I was especially struck by this amazing fact earlier this week. At the beginning of last week, I was on-call for Kiwoko Hospital, here in Uganda, covering all seven wards rather than just the surgical wards that I work on day-to-day. At 6am a small child was admitted, very sick, with a fever and difficulty breathing. The diagnosis of chest infection was fairly straightforward, and the treatment we are able to give, namely oxygen and intravenous antibiotics, was started immediately. Something about this six-month old made me wait to ensure that he responded – and five minutes later she stopped breathing completely.
We have limited options here in our rural hospital for any form of life support. Our oxygen supply comes from oxygen concentrators rather than gas cylinders, or pipes through the wall as in UK hospitals. We have no facility for assisted ventilation, other than by hand using a bag and mask. We have no blood gas analyser to assess how well oxygenated a patients blood is. We have no defibrillator to restart a heart that has stopped beating.
For this young child, I had to do what I could. After the IV antibiotics came some IV steroids in case there was an asthmatic component to the breathing problem, then some IV aminophyline, a respiratory stimulant. When breathing stopped, I had to stand there and ventilate by hand. After a few minutes breathing restarted again, and then after another few minutes stopped.
In the absence of any other facilities, all I was able to do was breath for this child using the bag and mask. After 30 minutes, the paediatric doctor arrived to start the day, but had no other suggestions, so we continued. After an hour of ventilating, it became apparent that we were not going to have a successful outcome. We took the difficult decision to stop ventilation.
However, the baby had other ideas, and slowly started breathing for itself again. I returned to the ward a few hours later to find to my surprise that she was still alive – albeit looking very sick and barely breathing at all. Our expectation was that she still wouldn’t last the course of the morning.
I was therefore very shocked a week later when Dr James mentioned that he was discharging the child that morning. Not only had she not died, she had made a full recovery, and had no evidence of any residual problems as a result of her lack of breathing. Miracles happen today – this child had no hope of survival, and yet did, against all the odds and medical explanation! I am extremely privileged to be part of the amazing work that God is doing here in the middle of rural Africa, and very grateful for the opportunity to witness Him at work as seriously ill patients receive the limited treatment we can offer, and recover against every expectation.
This particular patient made a huge difference to this week for me. Its been very busy as we’re a little short of medical staff at the moment, so I’m looking after surgery on my own, and was on-call for the whole hospital four nights in eleven. I’ve also had to book my flights home for the beginning of January, which releases a very different set of thoughts, as I’ve realised that I have less than four months before I have to leave to return to Edinburgh. The last eight months have gone by very quickly.
Still I have a few more things to look forward to. I have a couple more sets of visitors in the next two months, so I’ve some travelling planned, including visiting the Mountain Gorillas in the South West of the country, and a relaxing weekend on the “chilled-out” Ssese Islands. The Queen visits Uganda at the end of November for the Commonwealth Heads Of Government Meeting (or CHOGM as its called here), which will make the country pretty busy for a while. I still have several things to finish here in the hospital, not least my Endoscopy training, and my Trauma training, both of which are progressing well.
We have some more doctors arriving in the next couple of weeks, which should allow some relief from the current busy spell. In the meantime, apologies for not posting more frequently – I’m sure you understand!
Steve
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