Wednesday, 3 July 2013


Young Achta* was a normal healthy 13 year old girl. She lives in a village near Lake Chad with her parents, brothers, sisters, grandparents, aunts, uncles and cousins. Their village is made up of a collection of round huts constructed from a wooden frame and walls made of packed dried goat dung, topped with a thatched conical roof. To the untrained eye, it would seem the village is in a random location apparently no different from the next sandy spot a few kilometres away. A closer look however reveals the presence of some green trees, suggesting a water source deep underground. School is for the male members of the family so home life for Achta meant looking after the many younger children and helping her mother cook, clean and fetch water from the well. The men of the family tended to their cattle and livestock, frequently leaving the village for days, sometimes weeks at a time, to trade in the city. They would return with small amounts of money and supplies that could not be sourced in the village for the next few weeks.

In the village sickness is a part of life and it seems that there is always somebody suffering from some ailment or another. When Achta began to feel more tired than usual and began with fevers, she tried to continue her work as best she could. However, she soon noticed that she could not feel the rough ground beneath her feet so well, or the 4cm long thorns scratch her legs as the weakness caused her to stumble into a thorn bush.

Two days later Achta could no longer move her legs, control her bladder and from her mid back down, where a new lump had appeared, had completely no sensation. Her family called for the village traditional healer who cut deep lines into the lump to cause bleeding in order to allow the illness to leave the body.

However, Achta’s condition continued to deteriorate; she found moving her head impossible from stiffness and intense pain in her neck, speaking was increasingly difficult, while the fevers that raged and waves of nausea, left her exhausted.  At this point her family, having gathered enough money from other family members and neighbours, began the long journey to the city to seek further help. Initially they set off by foot carrying Achta in a quickly constructed stretcher made of cloth over a wooden frame and then having reached a transport route on a mud road, continued on in a packed mini bus, luggage piled high on its roof.

As the city neared the road became paved, and as the bus approached the outskirts, the driver stopped, waving in the direction of a dirt track on the right, informing Achta’s family that the nearest hospital was 5km in that direction.

Afia assessing a patient in Triage
On arrival at Guinebor hospital, Achta was identified by Afia, who works in Triage as very sick and was immediately taken through to the Emergency room where her initial assessment was carried out by Paboula, the Emergency Room nurse. While the male members of her family waited outside with their bundles of belongings, anticipating a long stay in the hospital, Doctor Mark thoroughly assessed Achta. He admitted Achta to the paediatric ward with an unclear diagnosis; Meningitis? Sepsis?  Brucellosis? Her treatments began immediately with strong antibiotics and medicines to help her sickness, fevers and pain.

Two weeks later, Achta’s fevers had lessened and her neck was freer but otherwise, little had changed in her condition. She continued to have no movement or sensation in her lower extremities below the mysterious lump on her spine and experienced generalised pain. Her exact diagnosis continued to baffle us, but Dr Mark increasingly believed that brucellosis, a disease affecting those working or living with cattle in close proximity, was at the source of her illness.

Her treatments continued along with regular physiotherapy with Rosane, our physiotherapist from Brazil. Although her prognosis continued to look poor, Achta and her family seemed to take each day in their stride and had ready smiles, allowing some sort of friendship and relationship to form despite the fact that we had no common language.

One ward round as we approached Achta’s bed, I felt my usual apprehension and sadness as I anticipated the almost daily neurological exam to be once again negative. As before, a small needle was pressed along the length of legs- no sensation. Reflexes were checked. And then Achta was asked once again to try to wiggle her toes. As her face contorted into an expression of intense concentration, I watched her feeble feet hopelessly. But what was that? It was slight, almost undetectable, but that was a definite movement! Achta tried again. Yes, there was no mistaking! Achta could wiggle her toes for the first time in over a month! 

Wahoo! Who would have thought that such a small action could cause such excitement, rejoicing and, for the first time in a long while for this young girl, a glimmer of hope!

How much Achta would be able to move and the extent to which she would be able to recover, we had no idea, but that morning she made a small but incredibly significant step forward.

In the following weeks, Achta’s ability to move and the level of sensation in her legs, increased daily. Before we knew it, Achta who had been bed bound for 2 months, was sitting up with less and less help, could lift her leg one at a time from her bed and could wiggle her toes to her hearts content! Miraculously, and all of a sudden, Achta took her first wobbly weak steps with the support of a walking frame, amid the applause and encouragements of the staff and her family. The sadness that had seemed to engulf her began to be replaced with a beautiful smile that would light up her face as she was frequently seen practising her walking up and down the hospital walk ways.

Two months after being admitted paralysed and desperately ill with a bleak future, Achta left the hospital walking with crutches, going from strength to strength. And “the lame walk…”

Achta on the day of her discharge from hospital

(*Achta’s name has been changed to protect her identity but her family agreed to me sharing her story. Some of the details of Achta’s village life before hospitalisation have been added purely to help communicate more of the background of many of the patients who come to our hospital).

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