Our medicine cabinet hosts the typical array of cold medicines, band aids, ointments and pain relievers but we also have a bag I have labeled "Africa meds." This bag contains a variety of of foreign treatments for malaria, worms, typhoid and other parasites; even as medical providers, these were all new to us. Though all common here, they are used quite frequently and written as standing orders for children admitted to the hospital. Today, Mason and I administered my first familiar medication Cytotoxan, though it has been over 14 years for me and 16 for Mason since either of us had used a chemotherapy drug.
Our morning was filled with ethical and moral discussions for the use of this drug on our specific patient. He is very malnourished 2 year old who has been treated for every typical infection and illness and almost every drug our pharmacy shelves. Despite months of treatments, examinations and receiving nutritional supplementation, he remains a very sick and malnourished child. Upon yet another consult and blood test, our mission physicians have narrowed the suspects down to lymphoma or TB; neither which has a good prognosis for this child. With limited diagnostic equipment and tests, treatment here in many cases is a diagnostic tool. After much discussion, it was decided Cytotoxan was the best course of treatment.
Yet Mason and I walked away conflicted with ethical dilemmas: lack of protocol, lack of medications to treat side effects, lack of educated provider, and immunosuppressing a child in a remote disease and dirt laden hospital. This treatment will surely kill this weak, weak child. Our only impetus; if we do nothing, he will also surely die.
So yesterday afternoon, after an early morning call to one of my besties on the stateside who I knew wouldn't mind, pleading for help locating a protocol as we were unable to download anything ourselves, we began IV administration without a pump of a chemotherapy drug to our patient laying a on shared mat in the Chadian worm filled and bacteria infested dirt. Modern medicine doesn't look the same in third world country. In a few short weeks, Mason has functioned as a pediatrician, oncologist and oh yeah an anesthetist.
P.S Thank you Kleins for your expedient and informative emails
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