Massachusetts General Hospital, Family Treatment Fund – Uganda

 

Sarah

Sarah is a three-year-old girl from the Isingiro District, which is very rural and heavily affected by malnutrition. Prior to admission to the hospital, Sarah had had a fever and cough for approximately one week. She went to the local clinic (one of the lowest level facilities in the hierarchy of clinical centers supported by the Ministry of Health), where she was treated empirically for malaria. She took the medication for three days as prescribed, but did not improve. That local clinic then recommended that she come to our hospital, which serves as a referral facility for the region. When she arrived, she was very ill. She had underlying malnutrition and looked very frail. After performing a history and physical exam and obtaining a chest X-ray, we diagnosed her with pneumonia, which could be easily treated with several days of an intravenous antibiotic called ceftriaxone, followed by an oral medication called amoxicillin. Unfortunately, the hospital was out of ceftriaxone. It was available for purchase in town, but the family had spent their last month’s savings just getting to the hospital and did not have adequate funds to buy the medication. Fortunately, we had purchased ceftriaxone through our project and were able to supply it for Sarah. Due to receiving this essential medication, Sarah made a full recovery. We were also able to treat her malnutrition, and she left the hospital a healthy, happy, and smiling little girl.

Peter

Peter is a 2 old boy, who came to us with severe malnutrition. He is also from Isingiro, born in a remote village as the sixth child in a family of seven siblings. He was weaned off breast milk abruptly at 11 months of age when his mother became pregnant with her seventh child. Peter was then transferred to the care of his grandmother, who has no resources to take care of him.  His nutrition deteriorated gradually until he developed marked edema (swelling) and skin desquamation (sloughing). Peter’s grandmother was giving him herbs, which had no effect. He came to Paediatric Ward with very severe malnutrition, complicated with salmonella sepsis. He was hypothermic (low body temperature) and hypoglycemic (low blood sugar) and was unresponsive. With support from this program, we were able to supply him with lifesaving dextrose solution, antibiotics (ampicillin and ceftriaxone), and sundries like paediatric nasogastric tubes, which were not available through the hospital. At admission, everyone on the clinical team thought his chances of survival were very minimal in the next 24 hours. With the support from our program and dedication from his clinical team, Peter slowly pulled out and by 48 hours, he was awake and feeding better. His comprehensive treatment continued through the week, his edema significantly decreased, and he was feeding by mouth. He was moved to the nutrition ward and within the next 14 days was ready for discharge. His weight had risen by 20% and was quite active. His parents were counseled over the course of admission and a home plan discussed. On follow-up, Peter has continued to improve at home, back with his parents who are taking better care of him.

Another example of the benefits of this program can be seen in the way it complemented the development of a new oxygen delivery system in the hospital. As part of the efforts to improve hospital infrastructure, the Paediatrics Ward recently acquired a new, centralized oxygen delivery system with ports at multiple beds throughout the ward. This system is an enormous improvement over the prior system, which involved use of individual oxygen canisters at the bedside. These canisters were often empty and were a safety hazard. They could easily fall over and harm the child or others at the bedside. The centralized oxygen system works very well; however, the development budget did not include adequate support for the ongoing need for sterile oxygen tubing. We used funds from our project to buy that tubing, thus supplying the critical missing link in a life-saving treatment. Hundreds of children have been able to benefit from the supplemental oxygen, allowing them to recover from pneumonias, bronchiolitis, and other cardiopulmonary illnesses.