Seizure epidemic

   Periodically we have patients come to the clinic who are suffering from malnutrition or even starvation.  One little boy about 18 months old was so weak he could no longer sit up. He was just skin and bones, all his ribs showing etc...

Then we had a 3 year old come in a couple of weeks ago. This child had a very swollen belly and his extremities were COLD also. He didn't have good enough circulation. At this stage the children often have very swollen hands, feet, and legs. His feet and legs were so swollen the skin had burst open and he had weeping sores.

He was pretty dirty so we were washing him up and getting him some warmer clothes. We had some fleece pajamas we put on him and it wasn't long and he was telling his mom that now he was warming up.:)  We gave his mom some cans of pediasure and food and told her to bring him back when the food was gone and we would give them more. Just the other day his mom came back with his younger sibling. We asked how the little boy was and she said he had died 8 days after she brought him to the clinic. He had drank all the milk already. She said the last thing he said before he died was "When are you going to take me back to the hospital?" Lots of people around here call our clinic a hospital because it's the closest thing they have to one.
   Last Sunday evening we had a 5 yr old boy come to the clinic with his jaw locked shut. He had no previous medical history and had been fine, playing at 4:00. Now at 6:30 he couldn't talk, couldn't swallow his own spit, couldn't open his mouth, and couldn't even sit up by himself. It was a very strange presentation. All of his vital signs were normal. His blood sugar was 200 so it wasn't hypoglycemia and wasn't high enough to be hyperglycemia. We absolutely didn't know what to do. By now his breathing is making loud snoring noises and his oxygen sats are 60%. We held him in a sitting position and tried to open his airway. That helped but we still couldn't figure out what was wrong. We were thinking maybe tetanus but he had no recent injury we could find and we didn't have the tetanus vaccine so tried to think what else this could be. At one point we honestly thought this little boy is going to die right here in front of our eyes.  Blood sugar is pretty much the only lab we can check except urine dipsticks. This will sound strange to some of you, but we were glad when he started having more symptoms... Things we could recognize. His eyes started twitching and then his  arm started twitching. He was having a seizure! So we quickly put in an IV and gave him some medicine. It took quite a large dose to actually get the seizures to stop. He would stop for about a minute then start again. We had put some EKG leads on his chest and were wondering if maybe his potassium was high. Then we found out that earlier that day he had eaten quite a bit of sugarcane and mangoes. Maybe that's why his sugar was a little elevated. We had also noticed he smelled funny so were trying to figure out if this child had injested something. When we mentioned it to the family they said it was because they were rubbing some leaves on him on the way to the clinic. The leaves were supposed to make him breath easier and one of the family members pulled some out and that is exactly what he smelled like so... We still don't what caused his seizures and probably never will. He was quite sedated when we sent him home so told the family they had to bring him back to the clinic in the morning. What do you know, in the morning he walks in smiling and talking like as if nothing had ever happened.
   Then yesterday I had a 19 year old girl come in, carried in by one of her sisters. Apparently she had had a headache for 22 days and then the last four days she had been unable to walk or talk. She was also having seizures off and on. I gave her a liter of IV fluids and numerous doses of medication to  stop her seizures with absolutely no change. We would think she was falling asleep but it would last  at the most two minutes then she would be jerking again. Her one pupil wouldn't respond to light either. There wasn't anything more we knew to do for her so after numerous phone calls and quite a while waiting the family came up with enough money for us to take her down in our ambulance. We just have to charge a little to cover fuel costs etc... A hospital did accept her but that's all the details I have so far...
  We are also having an outbreak of chicken pox here. We have a few immunizations to give but not the chicken pox vaccine so everyone is susceptable. There have been some pretty miserable looking people come to the clinic. About all we can do is give them some Benadryl and anti-itch cream.
    We had a young guy come a little over a week ago. It was after hours and we just heard it was pretty bad. When we got to the clinic it was about 5 pm and we found out this man had been cut at about 10:00 that morning. All the rest of the day he had spent coming to our "hospital" to be seen. He lives about two hours walk away if you have a horse that walks pretty fast but was working over by the Dominican border. He had been cutting wood and had an accident. The ax had sliced his foot  open from the big toe over half way up his foot.

He had a string tied around his ankle and his foot was in a plastic bag and he had been riding on moto for hours coming for help. When we took the bag off we didn't know what this stuff even was. There was probably at least one and one half cups of blood clotted on the top of his foot. It looked like a big bloody growth. When we got most of the clot off we could see a tendon that was cut clear through and little spurts of blood like as if the artery was nicked. His big toe bone was also broken. We tried to tell him he needed to go down to the hospital but he just wanted us to sew up his foot. He said God would take care of the rest. So we attempted to sew the tendon together and sewed up his foot. Since that day I have seen him twice and am amazed at how good his foot looks so far. Only God knows if it will heal...