UgandAshis 53 A young patient with typhoid fever

UgandAshis 53

August 28, 2009

A young patient with typhoid fever.

Textbooks describe the progress of untreated disease. My young friend has been in the hospital for over 5 weeks now. Typhoid fever is a manifestation of Salmonella typhi. In the lymphatic nodes of the gut they multiply and can cause ulcers. These ulcers can perforate and that is what happened to my young friend. For about a week he stayed home without visiting a health worker when he finally came he had what we call a peritonitis. Stool and pus were floating in his abdominal cavity. Rapid surgery was performed and he seemed to improve until seeping through the abdominal we saw feces coming again. It was back to theater for our young man and again he did remarkably well. A necrotic part of his gut was taken out and the gut was repaired. This was a week ago.

Since a week he seemed to be improving very slowly until 3 days ago again the incision wound of the abdomen was leaking feces. This means there is another perforation. The surgeons in the hospital have 2 days they operate although for an emergency there will always be a place – so we thought - .

Over the last weeks we have been blessed with 4 new interns doing surgical rotation and 6 fifth year surgical students. One would say enough hands in the house to do all surgery. What you also need for a surgery are operation theater nurses and an anesthesiologist. So the last 3 days we have had surgeons checking in on our patient and pediatricians treating the sepsis and dehydration but we had no anesthesiologist available to do the narcosis.

It is a long time I have worked in Africa and I am sure that in certain ways my way of working has become pragmatic. There are moments that I do get itchy. Tracing the anesthesiologist and the senior surgeon (a complex surgery awaits) was not an easy job and I was not the first trying to do it. Yet somehow I have done my best. All are aware of the patient. Now to pray he is operated today and is not asked to wait till after the weekend. And then that the operation is a success.

Every morning when we do the round he smiles at us and asks us how we are doing. For the amount of pain he is in he hardly complains and his family takes care of him around the clock. At one point 5 of his relatives were admitted in the hospital. He however is the only one remaining. The others are home and healthy.

I have discussed this delay with many doctors and sincerely feel it is not a lack of will or interest. The bottom line is that the anesthesiologist (senior) works for obstetrics and surgery at the same time and he cannot split himself into two people. Patience for the patient is required.

Namaskar,

Ashis Brahma

Post Scriptum our young friend died yesterday of a sepsis.