Window on Kisiizi

Window on Kisiizi

Saturday, 25 August 2012

Saturday morning ward round...

Dr. Josephine is having a well-earned rest so Ian is covering paediatrics and neonates.  Happily we now have an intern so that is a great help.

I started in our special care baby unit where most babies were improving.  One infant had come to Kisiizi a few days old with a major problem called a sacro-coccygeal teratoma.  This is a form of tumour that causes a large mass over the lower spine.  Dr. Gabriel, our surgeon, had operated to remove the lesion, no mean feat as quite large and even involved the caecum and appendix anteriorly!  Happily the baby now looks really well and is thriving.
Dr Johnson, intern, and Sister Jane on Children's Ward

Then we have the usual mix of premature babies including one born weighing around 900 grams who has now doubled in weight and will be heading for home in the not too distant future.

One baby had been born on the way to hospital and had arrived very cold but is now improving.  Another was born here by a difficult breech delivery and needed resuscitation at birth.

The saddest case is a baby who was born some distance from us in the community, apparently in a house belonging to a nurse who is not a midwife.  The baby had problems and was seen in a village clinic who only referred her on after a couple of days.  She arrived in poor condition and needed urgent blood transfusion and had some initial fits which we were able to control.  Today she is much improved but we are guarded about her longer term neurological outcome.

I have just removed an umbilical vein catheter and put in a peripheral cannula on a baby who had a degree of birth asphyxia and still has abnormal tone.  It's sad to see such cases born in other places.  However, on a positive note, our own maternity and obstetric service is developing.  In addition to Dr. Helen Smith, Consultant Obstetrician, visiting again recently to support Dr. Francis Banya, our own Consultant Obstetrician and Gynaecologist, we now have Dr. Rachel with us for a few months as the first "Maternity Hub" registrar.  She will help Dr. Francis and the midwifery team in various ways as we seek to improve further the quality of care.
he ain't heavy... he's my brother!

After the babies down to Children's ward.  One lad is recovering from a laparotomy [surgical exploration of the abdomen] yesterday.  He had had features suggesting peritonitis after a preceding history of fever and abdominal pain and we suspected typhoid and a perforation of the gut which is a well recognised complication.  However it turned out that he had a ruptured gall bladder!  This is an unusual event in a child of 10 and there were no stones present.  It must have been linked to the direct effect of infection causing inflammation of the gall bladder plus or minus an effect of pressure on the drainage duct due to enlarged lymph nodes which we had noted on ultrasound and confirmed at surgery.  He seems to be reasonably well this morning considering how sick he was.

Another child aged 20 months came in with a long history of cough and a recent swelling over his thoracic spine.  I think he probably has TB and has some damage to one of the vertebral bodies causing some collapse and angulation.  Happily he doesn't appear to have any damage to his spinal cord.

So that's just a taster of some of our patients, and of course the usual mix of children with pneumonia, gastroenteritis etc as well.

Then a quick diversion to the hospital "canteen"  shop to get some milk as my dear wife is back in UK and the girl who helps run our household is off this weekend.  Back home for a coffee and to boil up the milk [it comes direct to the canteen in a metal container and isn't pasteurised] and time to update this blog and to thank you all for the messages of support and encouragement and your prayers that sustain us in this work.

Here is a photo of a child we admitted about 3 weeks ago - the child had a form of neonatal hepatitis that had caused her to remain jaundiced but the prognosis was good.  However, the family, advised by the mother-in-law, had taken her to a local traditional healer who had performed "ebiino".  This practice involves digging around in the infant's gum and pulling out an un-errupted  milk tooth.  The practice is usually used in infants with diarrhoea and, as this is usually self-limiting, it perpetuates the myth.  However the practice may result in severe infection including septicaemia or, as in this case, bleeding, probably exacerbated by the underlying liver problem affecting clotting.

We had to resuscitate the child, give oxygen and fluids iv and vitamin K and then Hanna, my faithful wife and O Negative universal blood donor, gave some fresh blood to help control the problem with good results.

This case highlights the need for health education and promotion to try and avoid such cases in the future and we hope to develop our community programmes in the coming months to pursue this goal.

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