Dr. Muthyala Checks In From Arusha, Tanzania

Kilimanjaro, as seen from Mount Meru

20/12/2011

Today was a regular day on the pediatric wards at Selian Hospital in Arusha, TZ......

The day began with a Continuing Medical Education given by the palliative care teams at the hospital. In the middle of rounds, a nurse informed us about a very ill child that had been brought to the outpatient clinic.

We rushed to the clinic, where we found an infant apneic. At this hospital, the nurses have minimal pediatric or neonatal resuscitation training, so nothing had been done. Quickly we

began bagging the child, found otherwise good vitals, and obtained a history.

A one-week-old boy, born at home without any prenatal care, was doing well until a few days ago, when he began to have fevers and had a seizure today.

The family initially presented to an outpatient clinic, where the child was given oral amoxicillin (a capsule of amoxicillin was opened and given to the child orally) without any improvement.

The child had a strong pulse, good chest rise with bagging but was coughing. Bulb suctioning resulted in the removal of about 2-4 ml of pink fluid, which was thought to be not blood but the amoxicillin that the child was aspirating.

There was no oxygen available in the outpatient clinic, so the child was taken (while ambu bagging) to the pediatric ICU. Oxygen via nasal cannula was started, and the child began to breath spontaneously.

The child was found to be hypothermic and there is no incubator so the mother was instructed to place the child in direct contact with her own skin. After this his vitals stabilized.

We started empiric treatment for meningitis (without an LP or blood cultures, because neither is available or reliable at the hospital) but first taught the ICU nurse how to dilute a vial of 250mg of ceftriaxone into 150mg doses, and then instructed how to mix D5NS and D5W to make D5 ½ NS for maintenance IV fluids.

Then back to rounds.

Doing well here in TZ, have one more month before coming home.. Happy Holidays, everyone!

Brian

Brian Muthyala doing x-ray teaching at Selian Lutheran Hospital in Arusha, Tanzania

Dr. Tundun Williams - Weeks 2 and 3 in Ogbomoso, Nigeria

The literature states that the prevalence of G6PD deficiency in Africa is anywhere between 15-30%.

Risk factors for hemolysis include use of mentholated products in the first six months of life, illness, certain drugs (e.g., Primaquine, sulfa drugs, Quinine) and fava beans (the jury is still out with regards to whether Nigerians eat fava beans).

We screened children at schools, churches and small villages. The screen included asking simple screening questions and collecting blood samples from children under the age of 16 years old. Samples were processed back at the hospital lab.

By the end of the third week, we had exceeded our goal of screening 1,000 children.

Initial analysis of our data shows a prevalence of 10-19%; differences in prevalence appeared to be related to ethnic group.

Parents of deficient children will soon be sent notification letters telling them what to avoid and how to recognize symptoms of hemolysis. Lab personnel have been taught how to do the simple G6PD screening test. We hope they will continue to screen children long after we leave.

The Baptist seminary elementary school, one of the first sites we visited to perform G6PD screens.

Ajinapa village; more children to screen for G6PD

Adodo village. These boys were insistent on striking fighting poses.

Ilota village school

Our host, Dr. Daniel Gbadero, speaks to children at Ayegun Baptist Church.

At Baptist Medical Center Staff School. This is Samuel, looking very sharp in his school uniform (the bowtie is optional, and as you can see, is worn by only those young men with discerning taste). You wouldn't know it from this picture, but Samuel is a giggler. He was particularly amused when I asked him if he had ever had tea-colored urine.

When the generator was not running, the power supply was unpredictable. Here, Troy Lund and I are running hematocrits on a battery-operated Hemocue machine by lantern light.

We used the fluorescent screening method for G6PD deficiency. Patients who have adequate G6PD activity produce NADPH, which fluoresces under long wave UV light. The spots that do not fluoresce represent patients that are G6PD deficient.

Ogbomoso, a town of just over 1 million inhabitants, is located in Oyo State (in Yoruba-land), about 150 miles north of Lagos.

Photo courtesy Google Maps and Wiki Commons

Like all other Yoruba towns, there is a story behind the origins of Ogbomoso. It is said that a mighty warrior named Elemoso once habitually terrorized the inhabitants of present day Ogbomoso.

The people got fed up with being pillaged and decided to send a warrior of their own to defend their city.

This warrior fought with and beheaded Elemoso.

The alaafin (king) of Oyo heard of this feat and was impressed. He dubbed the warrior "Ogbori Elemoso" (he who beheaded Elemoso) and crowned him soun (regional king) of his hometown.

Over the years, the name of the town, originally Ilu Ogbori Elemoso (the place of origin of Ogbori Elemoso), has contracted to just Ogbomoso.

We chose Ogbomoso as the site for the G6PD deficiency study because of Tina (Slusher)'s long-standing ties with the Baptist Medical Centre, where we have guaranteed access to a lab.