Sunday, October 19, 2008

Meet my referrals...

Last week I ended up referring 18 children with severe pneumonia, malaria, severe anemia, sickle cell crisis, Burkitts Lymphoma, abscess, sickle cell testing, hemangioma, malnutrition. 10 of these children were sent to the government-run Children’s hospital. So, on Friday I went there with my nurses to follow-up on my patients. Unfortunately one child wasn’t there; he had either been discharged already or never went. Out of the others 1 looked much better, 1 looked worse, 2 had literally just been admitted and the others were improving. So, overall I was satisfied.

On ward one I found 9 year old Mohamed with sickle cell anemia (Hb 4.5), malaria and a high white blood count. I saw him on Thursday but unfortunately rather late in the afternoon so he didn’t arrive at the Children’s hospital until about 8pm. Fortunately though, his mother was very on top of things, and he started receiving blood before midnight. Way to go mom!

Theresa was on the same ward, only 1 year old, but with an Hb of 3.9 g/dL. I had seen her on Thursday. Seeing her a day later was like seeing a different child, she was sitting and happy, having had received her blood the previous day. Mom seemed satisfied and I was very impressed with the doctor’s notes- very neat, very thorough and good case management. Well done doctor X!

Then there was Mohamed, age 1 year 8 months, weighing 5.7 kg. He was actually referred to the therapeutic feeding center, but since they had no beds, he is temporarily on the children’s ward. Not much improvement to be expected in one day. Hopefully he will be transferred soon because right now he is not receiving the free food supply he so desperately needs.

On to ward two where I found 3 of my patients referred due to chest infections, with respiratory rates between 80-90 per minute, subcostal recessions and on/off nasal flaring. Two of the infants looked a bit better and one of the fathers wanted to take his child home, to which I responded that he needs to wait until the doctor discharges the child. The question is: will the doctor see the child that day? One of the children, 5 month old Deborah, was admitted on Tuesday and actually looked much worse. After 3 days of iv antibiotics she still had a fever and wasn’t breathing well. The doctor last saw her on Wednesday. I was worried about her and hoped a doctor would see her soon.

Up to ward three. The other wards were extremely full, but this ward only had about 10 patients admitted. I guess Friday was their day to receive admissions because the 2 patients I found there were ones I had referred only hours earlier. Fatima, 5 years, with malaria + anemia had an Hb of 5.2 on Thursday but unfortunately when I reviewed her on Friday it had dropped to 4.5 so I sent her in. As I was talking to her mom the lab people came in with her pint of blood. Fatima had big eyes as the nurses attached the blood bag to her iv line and the red blood started making its way towards her arm. I assured her this blood was going to make her strong! And I made sure to let mom know I was very impressed she made it to the hospital so quickly. On the next bed lay 2 year old Eddie, also with malaria and anemia. His Hb was just above the level for transfusion (5.1) but had dropped since I first saw him on Thursday, plus he was quite lethargic and ill looking, so he also was sent only a few hours from our clinic to the Children’s hospital. He was still waiting for his father to arrive to donate blood for him.

After the wards I made my way to the Feeding Center, where in the previous week I had referred two patients. I had seen them both the previous Friday and they were making an improvement, but unfortunately 3 year old Mamadu weighing 8 kg and on TB treatment passed away only 3 days later. Sad.

All in all it was a good day at the Children’s Hospital. I know these families have had to spend a lot of money to mend their children, but better that then to lose their child. That’s what I always have to point out to them. And I was happy that most of the children were receiving adequate care. I just hope someone went in and looked at Deborah…


Gabriela said...

You are so brave... I sincerely admire you so much.

sambw said...

Hi Sandra

I've just discovered your blog - fantastic stuff!
I'm a final year medical student from Western Australia, and I'm heading to Freetown in january 2009 for an elective clinical placement.
At this point, I'm going to be based at the Connaught hospital, with Dr. Victor Willoughby, but he's keen for me to gain wider experience, as am I.

I have a specific interest is in paediatrics, and I would love to be able to come to your clinic. Will you be in Freetown early next year? And if so, would you be amenable to having a medical student tag along with you?

Looking forward to hearing from you,

Kind regards,


~ Act Justly. Love Mercy. Walk Humbly. micah 6:8 ~