Contrasts

Mark Dornan helps to try to save a baby's life in a Kenyan hospital. Back at home, he is shocked by the contrasting affluence of British hospitals

Out patients was bustling. A mother brought in her 3 day old baby; it had been vomiting. The three day walk had exhausted her. The baby was dehydrated and had an imperforate anus.

None of the three doctors in the missionary hospital were surgeons. The poor roads made a transfer unfeasible. One doctor had some surgical experience, and so, armed with the hospital copy of Surgery - the low priced edition, the operation was planned. Meanwhile, another doctor worked out paediatric doses with the "anaesthetist" - a local nurse who had a few weeks' training in anaesthetics.

After the child was rehydrated the operation started. The anatomy was distorted, but eventually the descending colon was found among the mass of grossly inflated bowel. The relieved doctor started to perform a colostomy. My job was to assist and keep the bowel warm with swabs bathed in warm water. Half an hour into the operation the power supply cut out, so the anaesthetist went off to obtain a car battery and lamp from the laboratory. Amid the commotion we realised that the baby no longer had a pulse. Desperate attempts were made to resuscitate the patient. After 10 minutes, still holding the baby's bowel and our instruments, we gave up. The doctors sadly shook their heads and had a last listen to the heart. Suddenly they jumped with surprise - there was a slow heart beat. Chest compressions were continued, and gradually the baby's heart rate picked up. We thanked God, the operation continued and was nearly complete when the heart stopped once more. Another lengthy and seemingly fruitless resuscitation took place. Eventually the tired heart started slowly to beat. We had no means of measuring any biochemistry so I went off and looked up possible causes for this slow rate. I came back with a list of things to try so we measured out the drugs and tried them one by one, hoping that something might help. Miraculously the heart rate stabilised, and the operation was completed. The baby was taken back to the ward and given hot water bottles, as the incubator had no power. Throughout the night the baby repeatedly stopped breathing and had to be resuscitated. A few of these attempts were at my hands as I was "passing by." Astonishingly, the baby survived the next day, but, unfortunately, it developed second degree burns from the hot water bottles. Progress went well, but eight days after the operation the patient died during the night.

Returning home

In medical school health statistics showed the apparent chasm between life expectation in the West and in developing countries. Now these figures have become real people. Many students on elective have noticed their hospitals crying out for doctors, equipment, and even old copies of the British National Formulary. In contrast, on my return to the United Kingdom I stand waiting on wards that are swamped with numerous disused items of equipment while pharmaceutical representatives ply us with free stethoscopes and such like. I experience doctors tired and wanting a change, and I find those precious copies of the BNF collected and binned. Is it just me who notices a tiny contrast?
 

Hospitals in Kenya need more staff

How you can help

So many hospitals need doctors and elective students to help run them. You really can make a difference. International Health Exchange (Tel: 0171 8365833; email: info@ihe.org.uk) publishes a list of organisations that might help if you are interested in working in developing countries. If you go, hospitals would love you to donate equipment they cannot get hold of, such as dipsticks. ECHO International Health Services (Tel: 0181 660 2220; email: cs@echohealth.org.uk) provides cheap medical supplies for developing countries. Equally valuable are copies of the British National Formulary. You could encourage your hospital pharmacy to donate 6-12 month old copy of the BNF to the Commwealth Pharmaceutical Association (Tel. 0171 820 3399, ext 303; email:eharden@rpsgb.org.uk). Medical Missionary News (Tel: 01268 765 266; medical_miss_news@compuserve.com) is sending containers with medical equipment, blankets, and other useful items into developing countries - donations of useful items is greatly appreciated.