It has been a whirlwind of a week. I have seen malaria in most of its permutations and degrees of severity, from relatively mild febrile illness in a 5 year old boy seen in the clinic, to life threatening cerebral malaria in a 3 year old boy admitted to the ward. The children with malaria generally do remarkably well if they get timely treatment. Even the children with cerebral malaria who arrive looking comatose after they receive a couple of days of IV quinine wake up and are largely back to normal. The pediatric patient is incredibly resilient.
We have been able to make a small difference in the care provided at JFK Hospital through access to simple diagnostic procedures like bedside blood glucose testing that we take for granted in the United States. A clear example of this was a 3 year old boy who came into the Emergency Room with very labored breathing and an altered mental status. He looked like every other case of severe malaria with respiratory distress that had come into the Emergency Department that day, but the astute resident volunteering in the ER that day thought enough to check a blood glucose thinking that it might be low, as it often is in severe malaria, and found that it was actually high. She then asked some more questions and checked a simple bedside urine test that confirmed the diagnosis of new onset diabetes. Two simple tests that cost less than a couple of dollars saved a 3 year old boy’s life. Sometimes there are successes to report, and that is one of them.
There is still a long way to go. The case fatality rate for patients admitted to the pediatric floor with severe malnutrition is still above 20% meaning that one out of five patients admitted with that diagnosis die on the floor. The reasons are complicated and have to do with limited resources both on the part of the hospital and the parents, as they are required to pay for each test and procedure if their children are older than 5 years. However, even the alarming case fatality rate cited above is an improvement from the 30% rate of less than a year ago. This improvement is the result of better adherence to guidelines published by the World Health Organization for the management of severe malnutrition and the hard work of the Liberian staff at JFK Hospital. Bravo.
Brad in Liberia 