Burns

Yesterday the batsignal went off. One of the buildings at the Lagos University  Teaching Hospital was on fire. The fire at the Directly Observed Therapy unit or teatment of the dreaded tuberculosis was controlled and files and documents salvaged from the prompt response of other vigilantes.

http://thenetng.com/2012/08/31/luth-fire-leaves-patients-and-staff-devastated/?utm_source=dlvr.it&utm_medium=twitter

This morning I got the signal again some lunatic near Gotham City succeeded in reducing the population by three. Also the same time three died a stampede in Kenya. That is nothing compared to the 1.4 billion at risk of dying at the hands of agent Cholera. We are so used to  agents malaria and HIV that we do not talk of it  news.
  At the time my pager went off I called the attendant at Gotham Village General Hospital. She answered at the first chime of her polyphonic ring tone,
 "Doctor we have an emmergency. Hot water burns and it is a small child!"she cried with urgency.
"What have you done?"
"Nothing, it just happened. We are waiting for you."
"Get lots of water and poor on the wound"

I hurriedly put on my clothes and bolted out. There was no Batsmobile. I remembered two years ago someone made away with my Pontiac Transport and Detective Burns of the IMPD had no clue about it. So I got into my Leggedese Benz and made it in ten minutes. That did not stop this lady from calling me again while I was at the entrance of the facility. The gate and some sections of the walls had gone AWOL.
   I met my attendant still in her nightie pouring water on the wound with another first aid amateur fanning the injury with a piece of hard paper. I quickly assessed the damage. Second degree burns, 20% body surface area, 18 months old female. I started trying to remember Parkland's formula for estimating the fluid requiremejnts. Then it hit me. There was no nurse on duty, neither was there any Lactated Ringer's nor normal saline! It wasn't practical to admit his child and it was not possible to convince these poor folks to take care of this case successfully on their own. Giving them a referral to another centre will be a death sentence.
I prayed for a miracle. I figured our greatest problems where fluid loss and infection. I sent for honey and eggs and polythene bag and guaze. the attendant had sent for procaine pennicilin and petroleum jelly. There was no rectal diazepam so this child received 5mg of tablet diazepam after grinding to form  suspension. this was repeated twenty minutes later. Oral Rehydration Therapy was the only plan for fluid eplacement. The child was wrapped in plastic and held firm with gauze. A slit was made in the groin area for number one and number two.
    I spent time lecturing both parents and their Pastor who came to sympathise with them on the salient points in caring for this child. I touched on issues like birth control but this sounded Greek to them.

   Accidents will occur in the best-
regulated families; and families not regulated by that pervading ifluence which sanctifies while it enhances them I would say, in short, by the influence of Woman, in the lofty character of Wife, they may be expected with confidence and must be borne with philosophy.

So said Mr. Micawber elaborating on an anonymous prover in Charles Dickens David Copperfield. You need to go back to the time of Dickens to appreciate this saying. Accidents are the reason for having insurance companies. In the abscence of that we have only God to look up to. That is why the pastor part of the conversation. He has to be educated about the direness of the situation.

  What is the level of awareness for accident preparedness?
Some women get pregnant without realising that although this is a physiologic (normal) process complications can and do occur. In a health system that has patients pay out of pocket it is wise to curtail the family size. Women should save money before getting pregnant. That is the meaning of family planning.
  In the index case, the farmer(subsistence level) and his petty trader (once in five days) wife had two boys and two girls and the lady still has a lot of eggs waiting to be fertilised each month at a particular time. They don't know it.
"Doctor, children come from God" The pastor solemnly reminded me.

"She get Rival ! "

 Thrush is known medically as candidiasis because Candida albicans is the microscopic fungus which is responsible for thrush. While this organism ordinarily lives in the intestinal tract of men and women, nearly one out of three women have Candida albicans present in their vagina. This can become a problem when its numbers outgrow the good bacteria – it’s a battle of the good microbes with the bad microbes and the rival with the most survival attributes wins.

