Paediatric Quiz solution...

Thanks to those of you who posted comments or sent emails suggesting a solution... it seems that my clues were too cryptic!Here is the clue again but with highlights...

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Some need a clue to the diagnosis in this case for a bolus point:

A scar is the solution, it all comes to the helm in the end!

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The answer is that the child had sub-acute obstruction caused by a bolus of ascaris roundworms, a type of helminth parasite infection.  Ascaris are quite common but usually only cause mild problems such as malabsorption with the risk of compromise of the child's nutrition.

This unfortunate child had hundreds of worms which were vomited or passed once we gave the child anti-helminth medication [mebendazole].

Re-generation...

Kisiizi Hospital Power Ltd, our hydro-electric power company, plays a vital role in keeping Kisiizi operational.  For many years we ran the Hospital on the 60kW Gilkes generator and then in 2008/9 the new 300kW generator was installed by Charles Swainson and the team.  This has allowed power to be transmitted to our community for domestic use or, in some cases, providing energy for small industrial concerns such as carpentry workshops.

Gideon inspects the alternator bearings

Now the main generator has been running for 4 years and we are grateful that Charles has returned to supervise the essential maintenance required to ensure the on-going smooth running of the turbine, alternator and whole system.

Paediatric Quiz - CLUE TIME

Some need a clue to the diagnosis in this case for a bolus point:

A scar is the solution, it all comes to the helm in the end!

Draining...

Brain drain...

Occasionally we are disappointed when one of our Staff decides to leave for a higher-paid job in a big city rather than staying to help care for our desperately poor community... but on the other hand it makes us really appreciate the Staff who faithfully serve even though they could earn so much more elsewhere for less work.  One such is Dr. Gabriel, our Consultant Surgeon, who has now returned safely from a trip to Geneva to the World Health Organisation and this all went very well.

One other factor in a couple of Staff leaving is that we discovered some were holding full-time government jobs as well as their Kisiizi appointments and were trying to do them in their days off from here... but of course this could mean compromising on both sides.

Chest drain...

this youngster is an example of a child being brought to us late in a disease progression.

He was very breathless and had a large amount of fluid accumulating in his left chest.

The x-rays show the difference before and after a chest drain was inserted to relieve his distress.

The first film shows his heart pushed across to the right by all the fluid [which looks white on the x-ray].  In the second film the right lung looks more normal and the tube of the chest drain can be seen in the lower left chest.

We were able to remove the drain after about 3 days and he went home a few days later.

Tank drain....

Kisiizi has 360 beds and sometimes the number of patients exceeds this.  Then patients all have attendants who help them with washing, food etc [the nurses concentrate on observations, dressings, medication etc] so that adds another group of people.  Add a couple of hundred student nurses/midwives, about 430 pupils in the primary school and a few hundred out-patients every week and you will understand that there is quite a demand for basic water and sanitation.  We are blessed with a capped spring and gravity flow water system that has served Kisiizi for its 55 years.  The pipes will need replacing but happily there still seems to be adequate water for our needs at present. Sanitation is provided by a range of different facilities ranging from extremely basic pit latrines to western-style flush systems and anything inbetween.  Only problem is that a lot of these facilities drain into septic tanks and with time these fill.  So one joy to anticipate is draining some of these tanks in the next week or so.  Moses, our senior hospital administrator, assures us that it will be fine and not an assault on our olfactory senses...

Ambassador

Dr. Gabriel lecturing on the Kisiizi APPS Amplification seminar

Dr. Gabriel Okumu, our Consultant Surgeon, is currently in Geneva at the invitation of the World Health Organisation to represent Church of Uganda Kisiizi Hospital at a strategic planning meeting relating to the Surgical Unit-based Safety Programme.  This is a new initiative from WHO supported by a team from John Hopkins university, USA.  Kisiizi has been asked to participate following the recent successful amplification work as part of our role as the only first-wave hospital in Uganda on the WHO African Partnerships for Patient Safety programme. We will continue to liaise with our partners at Countess of Chester NHS Trust as the programme develops.

Kisiizi has also been asked to act as one of five worldwide WHO "Learning Laboratories" researching the ways to link Patient Safety to the Universal Health Coverage targets.  Other sites are in places like Bangledesh, Gambia and Dominica so hopefully we can all learn from one another.

Our large community Health Insurance Scheme, with over 35,000 members in 177 groups, will help us interact with our communities, sharing health promotion messages and listening to key issues raised.  In addition, as part of the North Kigezi diocese of the Church of Uganda we have another network with around 320,000 members, again in a structure of parishes and archdeaconeries that will facilitate similar interactions.

Special guests...

We were delighted to welcome Sister Esther Kobusingye, our former Principal Nursing Officer, back for a visit to Kisiizi this weekend. 

