polio outbreak

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THIS IS A PICTURE OF A TRAINING SESSION FOR STAFF INVOLVED IN DELIVERING THE POLIO CAMPAIGN


THIS PICTURE SHOWS THE MARKET WERE WE FOUND THE PATIENT BELOW. HE WAS THE POLIO SUSPECT.


THE BOY AND HIS MOTHER AT THE MARKET


THE PATIENT NOT VERY IMPRESSED WITH THE MUZUNGOS HOME MADE BALLOON


This week has been full of interesting medicine. On Monday I sent two patients to Kampala for opinions. One little baby was confirmed to have a hole in the heart and will need corrective surgery and the other young boy was for follow up of his Burkitts lymphoma.I also sent some x rays for an opinion from Richard my VSO colleague in Kampala. One of the xrays was of a young man with HIV who I thought also had a lymphoma. Richard suggested he may have TB a much commoner diagnosis and this was confirmed when I aspirated some pus from his lymph node. It is a much better diagnosis and with the right treatment he should do well. I also saw two patients with extensive Kaposi sarcomas. This is a horrible tumour that occurs in advanced HIV and is almost impossible to treat here so they will do badly.There was of course the general run of malaria including a young baby who was desperately anaemic. Again we had no blood available and I expect the parents took her home to die. Malaria still regularly kills children usually because of severe anaemia and our inability to provide transfusions. That is why prevention is so important.
Wednesday was Martyrs day a public holiday held to commemorate some christian martyrs. It was my intention to stay at home and catch up with some work but at 9.30 I had a call from the district health officer saying that there had been a suspected case of polio reported and would I go as part of the team to check it out.
Uganda has had 7 cases of polio in the last few weeks after being declared polio free a few years ago. This has prompted a huge immunisation campaign to try and prevent an outbreak. This week end is the last of the emergency sessions and there has been a great effort to mobilise people to take their children under 5 for immunisation.MTN the mobile phone company has been sending text messages to every one telling them to take their children. The government has threatened imprisonment for parents who do not take their chidren for the immunisation. It is a huge under taking staff have to be trained vaccines obtained and delivered to numerous out posts. the vaccines need to be kept cool. Unfortunately it is difficult to evaluate the success of the campaign as there has never been a register of all children. This time they are trying to register each child so the per centage up take can be calculated. Last time some of the clinics recorded uptakes of 120% which is a worry!
The case we needed to check on was a 2 year old who had stopped walking a month ago. In the same area there had been another child with paralysis of one leg. This child had been admitted for assessment but from the history it looked like this was nerve damage after a poorly given injection a not uncommon problem here. Mutondo is at the far end of Masindi district and it took two hours to get there. When we arrived at the village the child was not there but had been taken to the market. With the help of one of the health workers we were able to track the child down and take him back to the health centre for an examination. This examination took place under a mango tree. He was not happy to be examined by a strange muzungo doctor but it was soon pretty obvious he did not have polio. He appeared to have a painful swollen knee and a heart murmur so I wondered if he had rheumatic fever. I gave some treatment and arranged to see him in a weeks time. Because he had been listed as a suspect we had to arrange for stool samples to be taken to Entebbe for checking. The surveillance here is good but does depend on people getting to health centres and health workers reporting their concerns.
This trip did take me to a part of Uganda I have never seen. While we were there we visited the site of an orphanage being set up by a US medical missionary. This doctor had found a site of 500 acres next to the Nile. He has funded the purchase through churches in the US and is setting about building a school, orphanage and hospital in the middle of nowhere. You do meet some inspiring people here.
Library up-date:
The day that I had planned to go turned out to be Martyr's Day and therefore a national holiday. At the last minute I re-arranged everything to go on Friday instead. It turned out to be an interesting day and not at all as I had expected. Our first group to visit the library that day was one of the P1 classes. One of the two P1 class teachers hadn't turned up for work and the other one really wanted to go to town, leaving about 60 children without supervision. After a lot of chasing we managed to get a group of them in the library - together with a stray chicken! I decided to do a 'warm up' action rhyme with them but this took the whole session. At least they seemed to enjoy it. The following two sessions were with P5 and P7 classes and these turned out to be discussions on topics such as emotions and various sex education issues. As a teaching aid I was using a newspapers produced for primary school children. It has an Agony Aunt page and, because of cultural differences, the letters were nothing like what you would find in the UK! They were difficult topics to cover because the classes have pupils of all ages. Children progress to the next school year based on their ability rather than age so it is not unusual to have older teenagers in a P1 class.
Ritah, the librarian, invited me back to her house in the village at lunchtime. The house is actually a one-room brick building with a metal door, no bigger than most garden sheds, but typical of the way most people live here. There is just enough room for a single bed and a wooden chair with pots, pans and jerry cans piled up in the corner. Her latrine is shared with several families so she prefers to go down the road and use the one belonging to a colleague. Cooking and bathing are all done outside. As she prepared her lunch of fried cabbage and smoked fish we exchanged lots of culinary titbits - I picked up lots of tips! Ugandan cooking is not as easy as it looks. I find it quite tricky wrapping the matooke (a special variety of bananas) in banana leaves in such a way that it makes a tight parcel to steam over the charcoal. Then keeping the charcoal at the right temperature is also a skill. Chris is quite happy for me to not perfect the technique as he hates matooke anyway and thinks I should stick to pasta!
Maggie

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