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AusHeal Blog

Our last week begins – 25th October 2015

The AusHEAL presence at HEAL Africa Hospital (HAH) is maintained by Neil and Gwen Wetzig as they move into their last week at HEAL Africa after a 3 month stay. Previous blogs have explained what a typical day at HEAL Africa involves, but what sort of medical cases are treated at the hospital?

 

The breadth of HEAL Africa Hospital’s health care on campus is significant including General Surgery, Orthopaedics, Obstetrics and Gynaecology (with female fistula repair), Anaesthetics, Internal Medicine, Paediatrics, Dentistry and ‘Public Health’.  The latter department includes HIV management but predominantly is concerned with management of Sexual Violence cases. HAH’s recognised contribution and emphasis in this area resulted in a visit this week from the US Under-Secretary-of-State for Civilian Security, Democracy and Human Rights. HEAL Africa Hospital and its projects are well known internationally.  The US Government representative brought a commitment to extend the US-AID funding to HEAL Africa’s Ushindi project against sexual and gender violence for a further 3 years. USHINDI is a Swahili word for “victory” or “to overcome”.

#13 1C US Under Secretary of State arrives at HEAL Africa

US Under Secretary of State arrives at HEAL Africa Hospital

US Under Secretary of State vists HEAL Africa

US Under Secretary of State vists HEAL Africa

Sadly there appear to been so many cases of sexual violence referred to the hospital during our time here this year.  However staff opinion is that the number of cases seen are fewer than the same period last year. Neil performed operated on a 39 year old woman this week who was savagely raped a few months ago. She had had a colostomy (bowel bag) performed initially to allow the wounds from her attack to heal without contamination of bowel motion. Neil was able to close the colostomy for her.

More ‘mundane’ surgical cases have included a hernia allowing the man to return to work, dressings for burns and other injuries needing skin grafts. A goitre is a lump in the lower part of the neck caused by an enlarged thyroid gland. Goitres are frequent in DRCongo and often huge, more common in women. They can be as large as a fist and larger on occasions. Local diet and the lack of iodine significantly contribute to the high number of goitres seen in this region. Surgical removal of the neck mass allows the patient to breathe and eat without restriction as well as to return to their community without being ostracised.

 

Two areas of SURGERY are perhaps the most challenging.

  •  ‘abdominal catastrophe’:  Such patients have had inadequate surgery elsewhere in peripheral medical centres, often by untrained personnel. Their condition made worse by delay of referral due to distance and to cost . Subsequent treatment at HEAL Africa Hospital to restore the patient to near normal to a large degree involves multiple surgeries with significant in-patient financial and emotional cost.  Sadly many of these cases arise in women following a Caesarean section.

    Patient transfer to and from Operating Theatre

    Patient transfer to and from Operating Theatre

  • operations on children with congenital abnormalities (conditions present at birth):  Each week there are several new cases with deformities varying from abdominal and bowel conditions where some parts of the body have not developed, to hydrocephalus (swelling around the brain presenting as a large head), to many cleft lips and palates. This week there was the need to remove a large mass from behind a newborn baby’s knee that was almost the size of his head!  These cases are quite emotionally draining for the surgical and other staff.

#13 1B Mass to be removed from newborn

MEDICAL conditions requiring admission frequently include ‘strokes’ and high blood pressure, so prevalent in sub-Saharan Africa. Malaria cases have been more frequent recently. Many HEAL Africa Hospital staff nd members of their families have had to be admitted to hospital or commenced on treatment at home. This is far more common than we have seen previously in Goma.

Then there is the TRAUMA. Within the last week there have been 2 gunshot victims and numerous other road traffic accident victims.

Gunshot Victim in Emergency Dept of HEAL Africa

Gunshot Victim in Emergency Dept of HEAL Africa

One difficulty is that HEAL Africa Hospital (HAH) currently relies on external funding to function. It is a private non-government funded hospital. A percentage of patients have ‘medical insurance’ of a type through their employer, helping the hospital to maintain a measure of financial stability. However many patients with non-life threatening conditions have to be turned away from the hospital as they simply have insufficient funds to pay for their care. These cases are innumerable. A situation and problem almost par-for-the-course in Low-Income Countries. Many of the 6 million population in the province of North Kivu live in extreme poverty. DRCongo is one of the 10 countries in the world reported as having more than 60% of its population living on < $1 / day. A simple hospital admission can cost a family a year’s income.  HEAL Africa Hospital (HAH) maintains a ‘Mercy Fund’ which provides limited funding for a number of priority cases unable to pay for their care.

The ‘AusHEAL Hospital Patient Fund’ (AHPF) has been established this year to contribute money for the treatment of certain cases at HEAL Africa Hospital managed in conjunction with AusHEAL team members on the basis that the patient’s case can provide an excellent teaching opportunity for HEAL Africa staff. A second category contributes funds towards the treatment of patients with extreme conditions reliant on the high expertise of visiting AusHEAL specialists. Previous blogs have reported on oesophageal replacement surgery and hugely disfigured maxillo-facial cases. The distribution of such funds has to be carefully prioritised.

Percentage of countries' population living under the poverty line (2012)

Percentage of countries’ population living under the poverty line (2012) from Wikipedia