Most people are aware that haemophilia is an inherited disease where people bleed and don’t stop.

We had such a boy admitted to the ward last night. (His younger brother has already died of the condition.)

He bit his lip a week ago while playing football, and a stitch was put in the lower lip at a local health centre. However after 1 week it is still bleeding. Ten gauze pieces were soaked in blood that had oozed from the wound overnight. I missed staff worship as I tried to see what we could do for him. I put a new piece of gauze between the lower teeth and the lip, with part of it on the outside of the lip held in place with a piece of tape. After the doctor’s morning meeting 1 hour later it was evidently ineffective.

What to do?

I left Dr James holding some cotton soaked in adrenaline to try and temporarily close the capillaries while I went for help – in the form of superglue. (Don’t try this at home please – standard superglue contains cyanides, this was a slightly desperate measure.)

The treatment the boy needed was an injection of clotting agents his body is unable to adequately produce. Such an injection is practically and financially not possible for this boy.

Thus our superglue solution.

Under the spotlight (which having arrived in a recent container had been mounted in the ward treatment room) we carefully placed one drop of glue on the oozing area. Making sure the boy didn’t close his mouth we waited…and the glue set, the bleeding did not return, and the boy went home happy!

Perhaps not possible for all bleeding wounds in children with clotting disorders, but it’s probably saved this boy’s life. Dr James remembered a previous time trying to suture a bleeding would in this boy. Every time a stitch was placed, fresh bleeding would begin from the site of the suture needle’s entry point!

Practicing medicine in Kiwoko means you must be more reliant on your clinical skills than one’s colleagues who have the possibility of more investigations open to them. Frequently though a bit of improvisation is also required.

Teamwork and holistic care remain as our great strengths. As I write this I am just back from a round of the wards at 10pm. On the neonatal unit I had to wait for a minute before reviewing a baby, because Sister was leading the mothers in prayer, committing the babies and mum’s to a safe night. It is odd to be able to care for our patients and their carers so holistically on one hand as we can address spiritual issues in a way many clinicians in the UK would shy away from. (The only branch of UK medicine to pay more than very superficial notice of spiritual issues seems to be palliative care – sadly perhaps a little late in the day for many.) Yet it remains an odd dichotomy that many, such as our boy with haemophilia will never have access to treatment his counterparts in the ‘developed’ world often take for granted.

Bye for now

Rory