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Journey to Afghanistan

Khorasan - Chapter 9 - page 23

Doctor Abdullah is a young Afghan surgeon whom Northwest Medical Teams had hired to work with us. He not only spoke his native tongue but was fluent in English, as are many of the Afghan doctors. It was my privilege to work with him initially. Later I would work separately using an interpreter. Our first patients promptly were let in through the courtyard gate and three were brought to our room.

Doctor Abdullah spoke to a mother hidden in a dirty worn burqua and carrying a small girl, probably about two years old. As she approached the child demonstrated a weak, raspy cough. We learned the little girl had been coughing for about a week and was becoming listless and eating poorly. Indeed she appeared quite ill with drawn face and increased warmth to touch. However her mouth was moist and skin turgor (indicating hydration) seemed normal. Breathing was a bit rapid but not labored. As we removed her outer coat then sneaked our cold stethoscopes down the back and front of her think dress she squirmed and tried to pull away. A large area of rales, (the crackles heard with breathing, indicating significant congestion) was apparent in her right lower lung area. She had pneumonia. After mixing clean water in a bottle of Amoxacillin powder (antibiotic), Doctor Abdullah showed the mother how shake the bottle and then pour it into a tiny plastic teaspoon. It was to be given three times daily. He marked a tiny instruction sheet that showed a rising sun, a midday sun, and a setting sun and told her the meaning - one teaspoon-full of antibiotic three times a day. Again he made sure the mother knew to shake up the suspension each time before giving it. Like most of the refugees, this lady was illiterate. We were hopeful this little one would soon be well but the mother was told to bring her back if worse or not soon better. We hoped she understood. The mother, with her burqua now pulled away from her face, seemed grateful.

During this day and subsequent wintry days in this huge camp, we were to see numerous children and adults with pneumonia. One morning as we arrived Doctor Zabi met us holding a tiny boy, who appeared only about a year old, and was in very acute respiratory distress. He had stopped breathing. Doctor Zabi was giving mouth to mouth resuscitation while holding the infant in his arms. Doctor Zabi and the extremely worried mother were quickly loaded into the van and disappeared toward the Civilian Hospital with the Doctor still doing mouth-to-mouth resuscitation. This little one lived.

Another lady wore a very old light blue burqua. I understood why it had not been washed for a long time. As she pulled it away from her face I saw a lady who appeared much older than her forty years. She was thin and wrinkled. Wen asked "What is your problem?" My translator replied that, "She has a cold - for about a year." This response of course raised red flags. She was coughing up sputum that was not bloody but was described as thick, green and profuse. Night sweats were common. Her left lung included an area of increased bronchial breathing, (an abnormal transmission of sound from her main bronchial tubes) with rales (crackles) throughout much of that lung. Of course I suspected pulmonary tuberculosis but did start a course of antibiotics and arranged for a chest x-ray to be done at the Civilian Hospital. Sputum cultures were not available. She was to return with the x-rays, which is standard procedure there, and if the probability of TB was confirmed we would transfer her care to an NGO (Non-Government Organization) that was especially concentrating on the long-term care of tuberculoses patients.

We saw tuberculosis in all its forms. Later that day I saw a patient with a tender abdomen. It was swollen and intra-abdominal fluid was evidenced by shifting dullness to percussion. (This is dullness to tapping that remains downward even as we turned him from back to side.) The abdomen felt doughy to palpation - a consistence much like kneading bread dough. This was highly suggestive of TB peritonitis. Again that day a young man presented with lymph nodes swollen, but only moderately firm and mildly tender in his neck. This had been slowly increasing over a period of several months and some inflammation was associated. He had no symptoms of oral or pharyngeal or tracheal problems by history or inspection. Again I felt this was most likely tuberculosis. Even though Doctor Abdullah could have easily done a biopsy, there was no pathologist to inspect the histology of the lesions or method for culture of TB in this part of Afghanistan. Once again we had to do what was possible and embarked on a course of antibiotic treatment for TB. This needed to last for many months and we were hopeful the aforementioned NGO would be able to follow up on what we started.

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