All In A Day’s… (Part 3)

As a follow-up to my previous entry, here are a few of the most common diagnoses seen at Tansen Mission Hospital:

…In Summer (our hot monsoon season):

  • Leptospirosis
  • Typhoid (a.k.a. “enteric fever”)
  • Dengue (a.k.a. “break-bone fever”)
  • Meningitis (both bacterial and tuberculous)
  • Snake bites (causing coagulopathy if it’s a viper, or neurotoxic paralysis if it’s either a krait or a cobra)
  • Malaria (particularly in patients coming from areas to the south, i.e. India and Nepal’s terai region)

…In Winter (our cold & dusty season):

  • COPD (mostly women in their 50’s and 60’s, and almost exclusively due to decades of cooking over smoky wood fires in indoor kitchens)
  • Pneumonia (+/- empyema; +/- abscess)
  • Congestive heart failure
  • Acute myocardial infarction / STEMI

…And Year-Round:

  • TB (everywhere: pulmonary, pleural, abdominal, bone, lymphadenitis/ scrofula, miliary)
  • Rheumatic heart disease
  • Alcoholism and its complications (falls/ trauma; withdrawal seizures/ DT’s; end-stage liver disease; ascites; spontaneous bacterial peritonitis; hepatorenal syndrome) – far too common a problem here, affecting both men and women in surprisingly large numbers
  • Seizure disorders, frequently from neurocysticercosis (inflamed or calcified parasitic cysts lodged in the brain’s parenchymna)
  • HIV / AIDS (advanced presentations; CD4 counts of 50-100 or less are unfortunately not all that unusual)

A few other diagnoses from the past few months:

  • Bullous pemphigoid
  • Pneumothorax ex vacuo (trapped lung with recurrent effusion, due to longstanding pulmonary TB)
  • Bilateral hip dysplasia (in a term infant breech female)
  • Drug-induced lupus
  • SLE (lupus) nephritis
  • Ecclampsia
  • Acromegaly (due to excess pituitary GH secretion)
  • Elephantiasis
  • Multiple myeloma with “punched-out” skull lesions
  • CIDP (“chronic inflammatory demyelinating polyneuropathy”)
  • Severe, purulent bronchiectasis
  • Iatrogenic Cushing’s disease
  • Tropical eosinophilia (pulmonary filariasis) – 74% eosinophils with a white blood cell count of 29,600
  • Cholera (sporadic cases)
  • A huge right carotid artery aneurism (~3.5 cm!)
  • Amoebic dysentery with pyogenic liver abcess
  • Hydatid cyst disease (including multiple huge lung and liver cysts in a 35 year old male)
  • Mushroom poisoning [accidentally, by (literal) mushrooms]
  • Organophosphate poisoning [intentionally, and far too common]
  • Necrotizing fasciitis (we treated five cases in a single month, age 45-94 yrs, with 100% mortality)
  • Molar pregnancy with invasive gestational trophoblastic disease/ choriocarcinoma
  • Suspected neurosyphillis

This week I’ve been at a global medical missions conference in Chiang Mai, Thailand. It’s been a valuable time not only for learning more about these “rare” diseases that we see so often, but also to make space for refreshment, catching up with colleagues, and reflecting on the real privilege it is to walk through these times with our patients. It’s been a fabulous time so far!

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2 thoughts on “All In A Day’s… (Part 3)

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    Dear Becca,

    Been following your updates . . . true I did not really understand much of the medical language but Normie being a nurse did and enjoyed them so much. My primary doctor and his daughter (also a doctor) go often to the NE corner of India near were you are. They are extremely good friends of ours (Both took the Perspectives course – Ruth just recently). I took the liberty of sending Post 2 and 3 to them. And speaking of Perspectives, I’m sure you see a number of people from an unreached people group. According to the Joshua Project (google it!) there are 343 unreached groups in Nepal mounting to over 28 billion souls. Becca. the LORD has placed you in a very great place to make His name know to these nations. We pray for you often and need you prayers as well. Normie has been diagnosed with Parkinson’s and having difficulty with her movements.

    Blessings on you,

    Ray and Normalee

  2. The vastness of your medical knowledge astounds me, Becca. So proud to say you’re my sister!!! So glad that your conference was refreshing!

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