Not yet a Ugandan...

Wilsons_2013 Posted by Rory Wilson on Fri, 27 Aug 2010 | 0 comments | Bookmark: digg this Post this to del.icio.us Post this to Facebook

Just sitting down to lunch the phone rang. Sister Laura, one of our experienced nurses from male ward informed me that we had a new admission – a patient with heart failure. Having ascertained that his condition wasn’t critical, I wolfed down my soup and bread and headed up to see the old man. On arriving at the ward I discovered the 12 year old boy sitting up, significantly short of breath with oxygen in place. His heart murmur was so loud I could feel it with my hand, and noted the huge tender liver and spleen and legs so swollen that the skin had burst in several places leaving weeping sores. Thankfully after a few days’ treatment he has dramatically improved, and indeed even the very next day the medical students had difficulty appreciating the low pitched diastolic murmur.
I was amused at myself for the unwitting picture in my head of the patient before I arrived – I had expected him to be rather older than was actually the case. Heart failure in children is rather rare (thankfully) in Ireland – most of the patients I saw in my training in Belfast had ischaemic heart disease as the underlying problem, and thus were generally in their second half century. In Kiwoko most of our patients with heart failure are children – young children with severe anaemia (thankfully so long as they attend in time, usually effectively treated and cured,) or else older children with consequences of heart valve diseases, usually from Rheumatic Fever. Most of these children really need heart surgery to repair these damaged valves, or even heart-lung transplants as untreated heart problems have led to irreversible severe lung damage. Obviously such surgical options aren’t really available, so controlling symptoms with drugs is the best we can do. Of course the two teenagers I admitted this week had a deterioration in their symptoms when their month’s supply of treatment ran out and they tried to do without for a few days to save money which resulted in their admission!

Whatever age you are, it’s not good to have heart failure, and indeed whatever age your loved one is, it’s not nice to watch them suffer like this. People here just accept that this is what happens to some children. Like diabetes, sickle-cell disease, Hepatitis, HIV…what else can they do?
I still don’t quite fit with that I’ve noticed.
Maybe I should adjust my misplaced expectations?
Maybe I shouldn’t, and instead encourage people to lobby for better cardiology and cardiac surgery provision in Kampala at least?
Maybe I don’t know?
I do know that sick children like this isn’t the way God wants it to be, and I agree with Him on this one.
Maybe I’ll just go to bed now?

Sleep well.

Rory.

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