Raphael O., 17

Raphael is a 16-year-old boy and the third-born in a family of four children. He was raised in a rural village by both his parents alongside several cousins who live in the same household. He is a Form Three student at a local boarding school, where he studies through a scholarship. His father, a small-scale farmer, is the family's main source of income, but the earnings are often insufficient to meet the needs of the large household. At times, the family goes without meals to prioritize education and other essentials. During school holidays, Raphael works on the family farm and takes casual construction jobs to help buy school supplies and occasionally pay part of his school fees. He had previously dropped out of school for two years because of financial constraints before returning to continue his education. Hardworking and determined, Raphael dreams of becoming a teacher to help uplift his family from poverty. Raphael was referred to the hospital from school after nearly a week of persistent cough, severe generalized headache, repeated vomiting, fever, lethargy, poor appetite, and progressive weakness. His condition had deteriorated to the point that he was unable to participate in normal school activities and struggled to retain food or fluids. He had only received over-the-counter medication from the school nurse because he lacked funds for further medical care, but his symptoms continued to worsen. Concerned by his deteriorating condition, the school nurse referred him to the hospital, where he was assessed in the emergency department. Owing to the severity of his illness, he required immediate admission for close medical observation, further investigations, and appropriate treatment.

Raphael required ward management due to the severity of septicemia with malaria, which necessitated close monitoring, intravenous medications, and supportive care. In my opinion, inpatient care was essential to allow timely administration of antimalarial therapy, broad-spectrum intravenous antibiotics, fluid management, and monitoring of vital signs and laboratory parameters. The prognosis is good with prompt and adequate treatment, as the condition was identified early and managed aggressively. With continued adherence to treatment and follow-up, full recovery is expected without long-term complications