How to save a life

The hospital here is a missionary hospital and money is in short supply. When we arrived they said they were so grateful to have us because they'd run out of money and they couldn't afford to pay a new doctor until the new financial year, which starts at the beginning of July. The hospital doesn't have a lot of the basic equipment that we take for granted in the UK. For example, we only have 2 oxygen machine on the paeds ward, whilst neonates has 3. I'm very excited because at my Mum's work they have been raising money for the hospital whilst I've been here, and that plus the money I have saved should be enough for a new oxygen machine. It's so nice to be able to tell the doctors and nurses that we'll be able to buy them something so essential and I wanted to write a bit to explain what benefit it will have.

Anyone who has done basic first aid will remember the acronym ABC for how to care for a patient in an emergency. The same applies in hospital. A stands for airway and you decide whether the patient can maintain their own airway or needs help. In the UK, this means an anaesthetist gets called and any patient who cannot keep their airway open is sedated and a tube is placed into their windpipe so that their breathing can be controlled by a machine in the Intensive Care Unit (called being intubated and ventilated). All patients who are unconscious or semi-conscious come into this category. Here, we regularly have children who this applies to, but there are no intensive care facilities and only one patient in the whole hospital can be intubated at a time, as there is only one ventilator, so it is usually reserved for the operating theatre. This means that we basically skip A and move onto B, which stands for breathing.

To assess breathing you need to count the respiratory rate, look at, feel and listen to the chest and measure the oxygen saturations. This is done by using a pulse oximeter, a hand-held machine that clips onto a finger or toe and tells you the saturation of oxygen in the patient's blood and their heartrate. It's actually amazing technology but it's also something we take for granted in the UK. Here, they have a monitor in neonates but not on the paeds ward, and it's almost unheard of for a child to have their saturations checked unless we explicitly ask a nurse to go to the neonatal ward and get the machine and check the sats whilst we are with the patient.

The main treatment for breathing problems is, of course, oxygen. As I have said, we have 2 oxygen machines on the main paeds ward. Ideally, any child with low saturations should be on oxygen, as should any child who is unconscious or very unwell. Unfortunately there are often way too many children who need oxygen and if the neonatal machines are all being used only 2 children can have it (they have them on the adult wards but there are never enough there for all their patients either). I've had to decide which of two unconscious children with severe malaria to leave without oxygen when another needs it more. Since I've been here we've had about 10 children die (excluding neonates). I'm not sure if any would have survived with oxygen but it's not inconceivable. Furthermore, the children take longer to recover without oxygen and we have had a number of older children become very confused and agitated for a long while after recovering from a severe illness, be it cerebral malaria, meningitis or encephalitis, and I imagine that these children might have done better with oxygen therapy. It's frustrating and upsetting as in the Uk we  have oxygen supplies by almost every bedspace and all patients have their saturation levels recorded regularly so they can be started on oxygen as soon as it's needed.

The machines they use here are concentrators, so are able to create air with added oxygen. This is really useful as it means they can be used time after time and not have to be re-filled like the canisters back home do. Therefore, one oxygen machine can be used for a long time. My aim is to collect enough money to buy an oxygen machine, one or two sats machines and some resuscitation bags and masks. These are used for patient's who aren't breathing and basically involve a mask that goes over the nose and mouth and a bag that attaches to the mask which you squeeze to force air into the lungs. There's an attachment for oxygen. As I mentioned in a previous blog, we had a horrible resuscitation attempt when nobody could find a mask that fitted and so I had to start giving mouth to mouth before we got one. Even then it barely fitted and 2 of us had to hold it still onto his face. Resuscitating a child is  awful enough without these problems. I tried to order some here but it's proved very complicated so I'm going to buy some and send them over.

I'm sorry this hasn't been the cheeriest blog but I wanted to write it to says thanks and explain where the money's going and I guess  to say to anyone else that if you have any spare money you want to give I'd be very grateful. I'm going to collect it and donate it to the UK charity Friends of Kagando because that way we can get gift aid. I'm liasing with the staff here to make sure the money goes to the right place. I promise it will help enormously, and I hope it might save some children's lives.