We saw lots of tumors. This growth on this patient’s knee had been there 10 years, had not changed in size, and was not bothering her. It was quite firm, maybe a calcified suprapatellar bursa.
The growth on this woman’s arm had significantly increased in size recently, and was thought to be malignant.
Tons of kids had burns from being around cooking fires in their homes.
Onchocerciasis: river blindness.
Another common cause of blindness is trachoma, an easily treatable disease that causes the eyelids to invert, and then scratch and ultimately scar the cornea. Here you can see an entropion secondary to Chlamydia trachomatis.
Pott’s disease secondary to extrapulmonary tuberculosis.
Thought to be secondary syphilitic lesions.
This woman’s conjunctiva was pure white. Her hemoglobin had to be around 2. She was so weak she couldn’t walk without assistance. She was having dark stools, and likely had a chronic GI bleed from hookworm. No blood transfusions are available in South Sudan outside the capital, so I treated her parasites, gave her vitamin C and iron supplements, and had her drink fluids. That was all we could do.
So many people in South Sudan were malnourished. One of our responsibilities was to check kids’ mid-upper arm circumference, weigh them, and report it to the local health authority if they were severely malnourished. Unfortunately, the local health district/hospital didn’t have any nutrition supplements to feed kids that were starving in front of them.
A lot of the kids had Kwashiorkor syndrome as well as hair color changes because of protein and nutritional deficiencies.
This child developed lesions a couple days before I saw him. I treated him for a staph infection.
Here’s another sad case of a child who had a history of epilepsy. She had a seizure, and her foot fell into the fire while seizing. Not only did she have a badly burned foot with exposed bone, but the village ostracized her for her epilepsy because they thought she was under a curse. She obviously had a lot of trouble getting around, and we gave her a chair to put in front of her because we didn’t have crutches.
Dr. Carol, an American surgeon from Alabama who lives and works in Kenya, and Dr. Seno, a Kenyan doctor who is doing a surgical residency under Dr. Carol, both came on the trip. They were absolutely fantastic people. Here they are amputating a gangrenous digit under the trees outside the clinic.
Carol and Seno operated on a child who self-circumcised with his fingernails because other kids were making fun of his foreskin. His penis was badly macerated and infected, but he ended up having a good outcome.
People would begin lining up at 4 a.m. to see a doctor! They would wait until 6 p.m., and some would still not get seen. Each of the four doctors there would each see around 100 patients a day.
The waiting area outside the clinic.
Amos, a Kenyan doctor, has been working in Kenya and South Sudan for 20 years. He has worked with many NGOs providing aid in South Sudan. He has had planes drop bombs on him, has worked to save lives during meningitis outbreaks, saw patients during war conditions, and has just about seen it all. He was an incredible resource to have on the trip.
No one had seen a doctor in years, so the moms would bring all their kids in to be examined at once. This mother was in her mid-30s. The South Sudanese live such tough, brutal lives that they appeared so much older than they were. Another challenge was the mothers would tell us that their children were having fevers, headaches, and myalgias. I’m sure that they did because of the extreme conditions and lack of basic human necessities, but malaria was endemic in the region and also presents similarly. It was difficult to tell which kids were there simply to be checked and which actually had serious pathology.
Typical reactions when seeing the scary bearded white doctor!
A couple of the orphans helped me translate throughout the day. These kids were trained in the orphanage to speak English, Arabic, and local dialects in addition to math, science, and their other classes. They were fantastic.
It’s difficult to tell from this picture, but the thermometer says 106°. The ambient temperature would cause the thermometer to climb so high that every time I wanted to check a patient’s temperature I had to shake it to get the mercury below 98.6.
This was on our last day. We gave an address to the children, thanking them for their hospitality and allowing us to come visit them.
Most of the team on our last day.
Thank you to all the folks who helped and supported me through this experience!
Dr. Skaggs was raised in Africa. He attended the University of South Carolina School of Medicine, and was a member of the graduating class of 2013 at Palmetto Health.