Lightening struck Malindi District Hospital twice in less than a week: despite the fact that the WHO counted only seven cases of neonatal tetanus in all of Kenya in 2010, there have been two cases at MDH since Friday (the one on Friday and one this morning). Either there are a lot of Clostridium tetani bacteria hanging out in the soil in Malindi District, or the seven from last year was a gross undercount. I'm betting on the former, and so does the WHO: despite the fact that they have counts, they end up estimating that only 10-20% of all cases go to a hospital and are counted, so they inflate their numbers (overall numbers, not each country's numbers) to reflect that. So the two cases in less than a week is probably not so much a statistical anomaly as more women bringing their sick babies to the hospital.
Here's a picture of the case that came in this morning:
So when I came in, I immediately went to the pediatric ward to check on the infant who came in on Friday, and was told that that baby died overnight. And then they told me that they had a second infant with neonatal tetanus in the same "isolation" room. I put that in quotation marks because it's not isolated, it's not quiet, and it's not dark. When I went in to see the baby, the phenobarbital (anticonvulsant) was already being given, but the baby was still having small spasms. I tried to get a video, but it was too dark in the room for video. The story was pretty much the same as the last one: the mother had no prenatal care and no tetanus vaccine, gave birth at home, the cord was cut with a razor, ash was placed on the umbilical stump (not cow dung this time; I guess that's an improvement?), and for the first four days of life, the baby was fine and breastfeeding well. Then on day five, baby stopped feeding, and on day six, started spasming and mom brought the baby in. Unfortunately, the lack of proper medications (namely TIG, or tetanus immunoglobulin) led to the baby dying this afternoon.
I talked to Katana about what the response to this cases is, and he said that the local communities reevaluate their current community health networks (such as community health workers and traditional birth attendants; see the entry about Marafa if you missed that), and train more, if necessary. The community health workers provide education about the importance of prenatal care, tetanus vaccines, and attended births, either in the hospital or under the care of a traditional birth attendant, and the importance of taking the baby to the hospital if it stops feeding and starts spasming. They then vaccinate all women of childbearing age (and probably all kids who need it, while they're at it), a five-shot series over the course of several years. The most important thing is to get all pregnant women at least two shots by the time they deliver (well, and making sure they don't use anything that came from the ground to stop bleeding after they cut the cord).
After all that excitement, I went to the medicine wards, and was joined by a second-year medical student from Georgetown and a pre-med student from Alaska, who I chatted with for several minutes after rounds. I asked her what she got out of the experience and what she was hoping to get out of it, part out of curiosity (because I have no idea what good any of this would be to someone who doesn't know the vocabulary that is taught in medical school) and part out of frustration from interviewing prospective medical students who had similar experiences in their essays. As someone who is going into tropical medicine, there are few things that annoy me more than someone who uses something I do for work as a tool to get into medical school. If you write about crying yourself to sleep every night after the two weeks you spent taking care of babies dying of AIDS in Africa, the next line out of your mouth better be how you're planning on specializing in preventive medicine or infectious disease because you want to help other babies so they don't die of AIDS. If you tell me that you want to do emergency medicine or some such thing, then why did you bother writing about the dying babies in Africa? If it had no impact in your life, it shouldn't make it into your medical school application essay.
Fortunately, this pre-med student understood what I was saying, and she did express her frustrations at the rotation, saying that she thought it was more of a money-making scheme on behalf of the organization than anything having to do with medicine. She said it wasn't the experience that the brochures/website/whatever made it out to be, and after spending around $5000 in total (fees, airfare, etc), that that was pretty upsetting. I would be upset, too, but then again, I didn't go to Africa to check a box when I was a pre-med. I went to Haiti, and after I went to Haiti, I wanted to go in preventive medicine, because it's absolutely ridiculous to hand out chloroquine to treat people's malaria without giving them bednets to sleep under, and that's what I wrote about in my medical school application essay.
Okay, I'll get off my soapbox now. Bottom line: if what you're writing about didn't impact you enough to change your career goals/trajectory/whatever, then there's no point in writing about it.
Tomorrow: flight to Nairobi in the afternoon.
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