The Case of the Missionary Health Care Worker in Africa
Jenny, a twenty-two year old college graduate, has recently
decided to spend two years as a missionary in a coastal African
village. As part of her duties, she will work in the missionary
clinic that has recently been established in the village. This
clinic will provide routine medical care and a traveling physician
and nurse will visit once each week. Jenny feels fortunate to have
the opportunity to use the information that was presented to her in
various classes she completed while in college. After completing a
4-month intensive training period (language classes, medical
preparation for work in the clinic, and cultural enrichment), she
departed for Africa.
Upon her arrival, Jenny found that she would be spending most
of her time in the clinic since the village had been without
routine medical care for the past 2 years. The previous clinic was
closed due to flooding and insufficient funds to rebuild.
Initially, Jenny found that she was very dependent upon the
physician’s weekly visits since her training was limited.
Gradually, she found that she was beginning to call upon her
training (both clinical and classroom) and she felt comfortable
diagnosing and treating some of the more routine cases. One
morning, a mother came in with her five-year-old child. The mother
reported that the child had been unable to eat or drink anything
for the past day because of vomiting. In addition, her child was
experiencing severe diarrhea. Jenny asked the mother if any other
family members were exhibiting similar symptoms, to which the
mother replied that a few other members of the family had similar
symptoms, however, not as severe. Jenny’s first thought was that
the symptoms were very similar to those she had exhibited following
a bout of food poisoning while in college. Since the villagers had
no refrigeration and poor sanitation, Jenny gave the mother an
electrolyte solution containing glucose similar to
Gatorade® and told the mother to have the affected children
consume this solution and nothing else for the next 24 hours. After
that time, if the children were no longer vomiting, she could start
feeding them tea and broth. Jenny also cautioned the mother that if
the children did not seem to be getting better after 24 hours to
bring the children back to the clinic.
The next morning Jenny opened the clinic to find the mother,
and not just the child she had seen the previous day, but three
more of the woman’s children. All of the children were exhibiting
similar symptoms that now included muscle cramping and excessive
thirst in addition to diarrhea and vomiting. When checking the
vital signs of the children, Jenny noticed increases in both the
pulse and respiratory rates accompanied by decreased blood
pressures. Uncertain as to the appropriate course of action, Jenny
contacted the physician by radio. Upon conveying the histories and
information to the physician, Jenny received instructions to keep
the children at the clinic, start intravenous (IV) infusion with
lactated Ringer’s solution, and allow the children to drink as much
of the electrolyte solution with glucose as they would like. The
physician also gave Jenny a list of laboratory tests to run on the
blood, urine and stool samples that she should collect. Jenny
started the IV infusions and gave each child some of the
electrolyte solution. After this, she obtained stool, blood and
urine samples from each child and asked the mother to leave the
children with her for care and observation. The mother agreed and
said she would return later that night to help with the children.
The results of the tests run indicated severe metabolic
acidosis, an increased hematocrit, hypokalemia, and the presence
of Vibrio cholerae bacteria in the stool samples. Based
on the results of these tests, the physician and Jenny diagnosed
the children with cholera and obtained a more detailed history in
an attempt to determine whether these individuals were the only
ones exposed or whether these cases were the first of a possible
epidemic. Jenny and the physician found that the family had
recently visited relatives in a distant village where similar
symptoms had been present in a number of families that had all
celebrated a recent shellfish harvest.
The physician prescribed continued IV infusions with lactated
Ringer’s solution and electrolyte fluid replacement by mouth. The
children were not allowed to consume other foods or drinks,
especially coffee or any other beverages containing caffeine. The
children were also told that once the vomiting stopped they could
start consuming solid foods. The children were all treated with
antibiotics and stool samples were taken from other family members
to determine whether or not they were infected with Vibrio
cholerae. Infected, asymptomatic individuals were treated with
antibiotics. The physician later explained to Jenny that caffeine
was prohibited because the toxin produced by the bacteria (termed
choleragen) binds to the surface of the epithelial cells of the
small intestine and activates adenylate cyclase. In addition, the
toxin interferes with the active transport of sodium ions in the
intestinal lumen.
Why did Jenny initially suspect that the child and other
family members were experiencing food poisoning? Upon further
evaluation on the second day why would the child present an
increased pulse and respiratory rate but decreased blood pressure?
Here are the discussion board requirements.
The initial discussion post must be at least 250 words of
content, referencing the reading of the week, and include a
scholarly source.
Plagiarism of any kind will result in a “0”.
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