The Milk Mustache Sign

Today, we got to see that a few of my patients are better. The little boy with the swollen scrotum, after a weekend of antibiotics and twice daily cleanings, now has a less swollen scrotum. This time it looks like it's an indirect inguinal hernia that is not incarcerated but cannot be reduced. We have asked the surgeons to look at it and see if they want to repair it.

Also, my little boy who was in over the weekend with respiratory distress was sent home on amoxicillian, after we came in and saw him sitting up in bed, downing a big jug of milk and smiling at us with a HUGE milk mustache. We agreed that a positive milk mustache sign indicates that they can go home from the hospital.

We also spent a lot of time today getting a referral letter for our mentally disabled boy. His family cannot afford the costs of the special school in Butare, an estimated 300,000 francs per year (about $600). We were able to find a catholic organization that helps provide scholarships. We gave him the paperwork that he needed, and hopefully the organization, called La Lilliane or something like that will be able to assist them.

Then we had a little girl, one of the nurse's babies, come in with complaints of fever. We examined her, and she was doing fine -- playing well and everything -- but with a slight fever. Her mom wanted her to be admitted to the hospital, even though we really felt like it was just a virus (No increase in WBC, and 60% Lymphocytes). Richard admitted the baby but complained to me about "these mothers whose husbands are away."

"Soldiers, drivers, whatever. If the husband's away, the mom gets him to come home or pay more attention to home if the baby's in the hospital. And the kid is never sick."

I had to tease him, "well, when you're married and have kids, you better not spend too much time in the hospital or else your wife will make you admit your own kids."

Later today, we walked by a patient who was having a panic attack. Of course, we always have to rule out things like heart attack, but that was already done. Richard called it "hysteria," and then proceeds to tell me about how common it is in 14-18 year old girls. "All these girls in Forms 2 through 4, they always come in and it's because they are in love and now they are hysteric...Do you see that in the US?"

"On occasion, but not enough to complain about it!"

I also have a sad story, though. We had some twins born at 28 weeks gestation when I first arrived. It wasn't clear that there were actually twins until after the first one was born and they saw the other in breech presentation (feet first). They had to switch the kid around inside, and in the process they broke his left humerus. We have been trying to get these kids to gain some weight and to stay warm. These little babies are hard because they aren't developed enough to regulate their own body temperature or even to suckle. We've been feeding them expressed breast milk through an ng tube (tube that goes through the nose into the stomach), trying to get them to gain some weight.

Well, last night around midnight, the baby boy, the one with the broken humerus died. We think he went apneic. These little babies tend to forget to breathe. In the US, they are set up with all sorts of alarms, and a code would have been called and someone would have been there to resuscitate. However, no one noticed until it was too late.