Malaria and Leprosy

Not every day do you get to care for people with these two conditions, and I would beg your prayers for healing for these two patients.

The first lady is the same lady from previous posts who had the thyroidectomy - my "not a witch, not a wizard" lady. She's got malaria really, really badly right now. We had a couple of interesting shifts with her as she cycled through the stages of malaria- peaking in some horrible moments of fever (106.5!!!) hypertension, tachycardia, full body rigor, incoherence. So our medical crew quickly pulls out all the available "welcome to tropical medicine" books onboard and pour through them rapidly to figure this one out. Oh the joys of pouring in fun drugs into somebody without the backup safety of IV pumps - yup, we're calculating gravity drip rates! (My nursing friends are cringing right now.) Any drug that comes with the warning "infuse with caution, patient should be on telemetry as Quinine bolus infusion can cause QT prolongation and develop into Torsades de Pointe"- should start by being on a pump! (that's a lethal, shockable rhythm, by the way.) And then teaching your fellow crewmates what QT prolongation looks like so they can spot it during the night. We all know what to do with the torsades- yell for help!  The conversations get interesting at that point. One of the docs onboard posed the question - "so do you have any diazepam or dilantin should she seize during the night?" Supplies are always interesting onboard and you're never quite sure what you have. Although our pharmacy is literally the best stocked in Sierra Leone- one tiny room.

Another chap came to us having just gotten over his leprosy, but I can truly say i'd never seen what that can do to a person before. Yes, the missing digits, shrivelled hands and feet, but this poor fella also has a terrible pressure ulcer on the side of his left foot from having spent months in a bed and nobody turning him. His foot also then curled inwards, so now he walks on that side of his foot - so we got him a pair of crutches and he gets around not walking on that wound, but man! Talk about eye-opening! He's also tested negative for the leprosy since, for which I was glad 'cause or else we wouldn't have been able to bring him onboard - no way to isolate as effectively as needed. We do have two isolation rooms that are currently in use. He's actually here for hernia surgery, and we're treating his wound, and he's getting a cataract operation afterwards. I think he's done quite well by us! :-) 

  Now, I've been a nurse for 9 years now and have seen quite a bit, but this one was completely new. You kind of lean on your expertise to deal with current situations (experience) and I had zero point of reference on leprosy. And this is completely wicked but all I could think of was leprosy in the Bible and wondered if I should stand around the bed yelling "unclean! unclean!" and wow, I can't believe I just admitted that and I'm giggling as I'm writing it, but it is what crossed my mind :-) (and no, I wouldn't do it!! :-)