Ann Moore the Sister in charge of the Special Care Baby Unit at Kisiizi sent us this tale of how one child’s survival depended on the unit functioning as a high dependency / intensive unit recently.
Mugisha Hope was born at home at the beginning of November. She did not cry at birth and did not breathe well. She was not able to breast feed. The next day the mother and grandmother brought her to Kisiizi. She was almost dead when she arrived but after a brief period of resuscitation was able to breathe just about adequately. We assumed she had some sort of infection and gave her antibiotics. Because she was so sick we gave her intravenous fluids and did not attempt to feed her.
The following day, as she was a little better, we decided to pass a tube into her stomach to feed her some milk: it would not go. There is a condition called oesophageal atresia where the oesophagus (or gullet) is incompletely formed. I hoped I was wrong in thinking that this was her problem. To confirm or dismiss this she needed a special X-Ray. The problem is we do not have a portable X-Ray machine and Hope was dependent on oxygen. She became very blue if it was stopped for any length of time. So, we needed two oxygen concentrators, which fortunately we had. One remained in Special Care while the other was put onto a wheelchair and taken to the X-ray department. Then myself and another nurse quickly carried Hope and the resuscitation equipment to the X-ray machine.
Unfortunately my suspicions were confirmed. This meant the baby needed a very major operation. We had had a baby with the same condition last year and, because the operation had only been carried out at Kisiizi once before and because our surgeons were both away, she was transferred to the national teaching hospital where sadly she died before she could be operated on.
All we could do was offer Mugisha a chance of life. The anaesthetic was tricky in such a small, sick baby. The operation itself was very delicate. Thanks to the dedicated team of anaesthetists, surgeon and nurses it was successful. Three continents were represented in the theatre that day; Africa, Europe and Australasia.
The end of the operation was certainly not the end of the story. In the West Mushisha would have been nursed in a specialist neonatal intensive care unit, probably with assisted ventilation, for some days. This is not available in Kisiizi.
Two weeks after her operation she is now ready to go home. Even that is not the end of her story. It is likely that she will need further operations as she grows to prevent her oesophagus from becoming too narrow. Will the family be able to afford the the cost of the operation she has already had? Will they bring her back when more treatment is needed? We sincerely hope so.
