November 17th, 2019 by Burton Adrian

I had been caring for him for almost a week. I first came across this 14 year old boy during morning rounds on the Sunday morning of the third week at Baptist Medical Clinic in northern Ghana. He was admitted the day before by the doctor on call for “gastritis”.The chart indicated he had been vomiting the day before admission but it also stated he had complained of being blind, an unlikely combination of symptoms in addition to the rarity of complaining of blindness at age 14. He was only ordered medicine to reduce stomach acid.
When I first saw him, he was unconscious, completely unresponsive. His eyes were partly open revealing what is called dysconjugate gaze. This means one eye was looking to the left, the other to the right. I was able to look into the back of his eyes, the optic nerves were normal. His neck was stiff. He was febrile. In Africa this is meningitis or malaria or both. You always treat for both. They do not do spinal taps here. Yes, I know they should. I order the tests for malaria and order the antibiotics for meningitis and treatment for cerebral malaria. Before any treatment could be given he seized. Fortunately I was right there to help protect his airway, a dose of diazepam 5mg was available on the floor and quickly given. This is my first case of either disease in Africa. The patient is young. I can only hope for recovery.
Over the next days, his consciousness returned and the large forty bed open ward was filled with his screaming and crying out. Was it from the pain of his inflamed meningeal membrane around his brain and spinal cord or fear of the world of darkness in which he found himself? I presented the case at the staff meeting with the African doctors. I felt it was cerebral malaria. They were more in favor of bacterial meningitis or even viral meningitis. In either case I asked, in their experience, would he see again. All the African doctors shook their heads no, their eyes cast down to the floor. Somethings you learn from experience as a doctor are not nice to know, not good to know, even if what you know is true.
After a few days he was speaking words in Manpruli. I asked the nurse if the words were meaningful or was he confused. She said he was calling out for the doctor so the words were meaningful. It was clinically a good sign. The next day he must have heard me talking in English as I was seeing the patients in the beds for before him. I greed him with “Dahsubah”, good morning in Manpruli. He replied in the voice of the innocent pre-pubertal child in perfect English,“Doctor, open my eyes.”
I am still not beyond those words, like a man who has just stopped suddenly after running up to the edge of a cliff, not yet knowing if he have stopped in time to avoid falling beyond the edge to who knows what fate or has he stopped in time to remain with his feet on solid ground. The physician and the patient both not knowing what the world will be beyond the grim reality of the present. Christ healed the blind. That is the only thought there is for now for either one of us, the patient and his physician.
After just three weeks in this resource limited environment I had known the following experiences. A father would not consent to the amputation of his son’s gangrenous arm because, as he said, “I have five other children, I don’t need one with just one arm.” Even if the arm was amputated as would be necessary to save the boy’s life, the father would not accept him on anything close to equal status with the other children. He would be relegated to the status of being less than a “complete person”. Without amputation of the arm, the son will die. Families request they be allowed to take their critically ill alcoholic family member home, with the obvious expectation he will die. They don’t want to pay for the oxygen he is using that they will be billed for. What then is the fate of a blind fourteen year old boy? I asked this question to my African colleagues. Again they just shook their heads. Again, their eyes were looking at the floor. This is the truth you know as true and wish it were not.
We are blind to the world around us if we are unable to see, we are unknowing of what is there. We are also, equally unknowing of what we have never seen even if we have full vision. My father died this summer at the age of 95. After two years of profound dementia and poor quality of life I let sepsis end his life on this earth in the comfort of the nursing home on clean sheets and a soft mattress. A Ghanaian man took his father home to die today. I saw the father lying on the concrete in the small motorcycle parking lot, the cement curb was literally his pillow. A group of flies crawled around his eyes and mouth in anticipation of what is to come. The different worlds we live in is profound. Lab tests that are vital to the best medical care as it is found in the USA and done routinely are rarely obtained in Ghana. The referral hospital I work at in Ghana would be shut down in an instant in the USA due to lack of resources. The burden of disease from malaria, tuberculosis and typhoid is immense. The disparity between what is available for health care in USA vs Ghana is unimaginable until you have seen it and worked in it. It constantly brings the question “why”, “how can this be”, “what can or should be done”? Am I blind to the answer?
Dasubah.
Lord Jesus, open my eyes.