She retired from Kisiizi about 18 months ago and now works part time in Mbarara, about 80 miles away.  It was a joy to see her again, accompanied by Oriki, seen here with Esther and his sister Gladys and her young baby.

Paediatric Quiz time...

for the medics amongst you, here is a case we admitted recently...  a previously well child of about 8 months presenting with intermittent severe abdominal cramping pain and this appearance...







What do you think is the cause?

We will give the answer in a week or so!

Cinderella...

Ewan and Ian discuss building options

Kisiizi has a ministry to care for some groups who are often the "Cinderella" forgotten patients... these include patients with Mental Health problems [Kisiizi is, we think, the only non-governmental hospital in Uganda offering in-patient psychiatric services] and adults and children with Disability who attend our Rehabilitation Unit.

 We were delighted to have a recent return visit from Ewan and Mo Wilkinson.  Ewan is a Professor of international health / public health in Chester whilst Mo is a Consultant Psychiatrist. We were able to discuss a range of issues including the plans for the new Mental Health Unit buildings. We also enjoyed meeting up with Sarah and Kieran, doctors at Bwindi Community Hospital a couple of hours from here

Theonest

Ewan & Mo,Sarah and Kieran from Bwindi & us

With the generous support of some of our recent Australian Medical Students, we hope that Theonest will be going for training as a Psychiatric Clinical Officer to give support to Sister Nancy.

 

Part of the work of "Rehab" is the community outreach.  Hannington has worked with Kisiizi for decades... he used to translate for us when we first worked in Kisiizi back in 1987!

Groups meet up in the community for therapy sessions.

In the middle photo Hannington is accompanied by Alozius, our Occupational Therapist.

    

 

We are grateful to all our Staff in Rehab for the work they do with individuals and groups.  We are looking forward to a further visit from our physiotherapy colleagues from Dublin in the not too distant future.

A day in the life...

without looking for publicity we seem to have featured in a number of newsletters recently...

I was asked to write about a day in life here in Kisiizi and it has been published by RCPCH in their newsletter.  Prior to this we had a similar piece in the International Child Health newsletter and a report about Kisiizi in the World Health Organisation African Partnerships for Patient Safety [APPS] newsletter. Earlier in the year Kisiizi was on the front page of the WHO website.

I have also just contributed to an article for Archives of Diseases of Childhood in its final draft.

We do hope that this publicity will encourage more support for Kisiizi and help us recruit the right senior staff we need to develop our work more.


Royal College of Paediatrics & Child Health Spring 2013 Newsletter


International Child Health Group Winter 2013 Newsletter

WHO website African Partnerships for Patient Safety Kisiizi feature

Extract from APPS Newsletter Article spring 2013:

A breath of fresh air...

Our most common reason for admission on Children's ward is with pneumonia.  Most cases are young children in the first 3 years of life and they present with rapid breathing, cough and fever.

However, unlike a couple of decades ago when we first worked here, we now see some  patients with asthmatic symptoms.  It used to be only a few adults who had such problems.  Above is a child admitted in respiratory distress and having a nebuliser of salbutamol, a bronchodilator.  He also has an IV infusion of an old-fashioned but very useful medicine called aminophylline.


Here he is a couple of days later much improved and learning how to use a home-made spacer for his inhaler treatment.

What's on at the Theatre?

Our new operating theatres were opened in 2012 and a wide range of surgery takes place.  This includes periodic camps with visiting specialists.  We recently hosted Dr. Keith Waddell with a team from Ruharo Eye Centre in Mbarara who worked with our Ophthalmology Assistant Benon and operated on around 35 patients in 3 days, many having their sight restored after cataracts.  We had Keith for a meal and it brought back many memories as we found his name in our visitors book from 25 years earlier when he had come on a similar "Eye Safari".

Dr. Deo

Dr. Deo from Mbarara came with a team linked to North Kigezi Diocese to run an Orthopaedic Camp. 


Many children benefited from surgery and our Paediatric Ward was even fuller than usual with the post-operative cases.  As they improved they moved up to the Rehabilitation Unit where many are still staying in the dormitories as they are supported to mobilise with physiotherapy. 


Our Orthopaedic Officer Bedard, Phyiotherapist Night and Occupational Therapist Alozius have had a busy Easter!

post-op child with small bottles covering the ends of pins

Other specialists include colleagues from Royal Berkshire Hospital working with Dr. Gabriel on Urological cases.  These visits are a great help to Kisiizi and are allowing us to develop our in-house expertise to the extent that Dr. Gabriel received a referral from Mulago Hospital, the main government teaching hospital in Kampala about 7-8 hours drive away!



