Dr. Besser's Notebook: African Village Faces Pneumonia

March 17, 2011— -- You can learn a lot looking into someone's eyes. Sometimes things that are too painful to be said will be spoken by a look or a look away. When I looked into the eyes of three women in Kibera, the largest slum in Africa, I was the one who had to look away.

I know a lot about pneumonia. I spent seven years working on respiratory infections at the Centers for Disease Control and Prevention. I have been practicing pediatrics for 25 years and have treated a lot of children with pneumonia. I came to Kenya to shoot a story about pneumonia. It accounts for more childhood deaths around the world than any other infection. I couldn't do a series on global health without talking about pneumonia.

In Nairobi I met up with my friend, Danny Feikin, a former colleague from the CDC, now working for the school of public health at Johns Hopkins. He just finished six years in Kenya working on pneumonia control and treatment. It was a great chance for us to catch up and to celebrate the recent launching of a pneumonia vaccine with the potential for greatly reducing pneumonia deaths. We set off for a local hospital to see some of the faces of pneumonia.

Dr. Loice Mutai is a pediatric cardiologist and physician-in-charge on the children's ward at Mbagathi District Hospital on the outskirts of Kibera. She greeted us with a big smile and didn't stop smiling. She trained in pediatrics in Madras, India, and is very proud of the care that she can provide.

She shows us around the hospital. It looks nothing like an American hospital: a one-story building with multiple rooms built around a courtyard. Whitewashed walls, courtyard halls filled with people, mainly women, many waiting in line for a plateful of food being ladled from a giant pot. The smell of Kenyan food masks the other less pleasant smells of the hospital.

She takes us to the triage room where new patients are first examined to determine how sick they are: do they need to go to the room for the sickest patients? Are they well enough that they can be treated and go home?

Together she and I examine a little girl, nearly a year old, breathing with great difficulty. We listen to her chest -- wheezing. It is likely that she has bronchiolitis, a respiratory infection from a virus that inflames the small airways making it difficult to pass air. She'll need to go to the room for the sickest.

We get a quick rundown. They usually have around 150 patients on the wards at any given time, cared for by three senior pediatricians, usually a couple of interns or residents, and a number of less-skilled health care providers. Far too many patients for the number of staff.

Dr. Mutai's eyes are deep brown and exude incredible warmth. She speaks with the calmness and self-possession of one who knows that she is battling against incredible odds to provide the best care she can for children who have nowhere else to go. We have very little here, she explains, but we do the best we can. We could save so many more lives if we had more. She knows that we are there to see patients with pneumonia. No problem. They have many.