Getting to work.

From the beginning, I have understood that medical resources in Ethiopia are severely limited.  What I am discovering now is that, although limited, there are substantial resources here. The challenge is to identify those resources and to put them to the best possible use.

One of the most impressive resource is the growing numbers of young physicians.  They are bright.  They work hard.  They seem very committed to good patient care.  They are trying to learn how to put their strengths in book learning to practical use.  They seem to be aware of the many tools available in the developed countries which they lack.  Simple things like a routine lab tests, or the right size feeding tube are often not available.  Even eye drops for a simple conjunctivitis cannot be given in the hospital unless the child's family can afford to go to the nearby pharmacy and purchase them.  Today, an infant with a likely bowel obstruction, could not get an abdominal x-ray because the parents could not afford one.

Last week, five infants died in the neonatal unit.  These were infants who would most likely have survived, had they been managed in a neonatal center in the U.S. or many other developed countries.  Two of the infants had surgical issues.  Three were premature.

According to the World Health Organization (WHO) estimates, there are about 5 million neonatal deaths a year throughout the world. Ninety eight percent of these deaths occur in developing countries.  Infection, prematurity, and birth asphyxia are the main causes.

I'm beginning to work with the fellows to develop a workable algorithm to approach neonatal infections.  What other visiting neos and I have noticed is that nearly every infant admitted to the nursery gets placed on broad spectrum antibiotics.  This is probably four or five times as frequent as my experience in Seattle.  The babies remain on the antibiotics longer because reliable blood cultures are often not available.  The consequence of this practice is emergence of resistant organisms.  

Because the nursery is crowded, nursing staff is limited, and much of the equipment is shared,  the rate of hospital acquired infections is high.  It's likely that these hospital acquired infections contributed to some if not most of the deaths in the nursery last week.  

The purpose of the algorithm we are working on is to develop a more focused approach which will reduce the numbers of infants who receive antibiotics at the time of admission.

 A week ago, I had the pleasure of sitting in on the grand rounds presentation by Wodimageyn, a first year pediatric resident.  In his rotation through the nursery last month he had witnessed a child who developed kernicterus which is a form of irreversible neurological injury cause by prolonged severely elevated bilirubin levels.  His patient developed kernicterus because there were not enough bilirubin lights available in the nursery to treat all the jaundiced infants.

A new photo therapy light costs between three and six thousand US dollars.  On his own initiative, Wodemageyn purchased the necessary parts and built his own photo therapy light for about 1500 Bir (88 US dollars). 

He now hopes share his "invention" with other resource limited nurseries in Ethiopia and beyond.