999

ok, so we don't have 999 calls here, and no national ambulance service... though Ian was in Kampala recently and one set of meetings he attended was to do with setting up a Uganda:UK health alliance to co-ordinate projects.  Some of the people he met were from London Ambulance service scoping out the possibility of starting an ambulance service in Kampala....

But we still get emergencies...this child has come in the evening extremely anaemic and shocked and Ian has just put a needle into the child's tibia bone to give an urgent blood transfusion.
Note the wooden drip stand on the left, the angle-poise lamp for illumination.... the doctor on the right is our paediatric intern.

This child also arrived around midnight extremely unwell breathing at an extraordinary rate of 120 breaths per minute!  The child had pneumonia that had been treated in the community using traditional methods which involve making small incisions in the child's chest wall.  This may be done using a sharpened bicycle spoke and are usually superficial but it seems in this child that the right lung was punctured so when we examined her there was no air entry at all on the right lung which had collapsed.  The air leaking out from the lung then builds up in pressure causing a so-called tension  pneumothorax which not only compresses the affected lung further but also pushes the heart across onto the other good lung further compromising the child's respiration.

The treatment is insertion of a chest drain to relieve the pressure.

Another child also required a chest drain but this time for a huge collection of pus following complications of pneumonia.

Here are the two children happily playing together, each with their drains in place... the one facing us is the first little girl with the pneumothorax.