Kisiizi: a paediatric viewpoint

I’ve written in general about what we’re going to be doing in Kisiizi, but if you’re medically inclined you might have felt the information about the hospital was somewhat lacking.

A few weeks ago, Kate gave a presentation to her colleagues about the work she’ll be doing in Uganda. Here’s part of it.

Kisiizi is run by the Church of Uganda, and relies on charitable donations and small contributions made by the patients. It serves a region the size of Wales and comprises approximately 250 inpatient beds, two operating theatres and a busy outpatients’ department. Patients are subsistance farmers and will often walk for days to reach the hospital and receive treatment. No-one is turned away, and as a consequence there are often mattresses on the floor in the wards.

The medical staff consists of Ugandan doctors with general training who are able to perform caesarean sections and laparotomies in addition to all the medical care. There is also a doctor who has completed further obstetrics and gynaecology training. A UK surgeon was based at Kisiizi until earlier this year but has now returned home leaving Kisiizi without a qualified surgeon. The Ugandan doctors are paid, but far less than what they could earn in the capital. Overseas staff work on a voluntary basis, supported by a number of different charities.

Paediatrics

There is no doctor trained in paediatrics. The inpatient service is run by a UK paediatric nurse, Ann, who has worked at Kisiizi for about 10 years. My work will involve ward rounds on the children’s ward and the special care baby unit, seeing children in outpatients and training of local staff. I will also enable Ann to spend more time teaching at the nursing school, and to develop the nutrition programme.

Because I am only at Kisiizi for 1 year, it is vital that I support and train the local staff. I feel particularly excited about teaching adapted APLS and NLS skills, using a fantastic course on ‘Emergency Triage, Assessment and Treatment’ – developed specifically by WHO for use in resource-poor countries. Details can be found at here if you would like to find out more.

Paediatrics in Uganda will be very different from the UK, with limited availability of drugs, basic laboratory and imaging facilities and patients presenting late in their illness. Osteomyelitis and contractures from burns are examples of the consequences of late presentation; parents not able to justify paying for treatment for children. Traditional healers are often consulted before attending hospital, complicating clinical presentations. There is a high incidence of malaria, tuberculosis, HIV and malnutrition.

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