Work, rest and play...

WORK:

Hanna has been busy on Maternity, and delivered one lady who had had 11 previous pregnancies but only 3 surviving.  They had all been girls, but this time she had a boy who was healthy.  The mum went home very happy.

Other details of Hanna's work are not suitable for a general public audience but represent the aftermath of picking up the pieces where women have been inappropriately cared for in the community prior to coming to Kisiizi.

Hanna, conveniently for others being O Negative blood group, gave blood again recently and probably has the record for duration of a bruise which is still prominent over 2 weeks after the event!


We have had some challenging cases in the Children’s ward recently... as well as 3 children needing chest drains we have had a wide range of patients.   

Child with pneumothorax and right chest drain in situ

We have discharged one girl who had bad burns and has done well, but still have a young boy who has developed tetanus secondary to his burns and is quite unwell.  We have tried to access tetanus immunoglobulin [this is a preparation of body defence protein specifically against the toxins produced in tetanus] but it doesn’t appear to be available in Uganda and we are trying to access it from Nairobi...

Then a one month infant came in with a swollen everted lower eyelid related to infection... happily now responding to treatment.
 

We have had a few cases of dysentery all improving but tragically a little boy who had nephrotic syndrome [kidney problem with big loss of protein in the urine causing body swelling] and who had a background poor nutritional state died yesterday.  I had a day off so wasn’t there but he apparently collapsed having been out to a washroom.  It highlights how limited our resources are as we would have had a much greater insight into his diagnosis and guidance in how to manage him optimally if we had been in UK with all the tests available.  Having said that, we are much better off than many other places in Uganda having ultrasound, basic tests and specialists around.

We have a 9 year old admitted unconscious, it seems this is caused by very high blood pressure in turn due to kidney problems.... not very common fortunately.  I was pleased to hear today she has started eating and communicating.

Then we had a baby who had come in to the hospital at the age of two weeks with infection of the tibia [bone in the lower leg] sufficiently serious to expose the bone.  A couple of weeks later he had developed very unusual swellings of the ends of his collar bones [as shown in the photo] where they join the breast bone.  These were quite prominent and symmetrical.  I had never come across this before but one of our visitors from Chester told us she had seen it in older children at Alder Hey hospital in Liverpool.  It is due to an overgrowth  called hyperostosis.  A quick look at the literature has not turned up any cases younger than 3 years with this condition [Sapho syndrome] so we might write up the case...

REST AND PLAY

so at last due for some days off...

but had to go in the first day as the Primary School had arranged an end of year concert and I had to give a speech... 

then it turned out one of our medical officers had also arranged another meeting for in-charges of health centres that we are responsible for in our health sub-district so, yes you guessed, another speech... [fortunately I managed to avoid mixing up the speeches!]...

 ...then in the evening after having a couple of people for a meal we had a surprise birthday party here for Peter, one of our two Australian medical students who have been with us for about six weeks.  

 The guest house had produced a good cake and someone brought roasted g-nuts [ = ground nuts, the local name for peanuts which we more usually eat as g-nut sauce...] and Gloria Banya, aged 1, was of course present to share in the fun...

 

But yesterday was a proper day off, and we needed it.  Good to unwind a bit and Kisiizi is a beautiful place to do this.

  

 The sun was out, the sunbirds were out, the spray from the waterfall picked up by shafts of sunlight through the trees,

the hospital cows chewing the cud contentedly

[they provide milk for malnourished children on the ward and for Staff] 

 

and Hanna enjoying a break on the verandah. 

 

I had a short game of badminton and paid the price in the evening with stiff muscles not used often enough.

Last night we had a very enjoyable meal with Dr. Gabriel and his wife Sister Maureen and their 3 children, followed by a look at the night sky through a telescope... the moons of Jupiter were like tiny pinpricks next to the planet, the Seven Sisters beautifully clustered, and the almost full moon breathtaking.  Today Herbert, one of our electricians, spoke in chapel for advent Sunday and, having been sidetracked to see review the child with tetanus, we had a number of friends for coffee...  and later an enjoyable lunch with another group... so we thank God for the variety that is Kisiizi.

staff walking down towards chapel