Jesse Raiten, MD (Faculty, Anesthesia and Critical Care Medicine) - Blog Post 2
Sorry, this is a sad one
We have a functioning (usually) CT scan, so his head was scanned which showed substantial cerebral edema. There are 2 neurosurgeons in the whole of Rwanda, one who works at our hospital. The resident underwent decompressive craniectomy. As is the case for most young patients with cerebral edema in Rwanda, cerebral malaria turned out to be the cause, with the 4th smear coming back positive.We managed him the best we could in the ICU, and successfully negotiated with the Head of the Hospital to fix the ABG machine in a relatively timely 14 hours, although we could only see pH and CO2. I lobbied heavily to have him transferred to King Faisal Hospital across the valley, which has slightly better resources, but he was too unstable, and went into fulminant shock from malaria. In what seems to be the final common pathway in our ICU, he ended up on dopamine and adrenaline titrated to effect, and passed away, surrounded by his family and the entire surgery department.
Malaria is extremely prevalent here and the cause of many of our ICU admissions. Once cerebral malaria develops patients seem to go into shock rapidly. The sad part is that Rwanda had almost eradicated the disease, but poor compliance with preventative measures and mosquito nets has led to a large resurgence. And even more scary, more and more cases seem to be showing negative on blood smear until they’re very advanced.