Fecal-Oral…

So I was just thinking the other day that it’s been way too long since I wrote in my medical missionary blog about poo.  My colleague, Dave, tells me you can never really publish too much content on human feces.  I think most traditional missionary blogs try to broach this topic at least once a quarter, as it pertains to life living abroad, medicine, and the sharing of our faith.  And what better way to incorporate this topic than a public service announcement.  Therefore, I bring you ‘Fecal-Oral’:

A few weeks ago we had a very challenging week of medicine.  We were exhausted, with lots of complicated patients needing hospitalization.  To top it off, several of us fell ill with a nasty gastroenteritis.  What is gastorenterwhatikis, you ask?!  This is an illness that many people refer to as the flu, with symptoms of nausea, vomiting, and usually profuse diarrhea (‘PROFUSE‘ usually suggests that there is a pouring-a-bucket-of-water-into-the-bathtub sound that is generated during the defecation process, and implies a certain amount of rawness to the adjacent skin). However, this is not the flu, this is a viral intestinal infection.  Viral means it is caused by a germ that cannot be killed by antibiotics.

You may have asked yourself, how does one contract this uncomfortable and messy infection?   The transmission of this pathogen is spread through the fecal-oral route. That means that the virus is expelled in the organism’s stool (poo-poo), and somehow makes its way into the gastrointestinal tract of its victim (…You eat it).

So let me walk you through the logistics of this, in non-medical terms. Joe-shmo is sick with said intestinal virus, and he goes to the bathroom.  He wipes vigorously, but may have gotten stool on his hand. Or possibly, he forgets to wash his hands (uhhhh, gross…). Maybe he just doesn’t scrub vigorously enough. At any rate, he is left with particles of his own poo on his hands. He walks through the doorway of your office, touching the handle. Then, you leave your room and use the same handle. What you don’t realize is that the poo bugs were on his hand, hitchhiking.  They decided to stay on the handle and jump onto your hand. Finally, you go to lunch and eat your sandwich, or pick your nose when no one is looking, or bite your fingernails, and—BAM!  —the germs just made it into your body.

Let me explain to you how this played out in our hospital.  So that the victims can remain anonymous, we will refer to the Index case (first one to get sick) as Dr. Ro_. So the way I see it, somewhere along the line I accidentally ate Dr. Ro_’s Poo, and apparently many others after me followed suit. Whatever doesn’t kill you makes you stronger right? And maybe when I was hurling in the men’s bathroom between patients, possibly I didn’t scrub my hands sufficiently.  Then, I spread my particles of vomitus all around the hospital, thus perpetuating this infirmity.  Oopsies, sorry about that friends…

Take-home message of this story:  Don’t eat poo!

On a serious note, last week there was a boy who came to the hospital who really pulled at my heart.  Dr. Isaac and I attended the boy, and it only took a quick glance at 12 year old Miguel to know that he has a congenital heart defect.  This means he was born with an abnormal heart, and in his case it is ‘Transposition of the Great Arteries.‘  TGA is when the arteries of the heart are connected to the wrong ventricles (pumps).  This causes the blood to bypass the lungs, which is normally not compatible with life.  However, Miguel must have some additional defects that are allowing him to compensate.  He likely has some holes in the walls of his heart which allow mixing of the blood, some of which is oxygenated.

Miguel’s lips are blue, his body is smaller than average, and he cannot even walk because he is so weak.  His fingers are clubbed, which means they look like little sausages (see the pic), and his legs are swollen.  We had to draw some labs on him and put him on oxygen, which caused him a lot of fear.  He was crying and anxious, and he looked so feeble as he was laying there on the stretcher in the emergency department.  I  rubbed his arm, and told him not to worry.  But as we assessed his situation, I realized that this little guy likely has less than a year more of life.

In the states, this kiddo would have had surgery on his heart within a week or two of his birth.  But Miguel doesn’t have access to that kind of care, or the resources to pay for it either.  So his body has compensated for the defects over the years.  Consider this:  His baseline oxygen saturation is in the 75-80 percentile (your’s is likely 98-100%).  What would that look like for us?  It would be like living at an elevation of 19,685 feet/6000 meters (roughly the height of Mt Mckinley in Alaska, or Kilimanjaro in Africa).  His body has compensated by making more red blood cells, so consequently his hematocrit (blood level) was 82.  An average man has a hematocrit of about 42.  This means that his blood is incredibly thick, making him susceptible to a stroke at any time.

It doesn’t happen as often anymore for me in medicine, but I had to stifle back a sob as I soaked in his suffering.  Before he left, I remembered that we had a box of coloring books and small toys brought to us by a recent team (thanks Dr. Tram and Herman’s), so I took him back to the goody box and let him pick out his heart’s desire (actually, his big brother carried him.)  His big grin was heart-warming.  I asked him if he knew Jesus, if he knew He was with him always and was his Best friend, and He assured me He was.  We had very little to offer him in the way of his health this day, but I hope he saw that we truly cared for him.

We’d like to give a big thank you to Pastor Cindy Shively and Dr. Norm Shively from our Home Church, Grace of Christ, in Yakima WA, who came and visited us for a week.  It was truly wonderful and humbling to have them travel all the way down here to help serve with our ministry, and encourage us in our work.  Dr. Norm was able to share his skill by performing several surgeries while he was here, as well.

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Pose, during our Mother’s day hike in the jungle.

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“I love you mom!” donuts, during a trip to the big city (La Ceiba)

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To all you mothers out there, as the donut says, we love you.  (Mom, I love you!!)

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Papaya tree at Dusk

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Heidi found this leaf bug on a folding chair. This is a ‘dead leaf Katydid.’

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Pennsylvania Jim has been teaching some of the boys how to weld, and do some other metal work. Here, Will is cutting some bit of metal. That just looks Bad A…

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View from the underside of a jungle palm frond branch

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Sunlight through the palm fronds

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Mother’s day hike, and swim in the river.

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