Not yet a Ugandan...
Just sitting down to lunch the phone rang. Sister Laura, one of our experienced nurses from male ward informed me that we had a new admission – a patient with heart failure. Having ascertained that his condition wasn’t critical, I wolfed down my soup and bread and headed up to see the old man. On arriving at the ward I discovered the 12 year old boy sitting up, significantly short of breath with oxygen in place. His heart murmur was so loud I could feel it with my hand, and noted the huge tender liver and spleen and legs so swollen that the skin had burst in several places leaving weeping sores. Thankfully after a few days’ treatment he has dramatically improved, and indeed even the very next day the medical students had difficulty appreciating the low pitched diastolic murmur.
I was amused at myself for the unwitting picture in my head of the patient before I arrived – I had expected him to be rather older than was actually the case. Heart failure in children is rather rare (thankfully) in Ireland – most of the patients I saw in my training in Belfast had ischaemic heart disease as the underlying problem, and thus were generally in their second half century. In Kiwoko most of our patients with heart failure are children – young children with severe anaemia (thankfully so long as they attend in time, usually effectively treated and cured,) or else older children with consequences of heart valve diseases, usually from Rheumatic Fever. Most of these children really need heart surgery to repair these damaged valves, or even heart-lung transplants as untreated heart problems have led to irreversible severe lung damage. Obviously such surgical options aren’t really available, so controlling symptoms with drugs is the best we can do. Of course the two teenagers I admitted this week had a deterioration in their symptoms when their month’s supply of treatment ran out and they tried to do without for a few days to save money which resulted in their admission!
Whatever age you are, it’s not good to have heart failure, and indeed whatever age your loved one is, it’s not nice to watch them suffer like this. People here just accept that this is what happens to some children. Like diabetes, sickle-cell disease, Hepatitis, HIV…what else can they do?
I still don’t quite fit with that I’ve noticed.
Maybe I should adjust my misplaced expectations?
Maybe I shouldn’t, and instead encourage people to lobby for better cardiology and cardiac surgery provision in Kampala at least?
Maybe I don’t know?
I do know that sick children like this isn’t the way God wants it to be, and I agree with Him on this one.
Maybe I’ll just go to bed now?
Sleep well.
Rory.
Source: CMS Ireland Rory and Denise Wilson | 27 Aug 2010 | 1:00 am BST
Quite a weekend.
Last weekend I was ‘on call’ with Dr Peter (our surgeon.) It proved to be quite a busy weekend. Not that we had particularly excessive number of admissions – just those we had, were very unwell.
Of course ‘on call’ is obviously a bit of a euphemism for 2 people doing the work which it should take 8 to do. Usually the weekend is reasonably busy, but it’s not unreasonable to have time for a cup of tea between ward rounds to clear the head, and meal times can usually be maintained. Not so this time.
I was just starting the ward round in male ward – I’d seen our first and sickest patient. A severely jaundiced 12 year old boy with liver and kidney failure who, on account of his severe infection was bleeding from his stomach, bowel and nose. It doesn’t take a doctor to work out this is not a good situation. Getting adequate blood with the fresh clotting factors he needed took much effort – including tracking down a willing UK medical student to give us a unit of fresh blood. I had temporarily finished with him when maternity asked for my assistance – a lady with a placental abruption (and thus dead baby) had no recordable blood pressure. The lady’s significant body habitus and untreated psychiatric condition made the vacuum extraction of the dead baby more extreme, though probably not as sombre as it otherwise would have been! Back to male ward, my boy’s nose bleed had resumed and required packing his nasal cavity with gauze in an effort to arrest the bleeding. Before getting too far around the ward, maternity were back asking for help again – our lady was still bleeding – and her blood pressure had disappeared again…..and so it went on. Dr Peter spent most of the weekend camped in theatre resuscitating and operating on sick patients – two perforated ulcers and one piece of dead bowel kept him amused between the infected shoulder joint and fractures. Meanwhile I kept running around the wards admitting and reviewing faster than is clinically advised. In the middle of Saturday night I could hear wailing before I reached female ward and was told a new admission had died in the minutes before I had been able to see them. Disappointed I went to review the patient to see what might have been, had I been in attendance sooner – to find a lady grimacing and trying to speak from under the sheet the relatives had pulled over her face!
Monday morning doctors’ meeting we handed over from the weekend’s activities. We were tired – but what a worthwhile way to spend a weekend. There is no doubt that if it was not for Peter’s patience and attendance to detail (and a unit of blood donated during the night from a nursing student on ward night duty) our lady in maternity would be dead. My boy with liver and kidney problems is now stabilising and will be fit for discharge next week. Our burst guts have all stabilised after theatre and look like in due course they will be ok too.
At the graduation ceremony last week for nursing and laboratory students I quoted from the description of Jesus’ ministry being reported back to John the Baptist – sick healed, lame walking, dead raised….and I wonder how much of that has taken place this weekend. Quite a lot I guess. I haven’t pulled anyone out of their coffin by the hand – but several patients now alive and increasingly well would have been buried by now if it were not for the care they received here.
Having said that, I hope our next weekend has more sleep and less patients.
Lots of love Rory, Denise + Gideon Mugisha
Source: CMS Ireland Rory and Denise Wilson | 15 Aug 2010 | 1:00 am BST