Many days, I find myself frustrated by not being able to do more for my patients in the hospital. It might be news that test reagents are out of stock, so I can’t check a CD4% on a HIV infected child. Or the CT Scan is broken, so I can’t check if a child has a mass in the brain. Or the hospital has run out of certain medications, and we can’t treat the disease.
Even when we do have the tests or medications in stock, we may not have a good way to monitor for side effects.
For example, the past few weeks I have been caring for a 10 year old HIV infected girl, who was found to have dilated cardiomyopathy – caused from her infection. What has made her heart condition worse is she has developed a thrombus in the left ventricle – which could at any movement break off from the wall of her heart and travel to other parts of her body, like the brain and cause a stroke.
To break down the thrombus, patients are usually put on an anti-coagulation drug with extremely close monitoring of the body’s ability of coagulation, and adjust the anti-coagulation dose accordingly. The drug is available here, but we don’t have reliable ways to monitor the coagulation. Some weeks, the reagents are present, and other weeks the reagents are out of stock.
After discussing with other physicians, we decided the risk of causing her to bleed because of inconsistent coagulation monitoring was greater than the risk of the thrombus dislodging and traveling to other parts of her body. Not great options either way!
We are hoping the body will be able to dissolve the thrombus by itself, when her heart function improves with anti-heart failure drugs.
There are days when I wish I could take these children back to the U.S., get them treated and healed, and then bring them back to Tanzania.
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