Children are an important part of our work at Guinebor, under 5 mortality is amongst the highest in the world at 120/1000 children. We are playing our role in improving this with a vaccination and under 5's growth clinic, started earlier this year, which has just enrolled its thousandth child. Preventing disease is best but we also have curative treatment for malaria, diarrhoeal illness, malnutrition and pneumonia. Sometimes I have the impression that these diseases are all that paediatric medicine is about in Chad. Certainly these are the major problems and along with the other hospitals and clinics in the city we are working to combat them.
So today is an unusual
day, I did the Saturday morning ward
round and there are 3 empty beds and
more surprisingly none of the 5 children
that are here have the usual diseases.
In the first bed there is Ahmat, a young boy who has not walked for a couple of
months. He arrived a fortnight ago in a lot of pain unable to straighten his
hip. He hadn't been to hospital before but had been with traditional healers. As
our equipment isn't working h e was taken by ambulance to the city hospital to
have an X-ray and some blood tests. His hip was dislocated and there were signs
of infection in his pelvic bones. There
was little change with initial antibiotics and pain killers; he cried whenever
we went near him. After manipulating and draining the hip in the
operating theatre and applying traction he is making good progress and has
started smiling. Another X-ray is needed and there is still a long way to go to
get him walking again but he has turned a corner and is on the mend.
In the next bed is Idriss he has been with us for 2 months! He had an
injection at a clinic which it got infected.
The infection spread from the abscess and killed most of the skin on his buttock,
down his thigh to below the knee. He spent a couple of days at the Mother and
Child hospital and then left to come to
us. His father said that nothing was
being done. Once with us he had three trips to theatre to remove all the dead
tissue, thankfully most of the muscles were exposed but unaffected. A first
skin graft took well but only covered the lower
half of the wound. He has been up walking, at first with a frame and
then unaided. He has just had his second skin graft and is stuck in bed for a
few days. Another child transformed from fear and pain to smiles and laughter. His
father came and thanked me the other day, and said that the reason they left
the other hospital was because they wanted to amputate the whole leg. He is so
happy and says they will stay a year if necessary to get his son healed.
Thankfully it won't take that long.
The third is
Djidda an amazing young boy, he has shown such
determination. He was admitted 10 days ago. A week before that his
left leg was weak after a game of football, a couple of days later he couldn't
walk and his left arm was contracted. Again 2 days later his face became weak
and he lost the power of speech. He had been at the Mother and child hospital and treated as an
out patient with lab tests sent to exclude polio. When I saw him it was as if
he had a stroke he was paralysed down one side,
semi conscious and agitated. What could it be? Blood tests were normal.
I suggested a CT scan, but did say that although it might show me what the problem, a
tumour or abscess perhaps, but that we may well not be able to offer a solution
either here or elsewhere in Chad. There is no neurosurgeon in the country. The
CT scans at the 2 government hospitals were broken so the father got a private
scan at twice the price that I expected ($300, 2 months wages for our non
medical staff). It was worth it, the scan report suggested a deep seated
infection with small abscesses and swelling and the need for an urgent referral
to a specialist centre. A good report
from the new ' Modern Hospital', unfortunately it is very expensive and doesn't
treat pregnant women or children, but they did do our scan! Where did they
expect us to send him? I thought it was probably too late to expect a good
result but gave high dose steroids to bring down the swelling, and strong
antibiotics. He was fully awake in 36 hours. On the ward round it should have
been good news , but his mother wasn't there and he was awake, and crying. Was he crying for his mum or because he
realised his state and couldn't talk. I nearly cried too, and gave him a hug
and said a silent prayer. Next day he tried to walk and was caught as he fell
over, then he could walk and today he is even starting to talk. What can we
say- Al hamdu lilah- Praise God! He still limps and his hand is clumsy but such
progress and still improving, such courage and what a lovely, for the moment lopsided, smile.
Moussa is a 14 month old baby with his father and
grandma. His mother died after he was born. About 6 months ago and accident
when cooking scalded his leg and the result was a severe contracture with only
his heel able to touch the floor. He was
operated a couple of weeks ago followed by a skin graft and is set to go home
on Monday. His foot and ankle will now be free to move normally, and its time
learn to walk. Dad smiles much more than grandma .
The last case is also
unusual, Bechir has diabetes (maybe tropical African variant), a very high
blood sugar, off the scale of our machine, and is surprisingly well but it does
need to be corrected by insulin. He was
in hospital a few months ago and had 'decided' to stop taking his treatment. It
must be difficult to live with chronic disease in Chad both financially, his
family need to find about $12 a month ( about 1/2 a week's wage) to pay for his
insulin and finding time to come for occasional tests. He lives a long way from the hospital to the
north. His stabilisation treatment can be free but what will happen long term?
As you can see we have
5 complicated cases at the moment, only the baby with the burn has a quick
solution and even that will need follow up to make sure that the contracture
doesn't it doesn't recur as he grows, but we hope and pray for healing for all
of them. What's the chance of having 5 such cases on one small ward? I don't
know. I do know that the chance of having 5 boys and no girls, is 1: 32. We
normally have the same number of each, and normally have only one unusual case with 7 more normal ones.
We give thanks to God for what, with His help, we have been able to do with our limited resources, but also we give thanks for the help from the other hospitals. It
would be good to be able to do more tests and simple X rays here and we are
trying to get our equipment working again
but we have no plans for a CT just yet!
( Both parents and children
were happy and consented to have their
pictures and stories shared)
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