek. We see a large number of patients with this condition and often they are far younger than what we see in the states but he was by far the youngest victim of this disease.
The same day, I was called to our outpatient department to see a young woman with a “growth on her head”. She is 18 and for the past two years has had an expanding mass that started at the base of her skull. It is now the size of a small watermelon. She had recently been seen at another facility and had a biopsy done which revealed that the growth is in fact squamous cell cancer. Due to the advanced state of her cancer, it is not clear yet what her long-term prognosis will be even with resection/reconstruction.
Yesterday we had several critical patients undergoing resuscitation simultaneously. First there was an 11-month-old child who on initial presentation appeared dead. She had severe dehydration from several days of diarrhea and vomiting. After obtaining IV access, we discovered that her electrolytes were dangerously deranged. She is currently admitted in our ICU and remains in guarded condition.
Soon after she was stabilized we received a transfer patient who had reportedly been electrocuted. It turned out that he had been cutting a tree branch and accidentally came in contact with a high voltage power line causing him to fall 20 feet to the ground. We quickly identified the probable entrance and exit wounds as well as a hemopneumothorax. He had obvious lung injury, cardiac insult, and the expected muscle damage associated with these types of injuries. While he remains in the ICU, he is remarkably stable and we are hopeful he can make a full recovery.
As we were assessing our electrocution/trauma patient, a young man was brought in with an all too common presentation of having taken poison as a suicide attempt. The organophosphate poison he took is notorious for causing death even in very healthy individuals. Thankfully he presented early and although he was already showing severe signs of toxicity, we were able to treat him with appropriate medications and intubation. As of today, he was showing dramatic signs of improvement.
One of our first patients of the day this morning presented with the complaint of severe diarrhea. She appeared horribly dehydrated and was quite weak. Very quickly it became apparent that she was incontinent and was very ill. We created a modified rectal tube from an endotracheal tube and a foley bag to help minimize messes and contamination (MacGyver would have been proud) and began resuscitation efforts. The sample we took to the lab pointed to a diagnosis that I have never personally seen before…cholera. Recently we have had cholera outbreaks in only semi-close proximity to our area. This woman and her mother-in-law (who soon presented in the same condition) are from just outside of Bomet. It also turned out that the dehydrated baby from yesterday is from a village right next to theirs and likely has cholera as well. Much of my afternoon was spent going around the hospital with a family practice resident discussing a plan with nursing leadership, other clinicians, and the county disease surveillance officer.
Prayer requests:
Please be praying for all of these patients. We see so many critically ill and dying patients that it can be easy to become callous. But each one of them is an individual with family and friends…and more importantly is a created child of God. Please pray that even if they don’t experience physical healing here that they will be reconciled with God and that they could enjoy permanent healing.
Pray for our poisoning patients. While we can often pull them through their toxicities, the underlying social issues are much more complex and are very difficult to address. Pray for this young man and the difficulties that caused him to attempt to take his own life.
Pray for this current outbreak of cholera. Tenwek is at full capacity right now so we are hoping another hospital can serve as the treatment center, but right now nothing is guaranteed. Pray that suitable, clean water will be available and no more deaths will occur. We had another baby present today who died of severe dehydration from diarrhea. We can’t know for sure but it may also be due to cholera.
Pray for rain. We have seen increased rates of malaria, dehydration related illnesses and now cholera from lack of water. Today I was told about an unusual prayer request made by hospital leadership. When I think of the consequences of droughts, I often think of diseases, damage to crops, etc. What was mentioned though was the migration patterns of animals…specifically elephants. Apparently as they have been looking for water sources, the elephants have been migrating towards our location. As was reported, “The elephants are getting closer.” I haven’t seen a lot of patients present from run-ins with elephants ,but those that I have seen have not ended well. Obviously, we would prefer for any large mammals to remain a comfortable distance from populated areas. Please pray that rain would arrive and be substantial enough to replenish water supplies for people and animals!
Also, please be praying for our current medical officer interns. They have only a few weeks remaining until graduation. Pray that they will finish well, be successful with employment or further training, and that our incoming MO intern class will quickly adapt to the trials and stresses of internship.
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9 Comments
Ella Thoms
Mar, 12, 2015Oh my goodness!! I will certainly be in prayer for all of your patients and staff. I am in awe of the blessings you are given by God. Thankful that He is our faithful, constant, loving and compassionate Father.
Dee
Mar, 13, 2015Your posts are so interesting and humbling. Thank you for your hard work and meaningful work at Tenwek. You have a gift to see the person and eternal spirit along with the diagnosis and treatment. Praying for your patients and for rain.
dedra
Mar, 13, 2015Aaron and family, may I share with you that my grandfather, born 1913, recalled his “little sister” although she was actually his big sister, she died before he was born. His older brothers and older sister often talked about “little sister” who died from an infection upon their emigration from Scotland to America. His older siblings recalled how much they missed their little sister. My grandfather remembered her even into his old age even though he had never met her. Her name was Helena. I named my own daughter Elena in memory of “Little Sister.” Your children will never forget Hannah. Don’t worry about them forgetting. Even her baby brother born after her will remember her–as my own grandfather remembered Helena.
Melody Dearmon
Mar, 13, 2015What a report ! I’ve prayed as you have requested, and am trusting in our merciful, all sufficient Father to provide for every need. Thank you for your faithful work there.
Sharon Martin
Mar, 13, 2015Thank you so much for sharing your day with us. It reminds us that we must continue to keep you and your staff in our prayers. Many here at World Gospel Mission are joining you in prayer for rain.
We so appreciate all that you and your team do there at Tenwek. You are deeply appreciated. Thanks for being God’s hands extended.
Heidi Holko
Mar, 13, 2015Love reading about the work u do. I’m not really sure how u do it emotionally and mentally with all the casualties u have to deal with. Bless u on the work u do. I don’t always comment but always read UR posts. Keep up the great work!!
June McLaren
Mar, 14, 2015Heavenly Father, we come to you in agreement with the prayers of Aaron. May the needs be met wondrously, and may you be glorified through the answers to these prayers. In Jesus name. Amen
Miriam Wert
Mar, 16, 2015Bless you, Aaron, for sharing with us. I pray that your being able to write down all of those sad happenings and sharing them might give you some relief from an aching heart. In addition to your prayer requests, I am praying that Jesus will give protection to you and Steph, and your dear sons so that the Cholera and any other disease will not have access to your bodies You folks are every bit as brave as any soldier serving our country overseas. While they have their armor and guns to protect them (to a certain extent), you folks have no such protection. Therefore it is important that people pray for your safety and good health and that is what I am doing.
Please tell Steph that her mother and I hugged each other at church today. She is a dear person. Also, every Sunday your mother and I greet each other at church with a hug. She is so dear also. At age 90, it is such a blessing to have friends like that, and they are a real blessing to me. And that is one reason why I feel so close to you two even though I never met you.
May God continue to protect and bless you all as you continue to serve Him. Miriam
Eileen Nemec
Mar, 18, 2015Thank you for reminding me of what goes on at Tenwek. I am grateful for my experience there earlier this year and see how God continues to work in the staff there. My prayers of protection go to you snd the staff, all your families, and the patients.