During pregnancy, the vagina becomes rich in a form of sugar named ‘glycogen’, which feeds the growth of Candida albicans. It’s believed the higher levels of glycogen occurs due to increased oestrogen levels and reduced acidity in the vagina. This is why a pregnant woman is ten times more likely to get thrush than normal – instead of being a nice cosy home for thrush, the vagina is now a five star hotel!

Other things which can kill good pro-biotic bacteria include:

Antibiotics
Birth Control Pills
Steroidal/hormonal drugs
Fluoride
Chlorine
Coffee/Tea/Carbonated Drinks
Synthetic vitamins
Radiation
Stress
Additives
Pesticides
Fertilisers
A high acid diet can also cause havoc with good bacteria in your body and allow bad bacteria to thrive. Switch to more alkaline foods in an alkaline diet – you’ll feel so much better with so many aspects of your health, from good bacteria, to energy and less headaches.



Thrush is not a sexually transmitted infection (STI)


Thrush is not a sexually transmitted infection (STI) because many people already have small amounts of the candida fungus in their bodies. The fungus does not usually cause any harm because the body's immune system keeps it under control.
However, anything that weakens your immune system, such as an illness, like depression, or antibiotic medication, may cause the candida fungus to multiply, increasing your likelihood of developing thrush.

(http://www.nhsdirect.nhs.uk/en/sitecore/content/ExternalLinks/NHS%20Choices%20-%20Pregnancy%20and%20thrush)

I first learnt how to manage  thrush in pregnancy from a great rival of mine. He was a Senior Registrar ( Chief Resident ) and the rivalry was over the beautiful female medicos. I don't recall having learnt any other thing through him. You see
a little knowledge is dangerous.



"A little learning is a dang'rous thing;
 Drink deep, or taste not the Pierian spring.
 There shallow draughts intoxicate the brain,
 And drinking largely sobers us again."

The full text of Alexander Popes poem is so long and beautiful that I can't resist copying and pasting some of it.


And drinking largely sobers us again.
Fir'd at first sight with what the Muse imparts,
In fearless youth we tempt the heights of Arts,
While from the bounded level of our mind
Short views we take, nor see the lengths behind;
But more advanc'd, behold with strange surprise
New distant scenes of endless science rise!
So pleas'd at first the towering Alps we try,
Mount o'er the vales, and seem to tread the sky,
Th' eternal snows appear already past,
And the first clouds and mountains seem the last;
But, those attain'd, we tremble to survey

The full text can be found at http://en.m.wikisource.org/wiki/An_Essay_on_Criticism

  For me Medicine with all its branches is the Pierian spring. drinking deep means a lifetime of study. I had a lot to learn when I challenged the senior doctor about contact tracing and treatment for fungal trush in pregnancy. My interpreter was just making the same mistake I made several years ago.

  She has got a rival for her husbands number one but we will not spend scarce resources chasing after immunocompetent persons. She also has a rival living in her uterus and this was the cause of her problem. She will get better after she is delivered of the products of conception. She had got the condition in the past and got some herbal treatments which did not help her until after the birth of her first child. In pregnancy the products of conception are actually  foreign  body whose tolerance can only be achieved by a slight immunosupression. We all have rivals but she has one too many.
.
Concluded

" She get (has got a) rival ! "

