By Gregory Bartha, MD
At least half the population in Uganda is 15 years or younger, so a large part of my work at the clinic involved diagnosing and treating children. As I mentioned in the first blog post I had long dreamed of working in Africa and was aware of my need for pediatric experience. For about 15 years before leaving for Africa I filled in at the Community Children’s Clinic in Midland. And indeed at the Cross Clinic there were always many children coming for treatment.
There were many pediatric orthopedic problems the most common being clubfoot and osteomyelitis (bone infection). We referred infants with clubfoot to a hospital about 20 miles away which was founded by the Dutch people about 80 years ago. This hospital had orthopedists on staff. The treatment was serial application of casts to the foot and leg after manually aligning the foot in the proper position. After 3 or 4 treatments the results were usually very good with normal foot and ankle form and function. Osteomyelitis was more complicated and usually required surgery, sometimes multiple surgeries, to remove infected and devitalized bone and 6 weeks of antibiotic therapy. Unfortunately the infections frequently recurred, and additional surgeries were required. It was puzzling why there so many cases of osteomyelitis. Many times there was no history of infected skin wounds or penetrating injury. One of the reasons could be poor sanitary conditions in the home.
There were a good number of cases of hydrocephalus ( swelling 0f the head as a result of too much fluid surrounding the brain) usually because the mother failed to take folic acid during pregnancy. Also there were cases of spina bifida. There is a very good neurosurgery hospital in Mbale established by Cure International. Neurosurgeons from Europe and the US come to volunteer their services at this hospital and work along side Ugandan neurosurgeons. The hospital charges about $300 for each pediatric case.
We diagnosed a number of cases of congenital heart disease with the help of a good echocardiogram service in Mbale. These children tended to have cough, shortness of breath, and delayed growth. Surgery for the less complicated problems can be done in Kampala, but for more complex defects, patients have to go to India. The cost for each heart surgery is around 4 to 6 thousand dollars. Fortunately some international charities assist with these costs, and some generous persons in Midland have contributed.
We saw cases of childhood cancer – lymphoma,osteogenic sarcoma (bone cancer), kidney and liver cancer. Burkitts Lymphoma occurs throughout Africa and is associated with the virus causing mononucleosis. Malaria may interfere with the immune response to the virus and result in cancer. Cancer treatment is available in Kampala at Mulago Hospital. However costs associated with treatment and transportation are barriers to good cancer care. While most childhood cancers are curable in the US, the outcomes in Uganda are frequently poor. I remember one 13 year old boy with osteogenic sarcoma who encountered obstacles to travel during the lockdown in the spring 2020. When he was finally able to go to Kampala, he was short of breath and very weak. He died one or two days after arriving at Mulago Hospital.
The last year or two there was a large outbreak of measles in East Africa. We saw many children with high fever, red eyes, inflamed throat, cough, and generalized rash. Most recovered in 5 to 7 days, but some developed complications such as pneumonia and had to be transferred to the regional hospital.
We saw a number of malnourished children. One of the causes was the mother not producing enough breast milk. We transferred these children to a nutrition center which supplied them with Plumpy’Nut – a combination of peanut paste, vegetable oil, and milk powder. Most of the children responded well.