8 yr old chronic cough

Today was a good day. Padre Jack is back... until tomorrow. This morning we rounded in the hospital and discussed in detail some of the complicated patients, including Shermuly who is 8 years old and has a chronic cough. She was treated for TB for 6 months last year even though her PPD and sputum AFB were negative. Her CT scan is below. She improved a little bit with the treatment but then had a recurrence of her chronic cough. She came in a few days ago with fever, retractions and pneumonia that responded to Penicillin. She has persistent diffuse crackles and clubbing of her nails. We're sending her to Iquitos for further studies. If anyone (especially radiologists/pulmonologists) have any ideas, please comment below and let us know!!

Then I admitted a guy with tropical pyomyositis, a pocket of pus that forms in the muscle. He's had fevers and leg pain for 20 days. We numbed his thigh and stabbed it with a scalpel... about 7 cm deep, and encountered the pocket of pus. We put a drain in and I imagine he'll be better within a few days.

Then at 1pm we had an administrative meeting to discuss the future of CSSC and some other pressing issues. For example, we have emergency boats up and down the river to transport patients here and to Iquitos. Many of the motors are broken so when emergencies come up, we're stuck waiting until the motor is fixed... Our motor that was supposedly fixed today in Iquitos and on it's way up broke down again.. so we have no boat to transport the 3 patients who were ready to go to Iquitos tomorrow. We discussed helping communities build chicken coops, fish ponds, collecting debts that are owed to us, charging patients on a sliding scale rather than flat fee for care, and more.

At 7pm we had a conference call with Canada, Chicago, and Lima to try to coordinate some PANGO projects for this and next year. Brian and I are starting a Non-for-profit in the US and we hope that through this, we could secure some funds of the many new and ongoing projects we have here.


There is really never a dull moment here. The town electric goes out in 45 minutes, so I will head home from my office and do a few dished (to avoid an ant invasion) before I go to bed.