July Camp report

A TB patient who's family would not / could not find the finances to get to the District Hospital to enrol on a TB treatment program.

During home to home visiting several patients were discovered, living within a few hundred metres of the clinic who did not have the confidence, or felt too ashamed to seek medical help.

There is sometimes overlap with HIV and the stigma would lie heavy on both the individual and the family.

Treatment for TB is provided free by the government but the course is long and needs good compliance. Travel is costly and with the disease progress drawn out some families do not see the need to spend money going to and fro to the city for treatment. We are currently seeing how we can provide treatment from the Clinic base, and are liaising with the government.

This girl returned to the community from Lagos having been blackmailed, frankly, by doctors who demanded 30,000N (£120) for antibiotics for a chest infection, (should have been at best a few pounds). Unable to pay and without support she returned to her family in the delta creeks and was discovered malnourished and clearly very sick during house visits. She was encouraged to seek testing for TB and treatment in Warri where she is now established on a TB program, and doing very well, (despite the uncertainty of having her photo taken)

We have really learnt the lesson that staying small and focused is best (for our work), and that Primary Care is at its best when it reaches right into the lives of the community.

The weekly walk through each community quarter that both builds relationships with each family, affords opportunity for teaching, addressing ad hoc health concerns, identifying house bound patients and reviewing environmental hazards and hygiene. Sharing a joke en route is always a good social lubricant...

We also had a delivery,and the hcw expertly delivered the baby,cleaned the cord,weighed the baby, the baby was put to breast almost immediately after delivery destroying the idea that you do not feed a child immediately after delivery. The mother was counselled for exclusive breast feeding for 6mths,hoping she would adhere to this, and of course vaccinations.... - Dr Oghumu

A newborn child brought to the clinic with obvious congenital cataracts. He and his parents will see the eye team next time we hold a joint camp in November.

The 1st july camp was on the 14th, a child with acute malaria presented with a temp of over 40 degrees centigrade. He was tepid sponged immediately (see photo below) and given an antipyretic. He had been seen previously by the hcw and was treated for malaria,but he did not seem to get better
On examination he looked like he was losing consciousness very fast,so we placed him on parenteral quinine and crystaline pen. He showed remarkable improvement the next day,and we then continued on this regimen for the next 48hrs discharging him with oral drugs

He was followed up in the subsequent following days until the fever totally subsided.

This might seem like the normal kind of patient seen in town by GP's,but in the creeks where there are no medical facilities or professionals,this child would have died if unattended,which is the normal thing in these parts - Dr O.

The subtle rash of measles

Tepid sponging to cool the fever of malaria

 The government health worker had helped administer some vaccines  a few days before we started our camp,and we continued with ours the next day to try to take care of missed cases,because we believe that not every child was immunised,knowing that 85% coverage of measles immunisation would drastically reduce it's incidence .We intend to continue with these vaccinations plus pregnant women and women of child bearing age in the next 2 weeks. Vaccination coverage seems never to be effective as isolated campaigns, but needs continual and recorded effort. We managed 60 immunisations this camp, sending the details to the government vaccination officer.

On the last day of the camp we visited olota community where over 50 pts were treated for malaria and we have also noticed an increase in diarrhoea diseases in these camp and mothers were given a health talk on hygiene,the importance of vaccination prior to the vaccination exercise

'Our 2nd camp for the month of july was from the 28th to the 31st,just like the 1st camp ,we were faced with a child of 1yr with moderate to severe dehydration,whom we had to admit,the hcw on duty said she would have referred if she was alone on duty,but after considering the mothers social status i had no option but to admit,knowing that the mother would seek the help of native healers and probably worsen the child's chances of being alive
the child's anterior fontanelle was seriously sunken and eyeballs. Getting a line was difficult and we managed to get in some fluid into the child and then continued on oral rehydration therapy,which we personally supervised ourselves since the mother had lost all hope of the child surviving
we were up until dawn when the child condition changed from restlessness to calmness
The child was discharged the next morning and was given an appointment for a follow up visit
We have noticed an increase in the number of children that visits the clinic,and mothers are begining to attend the health center as they seem to agree that the mortality among children has seemed to drastically reduce since they started attending the health centre - Dr oghumu

Over 120 patients were seen on each of the two camps, beside the daily attendees at the Clinic.