Of course one key aspect of successful surgery is good Anaesthesia.  We are grateful to Gershom, Medius and Andrew, our Anaesthetic clinical officers who have provided our 24 hour service.  We have just said goodbye to a recently retired Consultant Anaesthetist, Dr. Angela Cooper, who came as a volunteer with Church Mission Society for six months to help us.  She has provided valuable input into various areas including Pain Relief and given us helpful advice on High Dependency Care as well as her support in the Anaesthetics team.  She has kindly agreed to help us acquire some much-needed equipment for general anaesthesia as our current equipment is decades old and, though it has served us remarkably well, is showing its age!  We do not have, nor do we intend to acquire, piped gases as would be used in western hospitals so traditional Boyles' Anaesthetics Machines are not practical here and we use more basic but effective draw-over equipment.

Dr. Anglea cutting her Goodbye and Thank-you cake

Dr. Angela is hoping we can obtain two portable Glostavent DPAO1machines which cost 2,750 pounds sterling each.  If anyone is able to help towards this cost we would be most  grateful - please contact Ian on khmedsup@gmail.com.

Dr. Robert

Looking ahead we will welcome Dr. Robert back in a couple of months when he will have completed his 3 year training as a specialist General Surgeon.  He has been generously sponsored by our friends at St. Paul's Church in Dublin who also provided the funds for the new operating theatres and previously for the two storey ward block housing Maternity and Paediatrics so we are extremely grateful for their invaluable support.

Michael & Melissa Webb kindly hosted us during our visit to St. Paul's Church in Dublin in January 2013 and have worked tirelessly to support Kisiizi

We are in the process of renovating our very old building that houses our Surgery Ward.  It was actually the centre of the original flax factory which was taken over as Kisiizi Hospital in 1958.  We are grateful for supporters in St. Mark's Church and Putnoe Heights Methodist Church in Bedford who have contributed towards this cost.  We are hopeful that this will allow us to renovate the first ward area [what used to be the old maternity ward in the past] with proper terrazo floors that we will be able to clean properly rather than the current very poor cracked concrete floors that are impossible to clean adequately.  Any support towards the much-needed renovation of the second ward area will be very gratefully received.  Thank you.

So all these strands are coming together as we aim to further improve the quality of our surgical services.  Following the successful seminars we ran recently for World Health Organisation, Kisiizi has been asked to participate in a further 4 year WHO programme on Safe Surgery.  We are waiting to hear if we have been formally approved for this by Uganda Ministry of Health but hope that Dr. Gabriel may be able to attend a meeting in Geneva next month to launch the programme which is being run by WHO in co-operation with John Hopkins university in USA.

Overview

For those of you in the UK or Ireland, do try and come to

FRIENDS OF KISIIZI DAY

SATURDAY 5TH OCTOBER 2013

 10am - 5pm

at Greyfriars Church, Reading [very close to Reading Station].

Booking not required. Bring a packed lunch.

We hope that it will be possible for Dr. Gabriel Okumu, Consultant Surgeon and Deputy Medical Superintendent, to attend

Challenging IT!

 When we first worked in Kisiizi in 1987 there was absolutely no communication available with the outside world other than walking or, if the mud roads allowed it, driving some hours, then queuing in a post office to try and make a phone call... now we have IT... and it can be amazing, for example I can sit here in my office in Kisiizi, download this article and people all over the globe can be reading it in the next hour... [welcome by the way to those in Russia, Romania, Ukraine and China who are reading the blog apparently according to the statistics...] 

but we do face challenges, not least the erratic internet connection.  The most common excuse from the company providing our connection is that the cable carrying the link has been cut by roadworks on the main road to Kampala...  This can be a real problem as increasingly important messages come via email such as information about meetings that we should send representatives to, so may cause issues if we fail to receive them.

Then sometimes the hardware can have its limitations - we thought you might enjoy the following email we sent to friends last year from a challenging laptop:

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greetings.... not easy to compose message as laptop missing 3 letters!
you can guess by a process o  elimination t e problem ones!

Still, really grate ul 4 t e recovery disc you sent, muc
appreciated!  Glad to recover some documents so merci beaucoup 4
sorting it!

Dis is one ov de most ridiculous emails I ave ever sent!  but ope you
can decip er it!!!

love +++

Ian and you kno....!

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Students in Kisiizi Hospital School of Nursing using IT

Tragedy strikes...

We are very sad to report the unexpected sudden illness and death of our Nurse Tutor Goretti this week who suffered a catastrophic blood clot to her lungs.  She was a gentle and much-loved member of the Kisiizi community and leaves a huge gap.  She will be greatly missed by Staff and Students.

We are comforted to know that she herself knew the reality of the hope of the Easter message.

