...The patient with the really bad bullous lung disease from TB passed away last night. He was really, really struggling to breath on oxygen, with a PO2 of 70% the day before so it wasn't too surprising. What a terrible way to die.
...I found out today just how difficult it is to have type 1 diabetes here. At least if you are poor. The 17 year old boy with anasarca and hyperkalemia most likely has end stage renal disease from uncontrolled diabetes. Meaning that there isn't much that can be done for him except lifelong dialysis and maybe a renal transplant. But he can't get a transplant if he has been non-compliant. But even if he had been compliant, he can only get twice daily insulin here which provides suboptimal control. The craziest thing is that to get dialysis his mother needs to pay $8000 shillings (about $100 dollars) every time he goes, so $24,000 shillings per week. That is an incredible amount of money here and she definitely cannot afford that! And because she can't pay this amount into the near future they won't get him a one-time urgent dialysis treatment now.
...also the above patient, also has pulmonary hypertension! why does everyone what pulmonary hypertension here!? People say it has to do with indoor cooking and indoor air pollution exposure from infancy on. However, recent literature has focused on the role of schistosomiasis in development of pulmonary hypertension, especially S. mansoni. High altitude can also increase susceptibility to pulmonary hypertension. Both of these risk factors are present here. As is rheumatic heart disease.
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