Bandiagara Day 8 (23/07/09)

This morning we went on rounds at the hospital; apparently the doctor strike is over (or at least here). There were so many people that it was difficult to hear the cases. There were more snakes bites (and the same little boy), 2 children with malaria; over in the maternity clinic there was one woman who delivered her baby but the cord came out first which cut off the circulation for the baby and it died before it could be completely delivered (it was a little upsetting because the doctors didn’t seem all that compassionate). After rounds Liz and I were back in the clinic with Dembele; there were the usually cases of vomiting, intestinal parasites, fevers, etc. I also got to feel a child with hepatomegaly (which sometimes happens after chronic malaria infection). Late in the morning a girl came by selling peanuts (a common snack here) and we all shared a bag. Liz asked Dembele for a Malian name (the French med student we had met a few days before had been given a Malian name). Dembele said he would think about it and talk it over with everyone so they could come up with a really great name. Before lunch we went back over to the hospital to watch the bandage being changed on my favorite little boy. I think he has a terrible fear of anyone in a white coat now (not that I blame him). This time his mother held him while the cut off the old bandage (which was very difficult as the skin had started to grow into it (I think if this had been in the us they probably would have used an artificial graft to cover the wound).
After lunch I brought a coloring book and box of crayons for the kids at the hospital (there’s nothing for them to do there and it must be very boring). The little boy with the snake bite was the only one in there at the time so I gave the gifts to him, maybe this will help ease his fear of white coats. After leaving from the hospital we went over to the maternity clinic to check on a woman there. This was a very sad case; the woman had begun having seizures some weeks ago at home, but her family refused to bring her to a doctor because they thought it was a mental problem or maybe epilepsy. She had three seizure fits before her husband went to get a doctor. The doctor came to the house and found the woman had a severe fever (over 105F). The doctor got an ambulance to take her to the hospital, but she slipped into a coma on the way. Apparently she was septic; she lost the baby and remained in a coma for several days. She’s conscious now and they believe she is able to hear and understand (she turns her head only to people speaking her language), but she won’t follow commands and she hasn’t spoken. I wonder if she is just sad and angry; it doesn’t seem like anyone is trying to council or comfort her. I’m also amazed at the lack of a doctor patient relationship here; Dembele started examining her without saying anything to her and made some rather delicate contact without telling her what he was doing or even looking her in the face (this is one of the few things I find significantly disappointing in the medicine here).
We went back to the clinic and Liz and I checked in on the lab. A Swiss medical student, who was doing a stage in a nearby village, was in to get some test done. She had a fever and had been ill, she wanted to be tested for malaria (though it was unlikely as she was taking prophylaxes); they also took blood to test for salmonella (though that wouldn’t be run till the following day). Back in the office we waited for Badry to be ready to return to the house and Dembele and Dialo mentioned that they would like to improve their English, so Liz and I offered to speak English with them while we were here.