Not a good week

Unfortunately last weeks smiles were a bit premature. On Tuesday morning I received a phone call from Chris the clinical officer saying that he had been asked to see Slyvia the little girl with diabetes who had been readmitted. She was dead. The story was that she had been admitted through a private clinic in coma. They had given her a shot of insulin and sent her to the hospital. The doctor on call saw her later and ordered a blood test for later in the morning. She did not survive the wait. She had obviously been given too much insulin and should have been treated urgently with dextrose. A simple injection would have saved her but no one thought of the right diagnosis. It is such a pity as she was doing well when I saw her in the clinic last week. Diabetes is not well understood here. It is only just being recognised as a problem in Uganda. Most of the emphasis has always been on infectious diseases which still represents the major risk here. There needs to be a big education programme and I am scheduled to start it next week. You realise how basic the training has to be when you realise some of the nurses do not know how to read urine dip stix.
If I can teach people that unconscious diabetics should be given dextrose then may be Slyvia will not have died in vain.
Th other big problem this week is lack of drugs. I have become used to shortages of antibiotics and anti malarials but we are about to run out of ARVs the essential drugs for treating HIV. These drugs have revolutionised the management of HIV and allowed people with HIV to return to normal life. The drugs need to be taken every day without missing any doses. Even missing a single dose allows the virus to mutate and can produce resistance. Now it looks like patients will be forced to have breaks in treatment and the consequences will be extreme for some.
Lets hope next week is a better one.
May be I should have gone to church!