Why I do what I do

5 May

Today was a typical Friday, except we had fewer residents at the hospital as the rest were in Kigali attending a research course taught by a good friend of mine, Peter Cartledge. Rounds started at a decent time in Ward A, the acute care wing in Pediatircs. It was me, the resident, a clinical medicine student (Rwandan version of a Physician's Assistant,) and a visiting student from Scotland.

Our 5th patient had been with us for a few weeks with complications from Rhuematic Heart Disease. This was her first hospitalization for this condition, and she was fairly sick when she came in: breathing very fast, low oxygen saturations, very swollen face and legs, and abdominal pain from extra fluid in her liver and abdomen, all signs of heart failure. This all happened due to previous infections with Group A Streptococcus, which cause Strep throat. The body creates antibodies against this bacteria, which in some cases can also damage the heart valves, causing heart failure. During the course of her hositalization, we put her on the usual medications to decrease the swelling and to support her heart to work more effectively, supported her nutrition with healthy food from the garden project at the hospital (www.kuzamuraubuzima.rw), and slowly weaned her off the oxygen. Over the course of the 2 weeks, she markedly improved.

Today, she was smiling, happy, and looked like a different child. Her vital signs were all normal, she no longer had the edema, and her liver was almost back to normal (it usually takes a while for all of the excess fluid in the liver to go away.) Both Mom and daughter were ready to go home. After the resdient finished his presentation of this girl to me and the team, I gave her a fist bump, which she returned with a huge smile on her face, and I said "Absolutely!" I turned to the team and said, "This is exactly why I went into medicine! To see a child come in sick, to give her the best treatment we have, and to see her smile and be able to go home healthy; this is why I do what I do."

She does face an uphill battle. She has to receive a monthly Penicillin injection to help prevent future infection causing more damage to her heart. She has to eat well. She has to make regular visits to the clinic here to make sure her heart is healthy. And eventually, she will need a heart valve replacement. But I feel confident that she and her Mom, with good guidance from us, will do what is needed to keep her healthy.

A big problem remains for her and the rest of the developing world: this is a disease of poverty. We have this same bacteria in the US, causing the same strep throat and skin rashes as here, but the poor and disenfranchised of the developing world suffer from this condition; few if any cases occur in the developed world any more. We can and must do more. On my side, I am creating a database of children with Rheuamtic Heart Disease at the public hospitals here in Rwanda, and in the future hope to find a way to help with diagnosis and treatment of Strep Throat and skin rashes here at the health cente level, so we can prevent this from developing in the first place. Again, this is why I do what I do: To help those in need, and to find ways to prevent it from happening again.

Until next time,

Love life, Find meaning, Be happy,

Craiger