Day Twenty-Four (July 26, 2006)

my last day at Tsepong, for now.

Yesterday, three of us tried to get blood from a very sick two year old. Dr. Lekana, the director of the clinic who is a Lesotho native, managed to get blood from her femoral vein ( in the groin). Her hemoglobin was only 20 ( normal is 120-160). She was likely reacting to the AZT that was prescribed last month which is part of the ARV cocktail of drugs. She died last night. Dr. Lekana is an extremely skilled physician with a great passion and love for these patients. She left this child in the hands of the ward doctor who did not start the transfusion she ordered. Despite her heroic efforts and great skill, many die.

A 32 year old man was carried in at the end of the day. All of the doctors were summoned by Dr. Lekana. He had reacted to the Bactrim that was prescribed to him last month to prevent PCP. He developed the most severe form of an allergic skin reaction called Stephen Johnson’s Syndrome. His body became covered in a rash that behaves like a third degree burn. There was not an inch of this mans body that was not spared. He rapidly went into shock with a blood pressure of only 60/30 (normal 120/80). His respiratory rate was 45 (normal 15-20). He was ready to go into respiratory failure- no ICU or ventilators here. We couldn’t even find the Oxygen, it was somewhere on the pediatric ward. One set of tanks for the whole hospital.

This man was in agony. I will never forget the sight of him, his face covered in blisters and scale so deep that his eyes and mouth were swollen beyond recognition, the skin beginning to slough off. Two visiting physician assistants from the US working for the Clinton Foundation were observing for the day and they just happened to be in the room the patient was carried into. Six North American clinicians in one room with one patient in Africa. He is dying. A room full of education and skill and this man is dying because of a complete and utter lack of technology and equipment. I still can’t believe we pulled it off. Marnie, the pharmacist from Deep River and Me Majulia, a nurse practitioner from Lesotho, took off running. They scoured every corner of the hospital looking for what we needed. One dose of a third generation cephalosporin (expensive antibiotic), a weeks supply of IV ampicillin, one vial of IV fentanyl ( a powerful analgesic I think they stole from the OR) and IV prednisolone ( a strong steroid). I have no idea how they pulled it off but it was the steroid that saved his life and the pain medication that relaxed him. We all watched for the next hour as his blood pressure climbed back to normal. He beamed that terrific African smile . Through the gruesome mess the disease had made of his face, he smiled in gratitude and we all sighed with relief and triumph.

I looked at one of the Clinton Foundation Mentors and stated that there is probably more AZT ( an antiretroviral used to treat HIV) and Bactrim (an antibiotic used to prevent PCP) prescribed at this clinic than in any other in the world. With this volume of drug prescribed, the number of serious side effects and complications are high. Tsepong handles these too.

As we sat watching this man’s recovery, the pregnant patient we put on ARV’s two weeks ago on the same day as her diagnosis, went into labour in the pharmacy while waiting for her prescription. She has had two weeks of meds and the risk that her baby will be born with HIV has been reduced to less than 1% as a result. She delivered a boy.

A good way to end my time at Tsepong.