Mr A, 62-year-old, drove into the facility on a Saturday afternoon and complained of fast breathing that started 2 days ago. He was seated some 4 feet from me putting on his face mask. With him was momma, his wife, who was rather calm. He was obviously in respiratory distress. Immediately Covid-19 registered at the back of my mind. I asked a few questions about coughing, about contact and about recent travels. Mr A hadn't traveled from his little village over the last 2 months before the symptoms. From the vitals the nurses had taken, I could see that he was febrile and his respiratory rate was 64. Now I was cautious. Further probing elicited that he was hypertensive and diabetic. He was quite literate and was religious with his medication. I wanted to rule out fluid in the lungs so I probed further. His cough wasn't associated with position and sputum was scanty. He didn't cough out blood. I requested he put on his face mask and never remove it. We hadn't an Xray machine so I requested he goes to a radiographer some 4km from the hospital to get one done. It returned Pulmonary oedema(fluid in the lungs space). The film wasn't classical for me but I thought well, let's see. I called the nearby general hospital that had been designated the Covid center to lay the complaint. I was told they hadn't had power and water for the past 3weeks( and counting) and they hadn't oxygen and would rather refer him to kaduna city center, some 3-4hours from there. They had no functional ambulance and time wasn't on our side. It was 5pm now. The blunder. I called the relative and explained to them the situation. They pleaded that he be admitted and managed briefly until the next day. I called my workers and cautioned them about the possible case and ensured they took the necessary precaution. At this point, few of my workers had had contact with him. The Man's relatives and children had had persistent contact. I started him on an Oxygen concentrator when his saturation was 89%. I had to run the power generator until morning. Monitored his glycemic level and blood pressure. At 9am, when I came in to check him, he was quite better, spo2 was 92% and had earlier told his kids he was well and the oxygen was working. They all smiled and appeared happy. Rate was now 34cpm. I thought well, maybe the diuretic and oxygen and antibiotics and steroids had worked. Hey, the patient was getting better and I had earlier asked the general hospital to take samples for COVID and GeneXpert but they said that would have to be Monday. I had a chat again with the relative and suggested he be taken to JUTH which was much closer than kaduna city, they insisted to wait for results before heading out, besides today was Sunday and baba appeared quite stable. 8pm, rate shot to the skies again, 66cpm. Commenced Oxygen once more. Saturation dropped to 87%. We worked on everything. Sugar level was 21. Commenced insulin and at 12am dropped to 10. Titrated insulin in dextrous saline. BP was within range. But breathing was not. He became restless. I placed a call on Juth and they assured me they were ready when I am. The previous night at about 7pm I had already drafted a referral letter to Juth already. 6 am he was completely exhausted and lethargic. Relatives scouted for an ambulance with an oxygen facility around and they didn't come across any. I had never seen an ambulance around here before not to talk of one with an oxygen gadget, nahhh, never. I advised them to get a car and sit him in and begin the journey to Jos. As at this time, spo2 was 66%. One of his daughters, a nurse, was fortunately around. I handed her our AMBU bag to continuously ambu bagging him until they got to JUTH, some 2hours from here. They got a saloon car and 5 of them squeezed in. They arrived Jos about 2 hours later, he was already unconscious and my colleagues informed me that his spo2 on arrival was 45%. He was quickly placed on O2 and every other thing monitored. He had previously been placed on a catheter from here for convenience and to monitor his urine. His u/e/cr was normal from here. The next day, a Tuesday, I called to follow up. He was said to be better, without oxygen his spo2 was 70% while with oxygen it was 80%. Ahhh, we are getting somewhere. I asked if a sample for covid had been taken. Affirmative. It returned. On Wednesday at about 12pm, I was told his condition went south and turned for the worse. He died at about 2pm. The result of covid was yet to be out before the relatives paid up their bills and whisked him away for burial. Two days later, I was told that the result was positive. He had had covid all along and I had been exposed. We had all been exposed. Well, this is the 13th day post exposure and I am glad to inform you all that I and all my staff are doing well, no symptoms, well unless for me who had tested positive for malaria parasites and treated it. I am fine now. My staff are as well. Thank you for staying in touch. I appreciate my employers kateri medical services and especially father Tom who kept on praying and calling to check. I couldn't have asked for a better staff who are teachable. I am happy that when I leave here I would have impacted on a set of midwives, nurses, chews, pharmacy and lab technicians that they would be able to make informed choices for the benefit of the community health wise. I am thankful to all our friends on social media who came to the back to check on the rural doctor initiative and all. We are grateful and work continues as we provide standard care for all our patients. Again, only a qualified doctor would have been able to manage a patient efficiently as this in a poor resource center. No quack would have had. There is an urgent need to have doctors in the rural areas to provide standard basic care to patients and make life defining decisions when this is needed. Please COVID-19 is REAL. It is closer than you think and it is already in the communities. Stay on your guard. Good morning.
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