Fieldset
Jean's sleep

I found Jean in the laboratory. He is from Dilingala in southern Chad.

Something was obviously wrong.

I found Jean in the laboratory. He is from Dilingala in southern Chad.

Something was obviously wrong.

He was a boy who looked about 6-7 years old, though his older brother said he was only 4 years old. Who really knows. Jean was draped across his brother's arms, limp and barely with his eyes open.

One of our out-patient department (OPD) staff had sent Jean to the lab. He had requested a serological screening test for sleeping sickness. This test looks for antibodies for sleeping sickness and just requires a quick pin prick.

I asked Jean's brother with the help of a local national staff "securiste" – or nurse's aid – what was the matter. Jean's brother said the patient got increasingly sick in the last one week. He could not walk, he would sleep all day, he would not eat and he was having fevers.

When I tried to make Jean walk, he could barely stand. He looked encephalopathic or in a confused state of altered mental status. He indeed could not talk and he could not swallow a few drops of water we tried to give him. He would not cry or protest if pinched. When he did open his eyes he looked around in a wild and confused manner.

This is sleeping sickness. The worst kind.

Not surprisingly, Jean's screening test for trypanosomiasis was positive. I did his lumbar puncture immediately and he had a very high number of white blood cells – 452 – which is a clear indication of the severe central nervous system form of this disease. Our superb lab technician Yvonne – who is always keen to show us important lab findings – showed the actual trypanosome parasites swimming in Jean's cerebral spinal fluid. Concurrently I tested Jean for malaria and meningitis. He had a moderately severe malaria as well and no meningitis.

We wisked Jean off to the in-patient department and I had the nurses immediately start his intravenous treatment for sleeping sickness. We also treated him for malaria.

Later in the evening Jean remained in a semi-comatose state. When I did the night rounds I found a woman sitting on the ground near our salle de guard – or nurse's station. It was Jean's mother who had come from their village. I told her Jean was very sick but he was getting everything we had to help him. And with that, we put Jean in the closest tent to the nursing station.

Let's hope Jean can recover from this severe episode of sleeping sickness. I will hope for his awakening and keep you posted dear readers and friends.

Warm wishes from the Central African Republic,

Raghu Venugopal