Three days ago(on the 26th of August) a group of women staged a protestin New York to draw attention to the situation of inequality in topless rights. Their argument is that it is sexist and discriminatory to put women in jail for showing their nipples. Thus they marched topless around the city where it is legal to go topless. Back in high school a friend of mine had suggested that boys should also get special the sanitary pads that were distributed to the girls. This week, Apple's top executives and lawyers smiled out of the courtroom with a billion dollar jury verdict against Samsung. This also represents a victory over Google their arch rival. Steeve Jobs must  be pouring Champagne now because his promised "thermonuclear war" against Google is picking up steam. Samsung is just an unfortunate little fry in this epic battle of the big fishes. Samsung and a hosbt of other tech companies use the Android platform developed by Google which Apple claims stole Apple patented technologies.
   Rivalry is a natural instinct of competition existing between similar  entities. It is as old as creation. The first recorded case of rivalry was that between the beautiful and proud Angel and the Supreme Being.
This event has led to a lot of catastrophic and phenomenal events and this will continue as firetold in eschatological prophecies.
This rivalry is eternal, ad infinitum, it will last till a time of the large infinity and was there at the time of the small infinity.
   At face value it would seem like the lesser rival is gaining an upper hand. This entity is winning a lot of souls to his side via a lot of strategies. The divine rivals seem to be contesting the title of the Light. It seems like the handsome Angel had this title initially but was stripped of it when she lost the first Great Battle. Lucifer's agents still call him the bringer of Light although the Christ the Son of the Supreme One pronounced Himself The Light of the World, The  Bright Morning Star.
 This rivalry rages on . There is so much confusion in the world today because of this ancient rivalry. Thus it is only a thin line between Good and Evil. Jesus who mostly spoke in parables for whatever reasons gave us one clear tip: that by their fruits you shall know them but these entities fruits can take a timescale which is divine to mature. This divine time scale is outside the dimensions of Space-Time. It took perhaps a 425 years perhaps 13.7 billion years  before Jesus Christ corrected or remedied one of the catastrophes of this enduring rivalry. Two thousand years later the true light bringer is elusive. The Jesuits are accused of everything contrary to their name and New Agers speak about peace and love and light more than the Vatican that considers it a false religion.Some muslims kill their rivals in the name of the Supreme Being while we allopathic medical doctors battle for patients with our alternative medicine rivals.
    At Clinic today, I saw a patient who complained of passing blood via the number two. I made a diagnosis of NSAID induced bleeding peptic ulcer. This lady believed that her enemies who wanted to kill her were after her. She had presented to a city clinic in Lagos where she was placed on the standard anti ulcer regimen but failed at compliance. She resorted to herbal medication which caused the bleeding per rectum. She
  was so pale that I had to place her on bed rest on admission.
    A pregnant woman gave me a  start when I saw that prominently placed on her gown over her protruding abdomen was a large shiny office pin. My fear was that she could puncture her abdomen with the pin since the sharp point ws oriented inwards. My interpreter said she had the pin on or protection against her enemies.
   The next patient I saw was also pregnant. This woman had profuse milky discharge from number one. I had a Nurse and an interpreter attending the woman at the same time. The attendant who had nineteen years of service to her credit acting as health worker where there is no doctor was superconfident because is aware of the guidelines of managing sexually transmitted infections. The nurse felt she could not manage the patient. I prescribed topical antifungal cream and my interpreter said " Doctor she get(patient has) rival o!" . I did not get it right away. She repeated her statement and the nurse (God bless her) trying to remind me to do sexual contacts tracing etc.
To be continued.

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The New Batman

It seems like the Summer Olympic games of 2012 or rather of ZION is over. The Dark Knight Rises is doing well in the theatres despite the shootings that tarnished its premier. The $230 million blockbuster would have earned a billion dollars in ticket sales before I conclude this debut of mine as a blogger.
    Yesterday, I met Samson who I last saw fourteen years ago. I met him on the way to the hospital. He was on his commute to deliver a 9:00 a.m lecture so we couldn't yak as much as I would have loved to. At ward round I attended a lady who had twins but lost one as a fresh still birth. I wonder if could have done anything to save that life. Anyways the patient who was not even stable with fever and bilateral leg edema up to the knees was itching to go home. I wouldn't have that. Admission at the hospital was free so I see no reason to let her go. The baby was perfect but I stressed the importance of monitoring her baby. At the moment it was baby boomers 1: 1 sustainable developers.
  The story of batman is said to be concluded with the July 20th release of this much anticipated thriller. Fandango claims it earned only $  7.2 million. I don't know if those stats are for Aroura alone. Well there seems to be an indication that Batman will continue to be but played by another hero. I think I know who that is.
   There are a lot of similar occurences between the old and the new Batmen. They are apparently rich and sophisticated reclusive bachelors with a love for techies. At this village I am living all alone in a mansion. I am brave enough not to be scared of whatever bird that is outside in the vacant slot in the wall for an aircondition unit. Conversely, I am repulsed at the stench oozing off my X-Ray Room at the hospital. The hundreds of bats there are reminiscent of a new hesitant batman at a Batcave!