When Naw PSN (40 years old) arrived at JSMK she complained of fever, diarrhea, vomiting and weakness. A week before coming she miscarried her 4-month pregnancy and bled heavily. She looked tired and sick.

On examination, she had was dehydrated, a little bit yellow and her spleen was enlarged. Her hemoglobin was 6, about half of what it should be and revealing significant anemia. Her first malaria test was negative, and she was treated with IV fluids and anti-nausea medication.

The following day, her hydration had improved, but her urine output dropped. An ultrasound confirmed the enlarged liver, and her Malaria smear was repeated but was normal. We added Acute Renal Failure to her problem list and managed her fluids carefully.

By day three, she continued to have poor urine output, fevers, an enlarged spleen, mild jaundice and weakness. A third malaria smear was + for PF Malaria, and her hemoglobin had fallen to 4. IV artesunate was started. Her anemia was now severe enough in the setting of severe Malaria to warrant transfusion. Her brother, visiting for the day, agreed to be tested for crossmatch. His blood was a good match for her, and he tested negative for Syphilis, HIV, Hepatitis C, and Malaria. He was not anemic, and agreed to give his sister some of his blood.

The combination of blood transfusion and antimalarial treatment was what she needed, and by the next morning, her urine output had improved, her fever stopped and we felt she had turned the corner towards recovery. We put her on Aurother, the combination antimalarial treatment provided by a grant fromBlessing’s International. Her daughter came to help her husband in cooking and encouraging her. All our combined efforts were the blessing she needed, and a 8 days later she was able to return home on Iron treatments. Oh, the cat went home happy as well.

We encouraged her husband to have a vasectomy while she recovered but he suddenly became very shy. We were persistent in encouraging him to take this step, and he promised that once she fully recovered he would return. At JSMK we can offer vasectomy as a means of helping couples avoid pregnancy when they have reached the point where they feel they have enough children.