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 Welcome to my diary of interesting cases, events, thoughts or quotes surrounding the daily activities at Clinic Lukumu L'Ololo, Lodja, DRC. At times these vignettes will expose some of my clinical blindspots, so feel free to drop me a line with your observations at congoeye@c-gate.net. - TGH, M.D. |
September 2003Here's a rundown of the mechanisms of eye injury I've seen this month. 41 y.o. man - iatrogenic insult by a remote health center nurse - double dose of Mectizan (NPL/NPL over 9 months) • 6 y.o. girl - hit in the R eye by a playmate's stick 1 month prior, came 100 km • 29 y.o. man - hit in R eye with a stick by a soldier 2 weeks prior • 75 y.o. man - came 34 km barefoot in an old tuxedo; after a blow to his L eye, he put pili-pili (hot pepper) in it to treat it • 56 y.o. man - came 75 km from Djalo where a rabbit snare he was setting "went off" in his eye • 34 y.o. woman - cutting field with machete, stick bounced back into eye • 51 y.o. man - his brother was pulling up a log to sit with him by the fire in the yard when a piece flew off into his R eye • 51 y.o. man - clearing a field to plant rice, a thorny vine bounced back into his eye; referred by Wembo Nyama hospital 150 km away • 24 y.o. man - bike spoke being tightened broke and flew into R eye • 4 y.o. boy - hit in eye by a rock thrown by a playmate • 30 y.o. woman - slapped across the eyes by her husband; OD in Oct02 & July03, OS in Aug03 • 45 y.o. man - thrashed across the L eye with a branch by soldiers who wanted his goat; referred from Wembo Nyama; globe ruptured beyond repair • 17 y.o. man - fell from the back of a truck onto his L eye and head in the dirt road. Mon 8 Sept 03 I hate to make a grown woman cry, but among all the eye cases today, I also saw a 44 y.o. friend and neighbor who presented with a terrible sore throat for a week; couldn't eat, could only drink for the previous 3 days. Feverish several days. The tonsils were not inflamed or white coated, but the right tonsil looked like it wanted to kiss the left one. A great swelling in the underlying tissue had displaced it from its usual location (on its own side of the midline). She was no more excited about the solution than I was as I approached her with an 18G needle on a 20ml syringe. After two attempts at various angles produced no pus she begged me to consider something else. I thought it was preferable to incision and drainage, but she would have no more. I put her on PenVK, with lots of hot tea, and wanted to follow it closely, but she never came back. I asked about her and folks said she was doing better, but only when I saw her singing and smiling in church did I know for sure. Tues 9 Sept 03 A 44 y.o. Lodja fisherman presents decreasing vision over 18 months. In fact, he came for consultation the very first operating day ever (2.7.02), but we were busy, so he has come back now, 15 months later. In the meantime, he says, he has been attending prayer for the sick at his church. He says that he has filled up three cards with prayer dates, but his vision keeps on getting worse. He went to the general hospital once, where they gave him Vit. A for weak eyes and Mectizan against river blindness, but no appreciable change was noted. Today his vision is OD:HM, with perhaps 30% of his normal visual field remaining, and OS:NPL. Pressures around 50 (3 times normal) in both eyes. Glaucoma surgery can only promise to preserve the little vision that remains. I see this sort of case every week. Early or late, the surgery costs the same in time, materials and effort; but it's much more useful to preserve 20/20 vision than hand movement or even light perception. Aren't we all like this now and then, desperately groping for a solution in all the wrong places. Jesus is the way, the truth and the life - the Solution. This man desperately needs the truth about his eyes. We're trying to express that saving truth here in the Sankuru, and when it comes to eyes, we seem to be standing alone. Thurs 11 Sept 03 A 34 y.o. man presents with burning stomach pain for a year. Says he's tried every product in the market - though from what he tells me he's underdosed every one. Exam is unremarkable. I don't have any GI cocktail here like we use in the states, so I tried something I've never tried before in Africa: I gave him 20cc of lidocaine to drink. He was reluctant to drink it - worried that his whole body would go numb! Once convinced, he said it was horribly bitter, but in five minutes the stomach pain was relieved for the first time in a year. Too bad it won't last - only of diagnostic value. We'll see what adequate doses of H2-antagonists and an anti-H pylori regimen can do for him. GI problems are second only to malaria among our general medical consultations. Fri 12 Sept 03 A 45 y.o. regular patient of ours used to get really uptight when she or a family member needed to see me. As a devoted Jehovah's Witness, she was apparently terrified that I would pray for her. Once when she told me that she could only pray at home, I offended her by asking teasingly if she'd left God at home. (Some other JW patients allow us to pray for them, and some even pray for us.) Now we have a sort of understanding, and I see that it really ministers to this lady when I DON'T pray for her. Wed 17 Sept 03 Judging from patients referred to us, it seems safe to say that almost no health centers or hospitals keep written records of their treatments. Most tear a loose sheet out of the common 30-cent school cahiers and write details of the visit and treatment on it, giving the scrap to the patient as he leaves. Most patients lose such 'medical records,' but a few hang on to them, producing them filthy, folded and tattered from a dirty shirt pocket when they come to see us. Needless to say, continuity of care is not to be found on the priority list of village medical health centers. The 68 y.o. policeman who came to consult me today with his much younger commanding officer was counting on our having no old records. He got hit in the L eye arresting someone, and was hoping the police department would pay for his decreased vision. It seems that they are more amenable to covering work-related injuries than chronic diseases of old age. As it turns out, this man had consulted us a year prior for decreased vision and was found to have early cataracts in both eyes. Since his vision was 20/60 OO last year and 20/80 OO this year with no evidence of pathology due to the blow to the OS, the commanding officer rightly concluded that his present decreased vision has nothing to do with his on-the-job injury. Rightly or wrongly, it looks like he'll have to scrape together the money himself for the cataract surgeries - and when that time comes, we'll have all the records. |
