This morning, I did a ward round at MKT and then drove to another smaller clinic, MRC. Because I go every Wednesday, patients will come on this day to see the doctor, have their condition reviewed or get a second opinion.
One young lady has been ill for a while with generalised body pain, itchy rash all over her body, bouts of fever and some swelling of the face and legs. She has blood and lots of protein in her urine, but no urinary symptoms. We have a biochemistry analyser at MKT, which allows us to investigate patients on site, without having to send samples off to the Thai public hospital laboratory. I suspect she has renal disease.
The baby with cleft lip also has a small cleft palate. This didn’t interfere with breast feeding and the child is on the waiting list to see a team of visiting specialists at Mae Sot soon. At three months, she could have had the lip repaired but most surgeons wait until the child is 12 to 18 months before undertaking repair of the palate. These babies often get middle ear infections, but this child was fine. I just need to make doubly sure she is on that waiting list.
The little girl has an infected meibomian cyst in the eyelid. At first I thought it was a style as it appeared to be pointing beneath a couple of eye lashes. I tweezered these out, but no pus. I prescribed antibiotics and hot compresses, plus massage, as frequently as she can. I should have realised this was the diagnosis when her mother told me she’d had similar problem in the other eyelid last year.
I was interested in the dark rash on a middle aged woman’s calf. To me it looked like a fungal infection, but I couldn’t work out why it was black in parts. “That’s animal faeces,” said the medic. “She says it works much better than the anti fungal cream we gave her at the clinic.” Well, if cow pat therapy becomes less effective, we might try oral anti fungal treatment instead. I know enough not to argue against traditional medication, especially if conventional therapy has failed. We lost the battle, but might well still win the war.
This mum isn’t worried about her child’s prominent ears; she has exactly the same feature. The child looked such a sweetie, despite having a viral upper respiratory tract infection (that’s a cold, in doctorspeak), I felt I had to take her picture.
The man with the bulge in his right armpit and chest came to clinic but he was casual migrant worker, paid less than £2 per day. He couldn’t afford to wait to see me. He knows we think this is a lymphoma, and he needs to go to Yangon in Myanmar to get treatment from a cancer specialist. We did some blood tests, but these didn’t show any other more treatable cause for the swellings. He has developed similar swellings on both sides of his neck. I still find it difficult knowing that this man will probably not receive treatment which could have cured him, because he is poor.
We brought another infant to MRC from the in patient unit at MKT who is also on a waiting list, for cardiac surgery. Child’s Dream takes on a small number of children with congenital heart disease for corrective surgery. I am worried about this one year old because there isn’t a great deal we can do to help, using medication. The child is failing to thrive and his heart might not be able to cope with the stress of another illness. Another ethical dilemma for me to think on.