WARRIED MOTHERS, MENINGITIS, MALNOURISHED BABIES AND MISLEADING TRADITIONAL HEALERS

Up on returning from Uganda, after 7 years of intense training at Kampala international University (KIU) western campus, I started my work at Hingalool, a very remote village, around 700km east of Hargeisa. The news that a new doctor was posted here spread very fast partly due to the dire need for a trained doctor in the village.

 The first thing I did was a feasibility study on the district hospital which was closed for about 2 years and had nothing but just an empty building.

As I was doing my assessment on the list of what is needed urgently and what can wait, a 12 days old baby boy who was unconscious and was having seizures was brought to me. The mother told me the baby was okay until three days ago when he started having high grade fevers and later refused to breast feed. She also told me that the baby is making abnormal movements which she thinks there is problem in the head. What she was describing was generalized tonic clonic convulsions indeed. The baby was dehydrated and had no glucose in his blood as he did not breast feed for two days.

 To make the matters worse, the mother took the baby to a traditional healer who burned the whole of the baby’s head and some other parts of his body. I realized that the baby had what doctors call neonatal meningitis, but the main threat to his life was hypoglycemia-lack of glucose, fever, convulsions and dehydration. I needed to tackle this very urgently. 

Luckily the local drug shops had diclofenac injection, ceftriaxone, gentamicin, diazepam and cannulas as well as a nasogastric tube. It was hard to cannulate so I have to put an intraosseous line and a nasogastric tube so that the mother can milk herself and give expressed breast milk to the baby. After doing all I could do and using all the resources at my disposal, there was one thing I could not tackle! The baby was in severe respiratory distress. He could not breathe. He was breathing very fast. And it was very clear that without oxygen my efforts were in vain. Even the mother asked me what I was doing about his failure to breathe and grunting. I explained to the mother that he needs oxygen urgently. There is no single oxygen concentrator in the whole district despite the fact that there are so many clinics and very many so-called doctors!

 This baby was lucky because his mother was a very rich woman, her name is Hodan, she has over 1000 (one thousand) sheep and around 50 camels. For her, cost was not a problem. All she wanted was good medical care for her son, her 13th baby! This is not the case for the majority of nomadic pastoralists around here. After explaining everything to the mother, I referred the patient to Qardho, small town, around 70km east of our village for oxygen only.

 Transporting that baby from where we are to Qardho costed the mother $300 (three hundred us dollars), around 1.2 M Ugandan shillings. I made sure I document all my findings and the treatment I have given. Fortunately the doctors at the other end agreed with my diagnosis and continued my management plan.

 Mohamed, is now around 2 months old, and is one of my regular patients. He is doing well and recovered fully. Most children don’t recover fully from meningitis due to poor management, poor health attitude of the masses and so many delays in making a proper diagnosis. Most of them come to our OPD with all the complications of meningitis be it seizures, focal neurological deficit, developmental delays and loss of hearing. Children don’t get universal immunization programs and organisms which could have easily been prevented with immunization cause meningitis here. Heamophilus B influenza being one of them!

 The first thing I requested for was an oxygen concentrator. Now that we have one, the biggest challenge is getting the electricity to run it in case a patient needs oxygen for some good time!

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