Global Health Progress

Dr. Glenn Geelhoed, professor of surgery, international medical education, and microbiology and tropical medicine at the George Washington University, recently returned to South Sudan for his fourth visit since 2008. Due to ongoing security concerns, including an incident in a neighboring village in which six people were killed, Dr. Geelhoed and his team have had to curtail some of their daily activities in Duk Payuel.  The mission is also facing lighter patient volumes, as patients are concerned for their safety during their long trek to the Duk Lost Boys Clinic. Despite the obstacles, however, one young patient managed to teach the team an important lesson about survival.

January 2, 2008 – If all the patients we expect were replaced by just one, this is it.

Things are not as placid as they seemed.  It is now easier to understand why the patient volumes have been lighter than expected.  The patients do not want to trek here for eight hours through an area at high risk of hostile activities.

We did not go over to the church to help bring in the New Year.  It turns out they did not want us to walk over in the dark without armed security guards.  We have no way to do that if we also have to keep them on site to guard the compound.

We did go over to the church by daylight, where we were serenaded by the marching chorus of the church choir and a gaggle of marching kids beating drums, waving flags and holding high the crosses they carry to church. As I returned from the walkabout, we planned to settle in for our dinner and evening tutorial, with a request from several participants that I do a re-review of tropical medicine.

I stopped by the clinic on my way—mainly to see if there would be any solar power to trickle into the camera batteries and laptop—and I saw a woman who had been in clinic the day before with a 15-month-old boy.  The child had a fever at that time and it was a suspicious fever for malaria, but I was told that the ELISA kit (Enzyme-Linked ImmunoSorbent Assay, a simple and sensitive diagnostic test) was negative.  The child also had pneumonia, and a course of ceftriaxone was initiated.  The baby boy got worse, and the mother returned to the clinic.

On examination, the nearly comatose child was very sick and close to death—a heart rate of 140 and a respiratory rate of 60, and only vaguely cognizant of his mother standing over him.  This time the ELISA kit test was positive, and a course of anti-malarials was needed—pronto.  But we have no more IV quinine, which would be the treatment for this kind of malaria, and we also had only Coartem, the artemesan-based treatment combination pills that would need to be pulverized and administered somehow to a child that was not capable of swallowing.

I remembered from packing at home in Derwood during our “Packing Party” with some members of the team during our orientation sessions and including supplies I had stored in my “Mission Control Room” into the SCI Blue Bags that we had pediatric feeding tubes, and just today we had unloaded the bags into the store room.  We found them labeled “Ten Assorted Size Feeding Tubes,” and immediately got out an appropriate size tube and inserted it. Natasha, a surgery resident from the UCSF surgery program, had got some rubbing alcohol to try to bring down the high fever, and turned to ask, “How long does it take to get a result from the Coartem?”

A half hour later, the child was awake, afebrile and cooing at his mother.

So, as I said at the tutorial held later with the rest of the team, “If ever you question whether you are doing any good in trying to treat someone here in less than ideal circumstances, remember this ‘shoestring catch’ as someone for whom your presence made a difference.”