Kenya: Lodwar District Hospital Support
Lodwar Hospital Report, Q2 2014
September 18, 2014
Summary of Activities
Continuing to focus on the hospital needs, LDH saw the need for other departments and wards to be supported and strengthened. It was ultimately agreed that the departments to support this year would be Physiotherapy/Orthopedics, Dental, MCH and the Maternity ward. During Q2, medicine, supplies and equipment were provided to Pediatrics, Physiotherapy and the Dental Department.
24,233 Patients Treated
Outpatient and Inpatient
A total of 24,233 Outpatients (9,614 pediatric outpatients) – up from 19,323 in Q1 2014; 959 In-Patients (574 pediatric inpatients); and 271 Occupational Therapy patients were treated at LDH in Q2 2014.
Medicine and Medical Supplies
The Pediatric Ward received a comprehensive supply of emergency medical supplies from RMF/MMI. The drugs are still being dispensed free of charge to the patients. For supplies: Plaster of Paris, strapping adhesive, catheters, tourniquet bands, gauze, skin traction, cotton wool, gloves branulars and crept bandage were purchased in the quarter.
Medicine and Medical Supplies
The Physiotherapy Department received last orthopedic weights, chest expanders, exercise balls, hydro collator pack heaters, leg elevators, jig saws, amongst other equipment. This was well received by the team at the physiotherapy department.
New support for Dental Department
Equipment and Supplies
The Dental department received forceps, incisors, premolars, surgical scissors, dental needles, cryer elevators, straight elevators, amongst other equipment. The Dental department was another department like the Physiotherapy department that had never been supported by any partner. Most of the equipment used was very old, rusty and outdated, or totally lacking, making effective service delivery very hard.
Lodwar District Hospital (DH) is the only functional government regional referral hospital for all of Turkana region, spanning a population of almost 1,000,000. This is where the vast majority of the Turkana and other populations of Northwestern Kenya as well as people from across the borders to Uganda and South Sudan seek help when they need more advanced care requiring medical equipment and specialized skills that cannot be provided at dispensaries, health centers, or private health clinics. Lodwar DH has been struggling for years with wards in need of major repair, and supplies and drugs that come in with great irregularity from the government health supplies department in Nairobi.
- Rehabilitate the infrastructure at Lodwar District Hospital, beginning with the pediatric ward and proceeding to male and female wards.
- Rehabilitate equipment set at Lodwar District Hospital, beginning with the pediatric ward and proceeding to male and female wards, outpatient department, operating theatre and physiotherapy department.
- Provide regularity to supplies of basic medical devices, disposables, and pharmaceuticals, complementing the items from Kenya Medical Supplies (KEMSA).
- Provide equipment maintenance and spare parts management.
- Organize on-site clinical training, beginning with general equipment use and care, and pediatric emergency care.
- Provide outreach campaigns.
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Age: 1 year
History: Alvin was admitted to the ward through the casualty department due to development of fever and edema; he tested positive on the malarial blood slide and was treated for malaria accordingly. Alvin’s mother attended the antenatal clinic at Lodwar District Hospital. She successfully delivered at the hospital, and Alvin received all immunizations as per schedule. Alvin is the only child of the family; there has been no known history of major illness in the family, no food or other allergies, and no history of tuberculosis contact. Alvin tested HIV+.
Malaria, kwashiorkor, HIV.
Alvin was admitted in very poor condition, a fever of 41.5 degrees Celsius with extreme edema +
-Quinine syrup 80mg/kg body weight 3x/ day
-I/V Flagyl 22.5mg TID
-Calpol syrup 2.5mls TDS
-Amikacin 35mg OD
-Nutrition support: F-75 for 4 days until the edema subsided then F-100 for 6 days; on discharge he was given supplementary food (first food) and was advised to come back monthly for assessment.
The baby’s condition remained unstable for 4 days but he started improving gradually on the 5th day, responding to treatment and the high fever settled. Alvin remained in the ward and was discharged after 10 days. This brought a lot of joy to the mother and pride to the support from RMF because the drugs used were procured by funds from RMF.
Age: 9 months
History: Dennis was admitted through referral from Lokichar health center (89km from Lodwar town) with complaints of diarrhea, vomiting, coughing and fever for a period of one month. He was treated with no improvement and was referred for a chest x-ray. The mother attended antenatal clinic at Lokichar clinic; she was immunized with Tetanus Toxoid vaccine, HIV test done was positive. The baby was delivered at Lokichar hospital with no complications arising. He has received expanded program immunizations as per schedule and has attained developmental milestones relatively well. Dennis is the third born in a family of four siblings, all alive and well, one girl and three boys. The father is a herdsman and the mother does small scale business of making brooms.
– Moderate acute malnutrition
1.HIV test +
2.Full hemogram –hemoglobin level 7g/dl
3.Blood slide –ve
4.Chest x-ray suggestive of tuberculosis
1. Gentamycin 20mg 3x/day
2. Zinc Sulphate 10mg 2x/ day for 2 weeks
3. Multivitamin syrup 5mg 2x/ day for 2 weeks
4. Resomal (oral rehydration fluids) freely
5. Ranferon 5ml tidx2/52
6. Vitamin A 100,000 IU STAT
Dennis did not respond to the above treatment, and was started on combined Anti-TB treatment for 2 months:
Then Isoniazid and Ethambutol for 4 months. He was discharged after 3 weeks and will be followed up at the tuberculosis clinic.
Dennis was put on F-100 for 8 days and alternatively started on ready-to-use supplementary food (plumpy sup). On discharge he was given supplementary food and referred back to Lokichar for nutrition support; we recommended that he would be taken back every 2 weeks for status assessment.
The mother was so happy with the progress of her child and for the treatment he received. She said the recurrent illness of her baby had interfered with her business and eroded the little income for the family. She was very grateful for the support.
Age: 18 months, female
Tracy was admitted through the OPD with complaints of diarrhea, severe wasting, mouth sores and difficulty in breathing. She had been treated with no improvement. This was the second time she was admitted with these symptoms. Tracy was delivered at home, no complications arose. She has had all immunizations as per schedule. The parents were tested for HIV and turned out HIV-. Tracy is the second born in a family of two siblings. There has been no history of allergies or chronic illness.
– Severe acute malnutrition
1. Blood slide (for malaria parasites) negative
2. Malnutrition (SAM – MUAC: 9cm)
– Amoxil 5ml TdsX5/7
– Paracetamol 5ml Tdsx5/7
– I/V fluids 320ml for 24hrs, 5% Dextrose
– M/Vit 5ml Tdsx5/7
– Oral Resoma
– Gentamycin 50mg ODx5
Management of Malnutrition:
– F-75 for 3 days
– F-100 for 8 days
On discharge, the patient was given RUTF (Ready-to-use therapeutic food), and advised to come back every 2 weeks for status assessment.