Kids in PNG seem to get Meningitis easily. I am not sure if this is due to a lack of vaccinations or just the overall amount of bacterial load that seems to be in PNG, but it is pretty common to have at least 1 if not 2 or more kids being treated for meningitis at any one time on the Pediatric ward. The signs are symptoms of Meningitis are taught early on in medical school, because you don't want to miss meningitis. Meningitis, if untreated, or treated too late, or even sometimes when treated correctly and on time - can be deadly, or can result in permanent brain damage, so you don't want to miss it. As a doctor, you learn to pick up the clues that a kid might have meningitis - the history of a fever with irritability, the inconsolable cry, the bulging fontanelle, and a stiff neck are all signs and symptoms of meningitis.
The diagnosis, outside of clinical suspicion, requires a lumbar puncture. Putting a small needle into the spine, to collect some of the cerebrospinal fluid that runs in our spinal cord. Clear fluid is a good sign, you will need the lab to confirm if they do or don't have meningitis, but if they do have it, you probably got it early and they should be okay. Cloudy fluid is bad - it means they have meningitis, even without a lab telling you such, they need antibiotics and admitted, and their overall prognosis you hope will be good. Pus in the fluid is the worst - this means they definitely have meningitis and not just a little infection of the meninges, but a big infection - one that has replaced the cerebrospinal fluid with pus instead. This usually means a very bad prognosis, mostly because you found out late in the game and the pus has already started affecting the brain - the organ that helps us walk, talk, coordinates our thinking and much much more.
Thankfully for this little guy, Azariah, the pus coming out of the needle, was no match for the IV antibiotics that he received. Seemingly, the pus caused no lasting effect on his brain, as evidenced by his huge smile that greeted me each day. I am thankful that not everything goes as my experience would otherwise predict. Pray for the other kids on the ward with meningitis who aren't all faring as well as he did.