By Dr. James Appel - August 22, 2014

Gillian asks me to round on pediatrics this morning. The hospital is filling back up again. The first patient is a two year old girl with an amulet around her neck.

“What is this?”  I ask.

“Oh nutting,” replies the mom with a sheepish grin.

“I have been in Africa for over 10 years.  I know what this is and you know what it is.”

“Somebody give it to huh to help huh.”

“Yes, but what gives it its power?  Is it God?”


“Then what?  There are only two powers in this world…one of them is God and one is the enemy.”

“It’s nutting…”

“Every day, our staff prays for our patients, but if God answers our prayers and heals your daughter, will you thank him or will you think it is the amulet, charm, fetish, gris-gris?”

Everyone else in the room starts to laugh and chuckle.  The mother looks even more sheepish and takes off the amulet and holds it in her hand.

“You should get rid of it, not just take it off…”

“I give it to da man who give it to huh.”  Some battles aren’t worth fighting. The baby is otherwise improving after Quinine and a blood transfusion. I move to the next patient.

“His tummy still huhtin’ him,” says the mom.

“It takes malaria a few days to get better,” I’m assuming he has malaria since he is on a Quinine drip.  He was admitted yesterday by one of the PA’s.

“He not ha’ malaria.  His body not hot.  He drink a bottle of medicine yestuhday.”

“Oh, really?  What kind of medicine?”

“Blood tonic.”

“What’s that?”

“A medicine.”

“Ok, can you bring it in so I can see it?”


I stop the Quinine drip and move on.  The boy looks stable anyway.

The next child is our little anemic boy who came in on death’s door.  I can barely recognize him now he looks so good.  He still needs one more day of Quinine perfusion but he’s definitely on the road to recovery.

Finally, I see baby Moses.  Surprise, surprise, the urinary catheter came out. I repeat our daily ritual of cleaning it in diluted bleach and reinserting it. This time the bladder is not nearly so distended and the urine is pale and clear.  

I go downstairs and start screening patients.  A woman is brought in who looks very ill and is gurgling when she breathes.

“What’s going on?”  I ask the family.

“She ha’ tooth pain an’ now she ha’ infection in huh neck.”

I examine her neck with a gloved hand and she does have a fluctuant area just under her mandible, suspicious for a well-developed abscess.

“Bring her in.”  We get a wheelchair and wheel her into the exam room and put her on the table. I order IV fluids and antibiotics. I get a scalpel, gloves, gauze and some lidocaine in a syringe. I numb up the area with difficulty as the woman jumps when I prick her skin.  I  incise down quickly and thick, bloody pus wells out as well as a clump of necrotic muscle. I stick in a gloved finger and sweep out some more dead flesh. She starts to really gurgle and yellow liquid pus starts pouring out her mouth.

“Get me a suction machine!”

Soon the OR tech brings in the suction and continues to suction out massive amounts of pus. I pack the neck wound and we send her upstairs.

Another patient is waiting in a car.  The family states he has diabetes and slipped into a coma. They took him to the ELWA hospital and was told he did not have Ebola.  They present a handwritten note on a blank piece of paper stating he has Diabetes: bad condition, septicemia, no suspicion of Ebola.  Signed Dr. G_______ MSF (Doctors Without Borders).  It seems suspect to me.  I ask if the patient is urinating frequently.

“No, no.  One to two times a day only.”  I get more suspicious. I turn to examen the man and he is not breathing and has no pulse. Very sketchy. They want a death certificate.  I state that I can’t give it and I confiscate the paper.  This needs to be followed up.  Is there really someone at the MSF Ebola isolation screening patients and writing on a hand written note that they are Ebola free without testing them?  It’s suspicious at best.  I call Dr. Sonii our medical director.  He agrees with me and says we will follow up in the morning. I don’t want to give them back the paper but they start to threaten so Dr. Sonii calls back and says to make a photocopy and give them the paper. They will probably use the paper to get past police controls and bury him in a normal graveyard, exposing more people if it is Ebola like I suspect. One of the lab techs, Geoff, calls the Ebola hotline and gives them the license plate of the car. They take the body away.