Today was a great day at the hospital, I felt really good in terms of my patient care and my ability to manage multiple cases. It also seems like the number of patients with gastro enteritis are going down leaving room for more interesting cases. There were a lot of new, exciting cases today. I saw a kid with a severe neurologic delay from birth. He was sixteen months old, couldn't sit up, couldn't hold his head still, can't talk, can't really interact with other people. On exam his muscle toner was very flaccid, but his reflexes were all hyper reactive. I spent a while with the mom trying to find a physical therapist and a child development specialist in Libreville, the capitol city. It was interesting to think about all the ancillary services that are available in the US (to varying degrees depending on where you live and how much money you have) that cannot be found here. Or they are extremely difficult to discover. Tomorrow I plan to call the pediatric hospital in Libreville to see if they have any leads.
I managed to convince a mother who was very reluctant to pay for surgery for her child with two broken arms (! fall from a mango tree!) to stay in the hospital overnight so that we could operate first thing in the morning. And, joy of joys, the tetanus child is still alive. We will see how he makes it over the next few days but I am cautiously hoping that he makes it out. We gave immunoglobulin, have valium on board to relax the muscles and calm spasms, are giving metronidazole as the recommended antibiotic, are lining up his tetanus vaccine to give him passive immunity, and are looking for esmolol. I have learned a lot in this case and will anxiously await improvement in his clinical course.
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