Fri Jan 3rd.  We seem to be acclimated and into our routine.  Up at 430 to 500, coffee and computer, exercise (though I still couldn't jog yesterday!) breakfast and off to work.  Below is sign for our office hours.  We all like that!

After a small bit of work, we break for shopping.  Produce at the market is incredibly good and incredibly cheap.  Only issue is all of the ladies want us to buy from them.  One has to distribute the wealth.  Our tendency is to overbuy because it is all so good.  No prices posted, but we left with 2 large bags yesterday for about $8.00.

Back to work.....

Front of hospital.  Hard to see all the people waiting, but will try for more photos.

Work yesterday included thymoma (another first for Nicole), carcinomas from various sites, probable ITGCN (intra-tubular germ cell neoplasm) from a young boys undescended testes, various other biopsies and not too much grossing. 

But most stiking were the two blood smears with no history provided.  So we trudged off to the wards.

First case is from a 7 year old girl who is essentially dieing.  Originally had typhoid involving her bowel with a perforation several months ago, has had multiple complications, and is markedly malnourished.  Blood smear was sent to see if she has leukemia.  I don't think so, but hard to be sure.  Her WBC count was 60k (normal under 10K) and she has lots of abnormal cells - lots of nucleated RBCs (indicating marrow stress) and immature WBC.  Not very many normal neutrophils...  Wish I could say more...
Second case is from a 16 year old with a WBC of 77k!  He has probable tuberculosis in his abdomen and enlarged liver and spleen.  Again he is deathly ill, and probably will not survive.  Clinicians are wondering if he has cancer (lymphoma) not TB (or both).  Plan is for bone marrow biopsies for both children.  One note said "pathologist arriving thursday, so will do marrow biopsy then"!

Seeing these heartbreaking stories, even from a relative distance makes one so grateful for what we have and wish there was more that we could do and more fairness in the world.