Pediatrics in macha

So this morning has been better than yesterday. I did rounds on the pediatric wards where I should be spending the majority of my time besides the ART clinic. Dr. Thuma led rounds. Dr. Thuma is from Pennsylvania and is a Pediatrician. He has been in Zambia since the 70’s and can speak Tonganese. Rounds last from 8 until about 11. Dr. Thuma does a lot of teaching which is wonderful since I haven’t seen many of the diseases before. There are two other Zambian medical students that were also working in the pediatric ward today. There were so many interesting cases today, but I will only mention a few.

There was a two year old girl who has been short of breath, sweaty, cyanotic, oxygen saturation of 45%, and poor growth since birth. She has a loud holosystolic, decrescendo systolic murmur: a VSD. Most likely she has Tetralogy of Fallot. She has an enlarged heart and liver on chest xray. We put her on Digoxin but that is all we can do here.

There is a six year old boy with sickle cell crisis only mild from pharyngitis. The interesting part is last year he had such a bad crisis that he had a stroke leaving him with a hemiparesis and blind. The blindness has improved. During that crisis he also had a bone infarct in his other leg that led to osteomyelitis. He now uses a wheelchair.

There was a little girl with meningococcal meningitis, which I hadn’t actually seen before.

There was a four year old boy with cerebral malaria. He had come in with a coma and seizures. Today he was improved and was alert. But he cannot hear anything. The doctor said often their hearing will return a month later. He is also very ataxic.

There was a little boy who came in with seizures and then developed diarrhea. This apparently is from the Shiga toxin from Shigella diarrhea. I hadn’t heard about that before.

There were two whole rooms of children with failure to thrive. The worst case was a four year old that was only 7.5 kg…that’s the size of a small 1 year old. That boy also had rickets of his ribs where the cartilage meets the bone; it looks like rosary beads so they call it rosary rickets. All of these children either have confirmed HIV or suspected. They all likely have another illness as well that causes them not to gain weight. Most of them appeared to have TB on their chest x-rays as well. The TB doesn’t show up as it does in the US- in the upper lobes- it shows up throughout the lung. I have already seen PCP in a baby with HIV as well.