Half Way!

Another few weeks have flown by and I have now passed my half way point in Sierra Leone, despite still feeling like I’ve only just got here!

There is a team of obstetricians and midwives from the UK out this week, delivering teaching and training to the staff at the hospital. Everyone seems to have enjoyed it but it has left the wards pretty devoid of staff, so it’s been a busy week on the wards for those of us trying to keep the wards running! It’s coincided with a busy week on paediatrics, so I’m looking forward to getting away to the beach this weekend!

I’ve decided to stay on the paediatric ward while I’m here. I’m really enjoying it, and there’s a lot to do! I’ve been trying to work with the dietician to try and improve the way malnutrition is managed on the ward…work in progress…keep getting distracted, but I’ve learnt a lot from reading through the Sierra Leone protocol…and it’s great to be able to put it into practice on the ward.

The most exciting discovery since my last blog entry was a big box of Artesunate found in the free health cupboard, which had been delivered from the ministry of helath. Artesunate is a relatively new (and expensive) drug for treating malaria, which has been shown to significantly reduce morality in severe malaria (as we learnt in the Diploma of Tropical Medicine), but it’s not available in much of Africa. So with the go ahead from the chief pharmacist we’ve started using it in the ward, and my anecdotal evidence suggests it’s the most amazing drug ever. Lets hope it doesn’t run out!

We’ve also discovered other drugs we didn’t know we had in the free health cupboard. There’s a lot of things not available here, but it’s crazy realising that some drugs are available, it’s just the front line health workers are not aware they exist…there’s just not the systems in place to make sure the right people are able to access and benefit from the drugs… another quality improvement project…

We’ve had some interesting cases on the ward. We had a 9 month old baby who I’m 90% sure had Down’s Syndrome. None of the staff on the ward had ever heard of Down’s Syndrome. I guess it’s less important to diagnose when there is nothing much that can be done to support the family or help the child’s development. The mother was very caring though, she referred to the baby as her half child. Although he will be different I like to think he will be well cared for in the community. We treated him for the malaria he presented with, and he went home again.

We have a boy on the ward this week who I think has nephrotic syndrome, where the kidneys leak protein into the urine and the body swells up. Some cases respond to steroids, but some do not and without dialysis (which is not available here) the outcome is poor. I’ve been getting advice from a paediatrician working at the national childrens hospital (who has also contacted a paediatric nephrologist from UK!). I wanted to transfer the child to the childrens hospital, which has a paediatrician, and more facilities, but after discussing with the paediatrician, realised that even at the national childrens hospital, they are not able to check U&Es (very basic blood test to check kidney function), and they have the same issues as us in keeping track of what medications have been given, and they don’t have any more facilities to escalate care. I was also surprised they don’t have access to oral furosemide there, which we can get (buy) in Kambia! There would also be cost implications for the family to take the child to Freetown (they would have to go by public transport as there are no free ambulances), and the family only speak the local language, Temne, which is not spoken in Freetown, so they would have difficulty communicating. So we’re following the advice of the paediatrician and keeping him here. I’m really hoping he will respond to the steroids and get better. We keep trying to reassure the family that we think we know what’s going on, and are discussing the case with specialists and that he is on the right treatment, it’s not unusual for families to take children away from the hospital if they don’t see them improving, and take them to traditional healers. It would be such a shame if they didn’t even give the steroids a chance to work.

I’ve got so much more to say, but I’m really tired and need to pack for the beach. I will try and write more next week. Hope you are all well.