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Friday, March 14, 2014

Kijabe Paediatrics

I had to submit a short report to the hospital board today, and Mardi told me to cut and paste it into the blog.  I hope you find it encouraging.  On the orders of the Medical Director, here it is:
1.  PERSONNEL:  Bob Okeyo graduated with a Clinical Officer Degree, Lilian Okeyo and Veronica Njaramba were sponsored to attend a Society of Tropical Paediatrics meeting in Germany where they presented cases from Kijabe, Rick Gessner survived a ruptured appendix and surgery at Kijabe, Ima Barasa survived months of bed rest and  preterm labor to deliver a healthy baby boy Jonathan on Christmas Day, and we all survived another doctor's strike.  We welcomed Elizabeth Kimani, an RCO, to our team in December after completion of her internship, and she now staffs MCH clinic daily.  In 2014 we will welcome Ima back from maternity leave in May, say goodbye to the Gessners in July, then in September/October have Sarah Muma rejoining us from South Africa, and a new paediatrician from the US Dr. Ariana Shirk.  

2.  OVERVIEW OF INPATIENT PAEDS:  703 patients over 1 month of age were admitted to the Paediatric service in 2013, including 71 to the ICU.  17% of our patients spend some time in the HDU during their stay; this monitoring has allowed us to care for progressively more and more critically ill children.  10% of our patients are severely malnourished.  A third of our patients are OVC (Orphans and Vulnerable Children).  We raised and spent 3.3 million KSH ($40,000) in 2013 through the Needy Children's fund, assisting 106 patients.  Our average mortality rate is 6.7% (compared to 5.8% last year); non-palliative mortality is 2.6% meaning that most of the patient who die at Kijabe are at an end-of-life palliative stage.  Our ICU mortality is 35%.  

Admissions this quarter (first quarter 2014) are running 9% above average for last year.  Beds are constantly full and we really look forward to moving into the new BKKH wing.  Personnel will have to increase to keep up with the clinical load.  Sheer numbers and also the acuity are increasing.

3. OVERVIEW OF NURSERY:  Annual admissions of infants less than 1 month of age have increased by 33% in two years, up to 800 in 2013.  Mortality in Nursery is comparable to Paeds at 5.7% overall.  For extremely low birth weight (<1000 13="" 3.6="" 47="" 6.3="" and="" birth="" falling="" for="" gm="" grams="" is="" low="" mortality="" normal="" to="" very="" weight="">2500 gms) babies.  These numbers are all well below Kenya benchmarks as presented at the 2013 Kenya Paediatric Association meetings.  37 babies were admitted to ICU with 17 deaths (46%).  We have now had 4 survivors of gastroschisis, an abdominal wall congenital defect that is uniformly fatal elsewhere in Kenya.  We continue to work closely with Paeds surgery and Neurosurgery to care for children referred from all over Kenya, Somalia, and beyond for severe congenital defects.

Nursery has been running well over capacity in the first quarter of 2014 with 25-30 babies or more routinely, on a service planned for 18 beds.  Nursing coverage is a challenge as we want a ratio of at least 1 nurse for every 7 babies, but generally only have 3 and sometimes 2 nurses to staff the unit.

4.  EDUCATION:  Paediatrics continues to teach CO and MO interns in a weekly conference and daily at the bedside.  We have a NICU doctor and potentially nurses coming again this year to update skills for Nursery staff.  Dr. Steere is in the planning process for a Paeds Critical Care fellowship in Kenya through the University of Nairobi that will include rotations at Kijabe. Our staff attended the Kenya Paediatric Association meetings and a national conference on improving maternal and child survival.  We are preparing several abstracts for this year's International Congress of Tropical Paediatrics meeting in August in Nairobi.

5.  OUTPATIENT/COMMUNITY:  We cover MCH clinic daily, see private clinic consults, and manage critical children in the casualty department.  Dr. Mary Adam continues her excellent and nationally recognized work with the Newborn Community Health Project, training groups all over the country.

Concluding challenges: 
  1. The reputation and reach of KH grows yearly, bringing us more patients and more complex ones.  
  2. The staffing lags behind the load, so that our nurses, CO's and doctors are constantly pushed to work beyond their limits.  Our excellent survival statistics may start to drop if we do not pay attention to this.
  3. Nursing staffing in NICU must increase.
  4. Lab staff and equipment, and radiology, must grow to keep pace with the higher level of acuity.
  5. Costs are a challenge for the poor and vulnerable patients Jesus asks us to prioritize.  The Needy Children's Fund (70351) is a real asset and we hope Dr. Steere will be supported in her efforts to broaden support for other needy patients.

We are thankful for close and positive working relationships with BKKH surgical team, and pray for continuing integration between KH and BKKH.  It is a privilege to work with you for the care of children in Kenya, and a joy to see the many miraculous recoveries.  Submitted by Dr. Jennifer Myhre, Clinical Head of Paediatrics, AIC Kijabe Hospital

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