"You Might Just See a Miracle"

_D818143.jpg

By Volunteer Pediatrician, Margreete Johnston

Today, a half a world and a year away from my last volunteer visit, while in an expert group of pediatricians in the US, I was reminded of how remarkable the care is at FAME Medical.

In my comfortable surroundings with coffee and brunch, we were given a few clues to solve our “study case”. Our study patient was a 14-year-old girl with eye hemorrhages, fatigue, and anemia. My peers are well-respected clinicians and specialists and I have been a practicing pediatrician since 1982, having volunteered at FAME on two month long visits. Cases similar to our “study case”, which took my colleagues and I over an hour to figure out, are every day occurrences at FAME. Here in the USA, differential diagnosis is pared down after doing multiple tests, finding results, performing more tests, procedures, and finally moving on. Very little today was said of a bedside patient exam, and a detailed, complete, history and physical.

It was an Ngorongoro Crater safari guide who mentioned casually to me on my first trip that you might just see a miracle at FAME. He was right.

It was just another September day in rural Tanzania when a hunter found a lost, unconscious boy who was about 14 years old and dressed as a student in the bush. The hunter somehow got him to FAME’s outpatient clinic. Word of mouth brought his father, who assured us the boy had been a well, healthy child just the day before. The boy could not be awakened, had a stiff neck, and difficulty swallowing. He could not seem to hear and responded slowly to pain. Our differential diagnosis included everything from trauma, to rabies, to meningitis. The FAME team supported the boy with intravenous fluids and antibiotics. Spinal fluid results returned suggesting encephalitis like illness. He was monitored as potentially a critical case and examined frequently.

 

Encephalitis is an inflammatory form of meningitis that can be catastrophic. Complications of encephalitis may include permanent brain injury, seizures, loss of language and purposeful movements. Some patients may even have brain swelling. After 36 hours with minimal improvement, our FAME team reached for the next line of therapy, including steroids and anti-viral medications. There was a global shortage of intravenous anti-virals, so we began to question if we should risk giving the medicine orally through a tube? It was risky giving liquids to a person in and out of consciousness. However, the answer became clear when we saw the pleading look on his father’s face.

Less than 24 hours later the lost boy was able to sit with help, swallow food, and ask his dad for his favorite music. Protocol requires treating encephalitis for a minimum of 21 days. By hospital day four, our patient got up from his wheel chair and told his father he would prefer to walk. What made this case a miracle for this experienced pediatrician was the confidence he had. To make my complete surprise even better, he stood up in front of American tourists visiting FAME to “find out what goes on here”. I smiled and said “miracles”.

Kathrine Kuhlmann