Haitian Child

Haitian Child

Monday, December 21, 2015

Time Warp

I entered a time warp, two time warps in fact. Must be a Star Trek thing. Perhaps I fell though a worm hole and I am now in a parallel world. 

The first time warp is very familiar and takes me back to 1973 to 1979, when I was a young resident at Sick Kids in Toronto. At that time my job was to see my patients in the hospital, talk to the parents and children, write orders, review the orders with the nursing staff, follow up on lab and x-ray results, and then reassess the patients at the end of every day. This feels a lot like my time as a resident.

The second time warp is totally unfamiliar. This time warp goes back before my time as a doctor. Ostensibly, this time warp has transported me to well before my training, before immunizations, and to the dark ages of health care in Canada when medicine was not socialized and when health care was not accessible to every citizen as a right.

Today I admitted two very sick children from the outpatient service. I had just returned from a quick lunch. The next two children presented with acute infections that I have never seen before. Since I am older and have seen a lot, for me to see two brand new infectious diseases back-to-back is nothing short of amazing.

The first patient is a 6 year-old boy with tetanus. Tetanus disappeared from Canada before my time. Routine immunizations made this happen. I had presumed that I would never see a case of tetanus. Go figure. The boy cut his leg on a metal gate 8 days ago and today he presented with spasms of his muscles in the typical fashion of tetanus. He has "lock jaw!"  Fortuitously I had reviewed tetanus a few weeks ago. "Why not," I thought. Glad I did. There is good and bad news for this boy. He came in early with the symptoms and the neural toxin has not spread very far. The bad news is that there is no Tetanus Immune Globulin (TIG) in the hospital. This makes a bid difference to neutralize the toxin. All I could offer today was an antibiotic to kill the remaining germs. The toxin already present will continue to cause neurological symptoms. I went to the pharmacist and asked about TIG. He confirmed there is none. I asked if we could obtain some in Port-au-Prince. He replied that he did not know but that the Medical Director, Dr. Sannon, would know. I tracked down Dr. Sannon and he agreed to find out. Cost is likely an issue.

The second patient is a 3 year-old boy with mastoiditis. I have looked for mastoiditis all my life because early in my career this was still a possible diagnosis in Canada. Since immunizations were introduced for H. influenzae and S. pneumonia, the most common causes of mastoiditis, the problem has become even less common. The boy today had classic mastoiditis. I treated him with IV antibiotics and asked for the surgeon to see him. He might need the infection drained. 

My academic interest is piqued but mostly my heart is saddened to see these serious but very preventable diseases. 

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