Happy Ash Wednesday from Kiwoko, Uganda. It was an early morning as church services occur before working hours. Some of the nursing students showed me the way to the nearby church for service at 7 AM. Once the working day started, I was in the NICU which is very well equipped. An example of some of the medical treatments/supplies they offer include oxygen, CPAP (the water reservoirs are Nalgene bottles), bililights, incubators and isolettes, NG tube feedings, and basic labs. Several people have told me it is one of the best Nikki’s in the country. I was surprised to find one thing not present- a bilirubinometer. Instead, hyperbilirubinemia is diagnosed clinically. This is surprising because this is a very serious condition that can lead to lasting effects on the brain which means in the US we check every baby for their bilirubin level using a measuring device. I am guessing this leads to a higher number of babies receiving treatment for this (bililites), but there is probably no issue with this as parents are very willing to allow the healthcare team to make decisions regarding their babies and the babies all stay in the NICU instead of with the mother which is typical in the US. There are many preterm babies that are born here for a variety of reasons. The top two are preeclampsia and maternal malnutrition. The youngest child that is in the NICU at this time was born at 26 weeks and weighed about 700 g. Any baby born that is able to live on at most CPAP for support is supported as much as possible and there is a “wait and see” approach as higher levels of care for very preterm babies such as surfactant, ventilation, surgical services for common gastrointestinal issues, etc. are not available.
Lugandan word of the day: Okusaba (verb, “oh-coo-sah-buh”, praying or to pray)
Medical learning point of the day: Malarone, like many drugs, can cause a skin drug eruption including hives. This is usually self limiting and may resolve after 5-7 days so, weighing the risks/benefits of contracting malaria, it is recommended to stay on the medication for at least a week (provided there are no signs of a severe allergic reaction like facial swelling, difficulty breathing, etc).
