UgandAshis 34 Paediatrics II

UgandAshis 34 Pediatrics II

July 14, 2009

Fort Portal, Uganda

So what do you do after a terrible start of the day as described in the last blog?
You go do the ward round – after all another 80-90 are awaiting you in 40-50 beds and several children of them on the floor and so are their parents eager for advice and treatment for their children. While we discharge about 10 children another 5 are lining up to be admitted. Those that can be sent home on oral drugs are sent so we can admit the sickest patients waiting on benches for a shared bed. One of those children was convulsing, another was one month old and about 1 kilogram. His mother had expired one week after giving birth of HIV/AIDS. His father had bottle fed the child for 3 weeks but it was not doing well.

As stated most of the patients have malaria, diarrhea, HIV/AIDS, pneumonia or a mixture of the previous. White ravens do exist as well and are a good starting point for discussions between the medical students, medical officers, nursing staff and myself. A learning experience for all and often it leads to a better treatment plan for the patients. As the young doctors and Nard ask many poignant questions I learn a lot myself.

One of the white ravens of the day was a child with a bad chest, shortness of breath, reduced air entry on one side. She had been examined by 5 people and all of them had missed one vital point. The heart beat was felt and seen on the right hand side. The medical officer and I noted it at the same time and asked the medical students to check the chest, heart and lungs. As it a very rare condition they also missed the diagnosis. It is called dextrocardia and may be seen in a syndrome called situs inversus which then leads to a multitude of organs in chest and abdomen to be located on the opposite side. She was also an orphan and the parents of the children in the bed next to here were helping her with feeding.

As our X-ray machine has run out of film we cannot take required X-rays to access her lung and heart function. Also an ECG machine is lacking let alone an echocardiogram. Given her social and financial status we will treat her symptoms and do a work up as good as we can. I am sure we can hoodwink her to the OTA clinic to do a chest X-ray.

As we rounded up our ward round I asked the nursing officer what had happened to the 1 month old malnourished baby. The last I saw of it a naso-gastric tube was inserted and an intravenous drip. ‘Oh’ he said the child had passed away. Those deaths are sadly just the tip of the iceberg as most patients do not reach the hospital.

Namaskar,

Ashis