Tetanus

Yesterday as I was getting report (update of all the patients) from the off-going nurse I commented on how much I've learned and seen already. Things I would never see "back home". Diseases so horrifying and cruel that faces, images and families are burned in my mind forever. Diseases that have been all but eradicated through vaccination in more developed countries. Things, that sadly, due to willful ignorance I may actually have to see break hearts, families and bodies again"back home".
I mentioned that the only thing I feel like I haven't seen, and that I hope to never see (as it is one of the most gruesome and torturous diseases imaginable) was TETANUS.

That day I saw tetanus. I wish I never had. Torturous is the right word for it. It's easily contracted through the soil. Yes, even in the U.S. soil and that of other developed countries. Just a small cut, sometimes so small it goes unnoticed or thought of as insignificant is enough to the let the tetanus bacteria in where it releases toxins. Within days these neurotoxins cause a systemic infection causing every muscle in the body to wrench, tighten, twist, and contort. A person has the tell-tale "lock jaw" sign in which the muscles in their face and neck (and everywhere) are so stretched, and strained, and tight that one cannot open his mouth, the jaw is locked shut. The back muscles constrict so extremely the skeleton is bent painfully, unnaturally into an awkward, arching, twisted backbend that lifts the patient off the bed as they whimper and cry in torment. But even crying is hard because the face is so taught. I watched it happen.

Aside, from vaccinate immediately (playing catchup), treat with antibiotics (often for several weeks/months) and try to relax the muscles with drugs and give pain meds for the unearthly contortions (all of which help...some...but not enough to make it un-excruciating).

I will try to portray to you, very briefly, the image I keep seeing over and over. As we went to move the patient from the emergency stretcher to a hospital bed, his father slid his arms under his shoulders and under his knees as you would to normally carry a child who had fallen asleep up to bed. However, the patient was rigid, and not a little. There was no bend in his knees, no flopping of his head or falling of his arms to his sides as he was lifted. Rather he lifted as one straight-backed stone, arms bent harshly at 90 degrees, muscles so tight it kept his whole body as if it were only one very solid piece. All I could think of was that it looked like someone trying to carry a surfboard. Because of the awkward stiffness of the patients body, it took two other people to carry this frozen body to the bed.

DON'T write/speak/tell me anything about anti-vaxx anything. Just don't. 

No shortage of need in this world

While at the hospital families provide all the cares for the patients. Many come from very far away and have almost no resources. A caregiver is required to be with the patient at all times except in extreme circumstances where there is no family or family is also hospitalized-or if they are an orphan. With the infants, many parents actually climb inside the crib and sleep with the baby in the crib. Others, sleep in the hospital bed with their child...and sometimes a spouse...and other children they had to bring along. These are not large hospital beds and sometimes an entire family sleeps in the bed with the patient (technically not allowed, but when there is no space, what are you going to do? Others sleep outside on the ground or in the outdoor concrete corridors of the hospital. A few have tents, many use whatever they have on hand to build a makeshift shelter for the night, days, weeks, months they are here.

The hospital doesn't feed the patients or families. The families either make or buy food and bring it in. This a problem for many who either come emergently or have no means to buy or make food once they do arrive. They also do many of the cares, like counting how much the patient eats and drinks, weighing and counting diapers and ensuring physical therapy exercises get done after they have been taught how to do them. It is all up to them. (This is common in many hospitals throughout the world, particularly in developing countries.)

As I mentioned before, many people come from far away and risk a lot by coming, particularly at this time of year. (Some villages don't even have roads that lead to or from them.) It’s harvest season and bringing their child to the hospital means they may lose an entire years worth of crops and salary and work. For those who come from very far this might mean walking, a scooter with several family members crammed on, or a long bus and tuktuk ride. Laos has very few “cities”. The majority of Laos is incredibly rural with very basic housing housing many generations together. There is no clean water. It all must be boiled or bottled. Much of Laos doesn't have electricity. Some parts of Laos that do have electricity often have shoddy, jerry-rigged set-ups and fires are common because the makeshift addition of electricity with crazy wires, etc hanging to/through a house not intended built for it. The villages (which are counted by how many families live there, not the number of people) are small and often only work as subsistence farmers, meaning they only grow enough to feed their own families and trade within their small communities without much, if any, excess. So again, missing the harvest can be devastating. I can only imagine the strain and stress this puts on them, not to mention the whole ordeal of having to figure out how to get here, often not knowing how they will get home. Mad respect for all of the people in Laos. There is some help the hospital can give for these families to ensure they have food while they are here, and in extenuating circumstances will sometimes help them get back home. As with most places, those who live closer to the city have more access to care, and are often more educated regarding medical care and disease prevention. 

One especially great thing about this hospital that I’m sure makes a huge impact is the “Outreach” program. The outreach team will, I think twice a week, go out to visit previous or chronic patients that have missed their appointments or ensure the family is doing the home care correctly. The outreach team will also ask if there are any sick in the village and bring them back to the hospital if care is needed. Some times they go out for several days if they are going some where that is difficult to get to are far away. They kind of work as a home health, social work, patient and family advocate, solve every problem team.  We have one child here right now that lives several hours away that outreach brought in. They patient has a serious chronic condition reliant on frequent blood transfusions but the family has no way of getting here. Outreach went out and found this child 5 months after he was due for an appointment. He, of course, is very, very sick. I would say we probably have about 10 kids with this exact story every week. Outreach does amazing work, and they do what they can but there are simply too many, too far away and sometimes family does not want, or cannot come in and the children pass away. There is no shortage of need in this world which is difficult for me to completely fathom, even in the midst of it, having come a from a land of so much excess.