All Work and Little Play Makes Katie a Lazy Blogger

Long time, no blog. As usual, I apologize for my silence. As of this coming Wednesday, I will officially have entered my third month in Lambaréné. There have been more sad moments in the pediatrie during the past few weeks, but instead, I’d like to talk more about some interesting, not-so-sad patients as well as life outside the hospital.

*WARNING: this will most likely not be interesting or funny to non-medical people*

As a young medical student hoping to uncover some rare diagnosis, I have offered up several zebras in recent weeks, only to have confirmation that I really should start my differential diagnosis with horses. One little girl came in with belly pain and splenomegaly. Incidentally, I happened to notice copper-colored rings around both of her irises…Kayser-Fleischer rings?! Wilson’s Disease?! (Despite the unrelated nature of her symptoms to such a diagnosis…) Man, I’m good. Not so much. As soon as I started doing a better job with my general exams, I realized that it is rare not to see said rings around children’s irises here. I don’t know if it’s a sun-related phenomenon, but it’s definitely not problematic, and I cannot imagine that copper-accumulation due to a genetic defect is rampant here in Lambaréné. Zebra #2: A 6-year old girl comes in with severe depigmentation over the left upper quadrant of her face, as well as some splotchy areas of depigmentation on the back of her neck (also left-sided) that her father & aunt state with utmost conviction did not exist before 7 weeks ago. Her skin was entirely normal and uniform before 7 weeks ago. Sudden loss of pigmentation in such a short amount of time? In Africa? Dermal oncoceriasis (river blindness), anyone? No mind that she has no ocular symptoms whatsoever nor any other symptoms at all. According to 5 dermatologists back home, it is most certainly segmental vitiligo. Even my non-dermatologist mother knew that one with certainty. 0 for 2. Zebra #3: A 10 year old boy describes swellings in his inguinal region as well as an increase in the size of his right testicle every time he has a fever (which is about twice a month for the last 2 years). Being the inexperienced tropical medicine student, yet also the student who learned that one must always take a sexual history no matter how unlikely the patient, I asked the mother to leave to room while I gently asked this scared, tiny 10-year old boy if he had ever had sex (he said no). All I could remember was a slide showing lymphogranuloma venereum. Anyway, his clinical exam showed enormous, inguinal lymph nodes bilaterally with hydrocele of his right teste. When his labs came back, he had an “important” (as they say here) eosinophilia. NAACP! Neoplasm, allergy, asthma, collagen vascular disorder, parasite…or something like that. Being that we’re in Africa…P is the most likely culprit, but neither the physician I was working with, nor I, knew what exactly the offending organism (or cancer?) was, so we sent off for some more labs and sent him home with a standard dosing of mebendazole with a follow-up in 10 days. This weekend, I’ve decided he most certainly has a chronic case of Wuchereria bancrofti (please someone tell Prof Pfefferkorn that I diagnosed it myself!). I swear this time though that it’s not a zebra. I believe I have successfully convinced both of my attendings of my hypothesis, so when he comes back, he’s in for several weeks of treatment with albendazole, ivermectin, and doxy (the last to kill some bacteria, Wolbachie…?, that lives in the Wucheria intestine & is released when you kill the worm). So I’m going to say the score is 1-2. Not too bad.

Outside the hospital, life has been relatively calm. Christy, the peds resident, returned to Yale (but not before coming upon a cadaver on the beach in Libreville during her last leisurely walk before heading across the street to the airport). Meredith Dixon, the pediatrics student who was here from May-July, returned to Lambaréné. She will be staying through April to conduct a need-assessment survey to better understand what is needed here to get a full pediatrics HIV program up and running. Currently, we do not give children here anti-retrovirals…it’s very complicated, so I’ll leave that to another time. Last weekend was a little different in that Christy, Lillian and Marie went to Résérve de la Lopé, one of the 13 national parks here. I wasn’t really feeling up for an African adventure of planes, trains and automobiles (having experienced several before), so I hung out at home. Saturday was a standard weekend day with my usual porch musings in the morning followed by pilates, pedatrics reading, journal writing, and finally, the viewing of several episodes of season four of “Sex and the City.” On Sunday, however, I went on a boat ride down the Ogooué with Meredith, Natalie (the French pharmacist), and Natalie’s parents. It was beautiful. The farther down the river we went, the fewer people we saw. We visited several of the large lakes of this region, had a picnic lunch at a tiny fishing island, and along the way saw treetops full of pelicans, monkeys swinging on vines and glimpses of hippos as they came up for air from the river bottom.

As for the pictures: the first one is of a man from the fishing island holding the palate of a sawfish? that his grandfather caught in that same lake 50 years ago. Needless to say, people didn’t swim in the lake back then. The second photo is of a group of kids who were playing near our PMI clinic one day. They were hilarious. Unfortunately, my internet is too slow to upload the video I took.

Until next time…

Katie