Child Health Newsletter article

for those interested, I have written an article for the International Child Health Group newsletter which is available to view by clicking on the link:

International Child Health Group Winter 2013 Newsletter

Re-creation

Amidst periods of intense activity where the on-call rota seems interminable and the list of "urgent to-do"  items expands rather than contracts and yet another email arrives asking why we haven't replied to their previous one, we have occasional oases of re-creation.

And Kisiizi and the region is a wonderful place to enjoy when we open our eyes and just pause to take it all in... from the astronomical, with the amazing stars at night, to the minute with insects on the dusty path in front of us.

 

Then, of course, there are the birds, amazing in their variety and beauty both at rest and in their aerobatic contortions that leave us breathless....

Ross' turaco in our garden

One of our favourite species is Ross' turaco - we have a pair that are often heard and seen in our garden.  They eat guavas and sit in the jacaranda tree and are stunning  when they fly and reveal the colour of their wings...

 

We had a wonderful break away at Lake Bunyonyi with visitors Dwight and Sandy Mcleod who were with us for three weeks.  Dwight is a physician and Sandy a health visitor and they are praying about their future and whether they are to serve in Africa longer term...

whilst on Bushara Island we were thrilled to unexpectedly bump into Chris and Polly Barton who have had an amazing ministry setting up dental services in our area and in Rwanda and Burundi.  We hadn't seen them in years so enjoyed a meal together and a chat around a blazing fire catching up...

 

Polly & Chris, Dwight & Sandy, Hanna & Ian

As well as the usual amazing mix of birds, butterflies and otters, we were amazed to see a "linear sunset" where the colour of the sky was divided as if a shadow was present in front of a projector... 

... and then we realised that it  must have been the setting sun's rays blocked by the massive volcano Muhavura not too far away on the border between Uganda and Rwanda...

so we thank God for the beauty of the world around us... and the people He sends our way... including those who inspire us:

The remarkable Joan Hall with Alice from Rukungiri

one such is Joan Hall, a remarkable lady who has given her life in missionary service to Uganda and is much loved by many.  We visited her in her new home in Kabale and then she came to visit Kisiizi a few days later so it was good to catch up with her and friends....

Another inspiration has been this young boy on our ward who has been in traction for a few weeks but remains full of fun exhibiting great patience.  He had fractured his right femur but here demonstrates that he has no problem at all  with  mobility of his left leg!  He doesn't need much to make him laugh and when he does it is infectious!  Good to have at least one positive transmission on the ward....

African Partnerships

We were delighted to welcome four colleagues from Zambia to join us for our African Partnerships for Patient Safety conference we ran here last week on behalf of World Health Organisation.

They arrived in Kisiizi on Sunday having flown to Entebbe via Nairobi.  Ndola is a large teritary hospital with a medical school in a large town so it was quite a contrast coming to Kisiizi but they fitted in extremely well and enjoyed their time with us.

They all made valuable contributions to the conference and we learnt much from one another.

They returned ready to implement some changes and progressions especially relating to the use of the Safe Surgery Checklist.


We do hope to meet up again at some time in the future...

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The Conference included  presentations, role-plays and the use of videos we had made in Kisiizi that were well received.

role play by Kisiiz theatre staff of use of surgical checklist

Practical demonstrations of the manufacture of alcohol based hand rub and assessment of the effectiveness of handwashing technique using ultra-violet light techniques were appreciated by the 30 or so delegates who came from the hospitals and larger health centres in our neighbouring region.


A range of presentations were shared on topics including Healthcare Associated Infection reduction, Safe Prescribing, Waste Management, Surgical Checklist, How to Teach etc.

Alia and Sr. Moreen

Alia Fry, our US Peace Corps volunteer; Sister Moreen Ahimbisiibwe, our Infection Control Sister; Dr. Gabriel Okumu, our Consultant Surgeon, and Ian gave the main presentations supported by Sr Jovita and our trainee pharmacy technician, Sandra who demonstrated the  production of hand rub.




We broke the group into three parties to tour the relevant parts of Kisiizi which they appreciated.

 The evaluations have all been encouraging, now we all need a rest, then work on putting into practice all that was shared.  We pray it will make a real difference to the safety and quality of care patients receive across the area... and even in Zambia!

look on the bright side...

we are sometimes inspired by our patients who show extraordinary fortitude...

this little boy has epilepsy and it had not been well controlled in the community.  He had a fit and fell into a fire and was badly burnt on his face.

He ended up in Kisiizi and was stabilised on anti-convulsant treatment and had dressings to his burns followed by skin grafts....







Through it all he kept his sense of humour, laughing very loudly if Ian played peep-bo around one of the pillars on the ward and always maintaining his sense of humour.