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| Women grinding nuts for porridge |
Mukinge Hospital was
originally founded in 1952 by Dr. Bob Foster, whose parents were missionaries
in Zambia. In 1973, the hospital was turned over to the Evangelical Church in
Zambia which continues to run the hospital in partnership with SIM (Serving in
Missions). The hospital receives resources from overseas donors in the form of monetary
gifts, as well as equipment. The Zambian nurses, midwives, and clinical
officers (PA’s) are assigned to this location and their salaries are paid by
the Zambian government. Western workers are all volunteers.
The hospital provides
services without the expectation of reimbursement. In order to alleviate some
costs on the Labor Ward, pregnant women are required to bring: plastic sheets,
three packs of sterile gloves, and a bottle of bleach. When women come in for an
evaluation of labor they first lay down a plastic sheet on the bed, and then,
over this they place a thin cotton sheet. If they are in labor they stay, if
not they are either admitted to the antepartum ward (primarily if they are in
latent labor or otherwise ill, i.e. malaria), sent to the Kelata, or sent home
if they live close by. Distances here are primarly calculated in the time it
takes to arrive; 15 minutes by car, one hour by bicycle, or three hours by
foot, may all be equivelant. So when sending a woman home it is important to know
their transportation status, as ten miles can be a long way if she does not
have access or resources to get a vehicle in which to travel.
Dan was observing one of the
midwives during a delivery and upon the delivery of the head the mother stopped
pushing. The midwife promptly smacked the patient on the thigh forcefully and
commanded her to push. At which time she imediately delivered a healthy baby.
While an effective means of communicating the need for improved maternal
effort, I doubt this would go over in our western culture, though I am sure
some of the nurses back in the states have thought about employing this measure
more than once.
I have been continuing to
round in the PEM ward in the mornings and have moved to the emergency room in
the late morning and afternoons. In the PEM ward, we have added four more
patient to our roster, however we lost Justin last night. He had been doing so
well, actually come off of his treatment for pneumonia and need for
supplemental oxygen. He had concurrent HIV and was on ARV’s and Septra.
Yesterday morning he spiked a fever, then started requiring increased
supplemetal oxygen again. We started him back on antibiotics, however within 8
hours he passed away. These children are so fragile and each is on the
precipice of death.
Hossana, a 19 month old boy I
admitted through emergency, presented with a 3 month history of decreased
appetite. All PEM admits get treated with antibiotics for 3 days, the receive
an anti-parasitic medication, if they have diarrhea they get zinc, if they have
dermatitis they receive topical antifungals, and if they are septic the get a
third generation cephalosporin. Additionally they all get screened for malaria,
and their mothers are screened for HIV. If the mother is HIV positive then
depending upon the age of the child and the recency of breast feeding the child
is either testedfor HIV or a CD4 count is obtained. Unfortunatley Hosanna’s
mother is (+) as is Hosanna. He refuses to eat much, anorexia is common with
severely malnourished children, so we will likely place an NG tube to start
tube feeds.
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| kwashiorkor - "the sickness the baby gets when the new baby comes" |
Children once admitted start
on feeds with an isotonic F-75 and once their edema resolves are transitioned
towards a higher calorie F-100. Once they are at max feeds for their body
weight and tolerate twelve (q4 hour) feeds without vomiting or diarrhea they
are then allowed free feeds, which includes porridge. The porridge is made from
ground nuts, maize, sugar and water. The porridge is cooked on the ward and the
mothers are employed in grinding the nuts. Everyone contributes.
