UgandAshis 33 Paediatrics

UgandAshis 33 Pediatrics

July 14, 2009

Fort Portal, Uganda

Nard and I strolled from our hotel to the hospital in the morning at around eight. To make sure we would be on time we woke up at seven and I had kitogo (banana with beef in a gravy) while Nard suckled his milky tea. When we arrived at the hospital I called on of my doctors colleagues to find out he was in Kampala. Then I called the nursing assistant he was about an hour drive away in Kasese. The medical officer was not in either nor was the nurse. (Later I found out the nurse was around trying to find the key to access the medical cupboard)

A young girl, daughter of the dental assistant was sitting awaiting medical attention. She had a high grade fever, convulsions, erratic breathing and was slipping into a coma. The most common cause for these symptoms is severe malaria. On investigations of the child it became clear she needed urgent treatment as her heartbeat was slipping to a rate of about 20 a minute and her breathing became more and more labored. Also looking at her conjunctivae an estimation of her hemoglobin (red blood cell count) would be about 1-2 representing a deep anemia.

By now the medical officer, nursing officer and the nurse had showed up. And still no key to the medical cupboard, or emergency medical kit. One hour gone and the child was rapidly getting worse. We sent for diazepam to control the convulsions and tried to get an intravenous line in. Left and right arm, leg to no avail the veins where collapsed. By now there were 4 people working on the child and almost all required drugs and equipments were available.

Alas too late for the young child. It always feels bad to lose a patient and to lose a 6 year old is even worse. Later in the day as we were reflecting on the situation I noted that she was from a relatively privileged position. She was living in Fort Portal with a mother working in the hospital. Less hurdles to clear and yet it was not enough. Cerebral malaria kills rapidly. Of our about 100 children admissions more than half have malaria.

If you happen to stay in the hospital with your mother and sibling one of the most common hospital acquired infection is malaria. Despite most Ugandans having gone through multiple bouts of the disease in life there is still under diagnosis and under treatment. Anti malarial drugs are generally available over the counter and it makes many people use the drugs in non optimal ways. Remember the story I wrote about Grace a couple of blogs ago.

With wide spread use of bed nets, public information, available treatment malaria remains one of the major killers in Africa. And those that die are generally the young like today.

Namaskar,

Ashis