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Monday, September 24, 2012

A new week rolls in

 Baby A is grateful for your help, though he doesn't really know it yet.  His mom agreed for his photo to be posted to thank those who contribute to Kijabe Hospital's Needy Children's Fund.  Like some of our recent visiting docs.  (If you've forgotten how email me  Baby A was born with a cleft lip and palate, a completely fixable problem if he doesn't starve to death before he's old and big enough for surgery.  His confused and upset father took one look and abandoned him to his mother, who is dependent upon her brothers now for support.  Those uncles have been kind but are not quite able and committed to cover all his hospital costs.  He's been with us several weeks surviving a serious infection and trying to gain some weight.  We're praying he can go home soon.  He's a least-of-these speck of wrinkly skin and hunger.

The fund has also facilitated echocardiograms for some babies with severe heart problems this week, and on the weekend allowed me to help a mom get home who had spent so many days waiting to raise the last hundred dollars of her bill (the small part not covered by insurance or what her family had given) that he ran out of his seizure medicine and started to convulse again.  Kijabe hospital is the hospital-of-choice for so many Kenyans these days of strike.  We're a hundred times more functional than the rest of the public health care system, and much less expensive than the private Nairobi hospitals.  So we get referrals from both.  In many cases we give care that is just as excellent or perhaps better than our more trendy and pricey counterparts in the city.  A recent ICU patient's family told Scott (after their relative survived a situation with about a 10% chance of making it through):  we would always come here, it's not all STERILE like _______ (fill in name of "best" hospital in Kenya).  Hmm.  Not being too sterile is not always a plus, but we're glad we had these happy customers.

This weekend a similar family requested transfer from their super-duper ICU to ours, because they were out of money (cost ratio 20:1).  Super-duper ICU didn't see the diagnosis right away in this newborn's xray:  not sure I would either . . .
But if you look very very closely, there is a bubble over the left chest that should not be there.  It's bowel, which has popped up through the diaphragm.  Not a huge problem in utero where the baby doesn't need to breath or eat, but rather bothersome after birth.  In case you can't see it still, here's the gastrograffin study outlining the bowel with contrast:
(It shouldn't be up by the heart).  This baby had a good amount of lung development and with the expert care of our paediatric surgeons today we have great hopes that he will be able to survive, which is certainly not the norm in Kenya for this problem.

Because the strike has packed our casualty and outpatient areas, the new Maternal and Child Health clinic building which was due to open in October had a rushed prayer-speeches-hand-over today, so that the area could begin to be used.  A few of us from the Paeds team, the engineers who did this work, the executive director and the chaplains gathered to recognize this milestone.  Looking forward to seeing patients in this bright clean new functional area rather than scrambling for a corner in the midst of the onslaught.

We can't fix all the problems, sadly.  One of our other admits in the last few days was a baby born at home with a mid-facial cleft, a huge gaping hole in his face where his nose and lip should be.  Sadly this is associated with a malformation of his brain (holoprosencephaly), probably his heart, and his kidneys and other organs.  He will not be able to survive long, but we are working to pull him through his current meningitis and jaundice to hopefully reach a point where he can be held and fed and loved and taken home.
Thankfully Kijabe has a palliative care team who will help us provide comfort and improvement and hope and support even when we can't provide a cure.  They work with the mother, us doctors, the nursing staff, the chaplains, and as a team we try to make a plan.

Lastly, there are the babies who should survive but don't due to the frustrating realities of life in Africa at this moment.  Like the 25-week preemie who was essentially dead on arrival this weekend.  If only the clinic where her mom presented Friday with labor pains had recognized them and prescribed rest and fluids instead of letting her go back to work Saturday.  If only they had made it to a hospital with a doctor in the midst of the strike on Saturday when her labor progressed.  If only there had been an ambulance available to get her to Kijabe faster.  If only she had been kept warm and breathing on the way.  I ran to the hospital when the nurses called, but even after intubating and drugs and lots of resuscitation, her little heart never picked up.  She was gone, and her parents wanted me to take photos of her and of them, looking so peaceful, for their memory.  Until they meet her again, perfect and whole, in Heaven.

Which is a good thing about this job.  I meet so many Heavenly citizens-to-be.  I look forward to eternal conversation over very good coffee from some Africa, or perhaps a whole Africa-like planetary system, with some of my current patients who are the weak and wounded and sorrowful in this life, but destined to rule and shine in the life to come.  So I'll close with a photo of the nearest-thing-on-earth cup of coffee Scott and I had on Friday.  This is one of those piled-up call weeks (tomorrow will be the 4th night in 7 days), which made that moment all the more precious as a taste of what is not-yet but promised:

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