January report 2009

Another severely malnourished child presenting at the Clinic, (note the visible intestines)

The Niger Delta is a region abundant in food though oil politics have decimated many of the fishing grounds through oil bunkering and contamination of the creeks from spillages, man-made and accidental. Despite this fishing and farming can yield a full, and nutritionally varied diet. Malnutrition can arise through ignorance, especially in teenage mothers, intercurrent illness and chronic disease.

This young boy presented floppy and severely dehydrated. Careful rehydration was given over 48hrs until he was able to take some soup. Encouragingly he made good progress, but relapsed after three days and his mother was advised to take him hospital. With such a small child accurate fluid balance is very difficult and without facilities for monitoring kidney function and electrolytes (given the child would have been in intensive care in a developed country), stabilisation is all we can do before transfer. Education and stressing early referral remains a focus of the work so we avoid these severely sick children presenting so late.

Each week we hold a nutritional session with examples from each food group locally available.

Emphasising the importance of dietary variation is invariably injected with humour, Rose being a born performer.

Another child presents with Kwashiorkor, a protein deficient malnutrition that results in fluid retention and weakness. Note the puffy legs and swollen hands. This child responded well to dietary advice. The child on the right arrived almost moribund, feverish and with rapid breathing. Clinically severely anaemic from malaria this was confirmed by fingerprick testing, the pallor of the sample corresponding to a heamoglobin of 4 or thereabouts. Like almost all children in this late stage of the disease he sadly died shortly after the picture was taken.

On a happier note Dr Lawrence Oghumu, our Medical Superintendent is undertaking a Post-Grad Diploma in Tropical Medicine at The Liverpool School of Tropical Medicine in the UK.

It is a testimony to the Health Care Workers that, with the active support of the communities in which we work they can continue to provide front-line care with clearly established referral pathways we have put in place for cases normally managed by the Doctor.

*With Dr Oghumu in the UK these photos were taken in december , but represent typical cases seen each week in the clinic. For the next two months each report will focus on a topical issue in the community until Dr Oghumu is back at the helm, and indeed behind the camera!