Penultimate update before I go on a wee travel (details below), it's been a busy couple of weeks (no change there!) with big changes in my schedule and lots of new experiences of environements and clients alike! Hope you enjoy it all..
Some facts from the last few weeks (some do not make for light reading I‘m afraid):
1 in 6 babies born in the first 6 months of this year at Kisumu’s largest hospital were HIV Positive. ONE in SIX.
1 in 27 pregnancies (at the same hospital) in 2010 resulted in the death of the child
I’m now trained to give breastfeeding advice to Kenyan mummies!
I saw my first ever new-born baby - approximately 3 minutes old!
I saw my first ever giraffe in the wild - came out of nowhere (I mean, we were in a national park, not just walking down the street) and was about 20 ft in front of us galloping away down the road. Chased it briefly on the bikes we were on. Felt like a kid again - Picture Elliot in E.T pedalling away.
Had my first proper thanksgiving - VERY unsure about pumpkin pie.
I’m booked to go to Tanzania and Zanzibar over Christmas and new year, then fingers crossed climbing Mount Kenya near the end of Jan.
My return to the U.K is currently Feb 14th. Valentine’s day was not picked on purpose for some romantic shenanigans. Though who knows ;)
The days gone by:
Infant and young child feeding nutrition
I was so happy to have snuck onto this 3 day training held at the hospital. The focus was around breastfeeding (how to/difficulties with), nutrition, breast milk vs. formula (hopefully I don’t need to tell people this but breast is best! Formula sucks/is evil) and HIV Transmission through feeding. It was a really fascinating insight into an area of interest that we don’t find out much at all about as we train as SLT’s.
I’m hoping to research/get a friend to send me info from the UK as although the presenters seemed on it and the info was really helpful/solid I just wanna make sure what I was told is something I can carry over worldwide or whether some of the info was Africa/Kenya specific. The final day included “practical” which straight away made me think we were gonna be expressing milk from mother’s breasts or something (!) but it was doing ward rounds of the 3 baby units:
Labour ward - Does what it says on the tin
Nursery - Newborns who require extra support
Post-birth (I almost wrote after-birth but don't think it was called that!) - Beds where parents (all mothers - didn’t see a single father) stay a few days after birth and where others who require support stay for longer e.g: Ill mothers, C-sections
Needless to say, although I haven’t been in a unit/dept like this back home I assume it’s rather different - Labour room was crammed to the rafters with one particular lady vomiting and whaling in pain without anyone really attending to her. We were showed into the delivery room where a new mother had literally just given birth. The child was barely a few minutes old, wrapped up underneath a heater, whilst mum was standing there in discomfort, surrounded by a not particular soothing environment of blood etc. Not exactly what I was expecting but it was an experience nonetheless! The nursery only consisted of a single child who was hooked up to all sorts inside a unbelievable warm room (think sauna crossed with an incubator for baby chicks). This child was born over a month premature and weighed 1kg at birth. Underweight is considered less than 2.5kg. The child looked like a baby doll and was and probably will be the smallest baby I will ever see - To try and put it in perspective the kid’s feet were smaller than the size of my thumbs, legs similar width to a crayon and torso around the size of my palm. Fingers crossed the little guy makes it. Finally, in the post-birth wards were ten’s of day old cuties with mostly smiling, happy mum’s :) The one lady that stood out amongst the rest was a 15 year-old who had just had twins. If I could’ve taken a photo of her, it would not look out of place in the dictionary next to a definition of “proud”. I know proudness isn’t exactly something that you can show/see explicitly like happiness but the smile on her face, the way she was lovingly looking at her twins, her giggling with joy when people asked her about them almost got me all teary. I doubt I’ll ever forget her.
The Weekender - Welcome to Hell
After a couple of home visits on the Thursday I was off for some fun in the horrible sounding Hell’s gate. Highlights included a mate’s ridiculous attempt at putting up a mozzie net, going on a good 40km cycle ride (cycling is NOT my sport), doing a 2 hour hike in a kick-ass gorge (which was used in a tomb raider movie don’t you know!) and seeing a huge load of animals - faves being the huge adult giraffe that jumped out in front of us and raced us down the street a bit whilst we were on our bikes, zebras and a hippo which we saw near our camp at night time..
Hospital
Back in for my usual stint but had an O.T who normally works in the paediatric ward come and whisk me over to her unit to see 2 kids for swallowing assessments. It’s truly brilliant to have staff who have listened to training and acting upon it :) ! The two kids have very different diagnosis’ but both have been on an NG tube (feeding tube that goes through the nose) since being in. M is 6 years old and has been in hospital for almost 2 months. She has had multiple cerebral infarcts (stroke) is sickle cell anaemic and is severely malnourished. The day before I saw her she had a convulsion (which are said to not be common for her) and her NG tube removed (why, I have no idea - I’ll get to that in a mo). C is 11 years old and has been in the ward for almost 3 months. He came in with meningioencephalitis (meningitis and inflammation of the brain) from which he has had several complications. He is still on an NG tube and is very underweight. Neither of the children are particularly alert, have difficulties with mouth control (M has clenched teeth the majority of the time), cannot support themselves at all physically and seem to have little to no understanding of spoken language. Therefore there are a LOT of difficulties they are likely to be having with eating/drinking (especially considering they have not had any oral intake for months) and a feeding assessment would proved to be difficult. The first thing I wanted to do was have a little look inside their mouths, which was a challenge in itself, to check the condition of oral hygiene. Both had severe oral thrush and there and then I didn’t want to risk doing any feeding until this clears up as aspirating (food/drink going down the wrong tube into the lungs) on anything can take this infection down and increase chances of illness which in the case of these 2 is definitely not a smart idea. I explained everything as best I could to all involved and when I returned on the Friday, low and behold C’s mouth was looking absolutely grand! J After a small feeding assessment, C had a good, slightly delayed swallow with no overt signs of aspiration and felt that starting him on a very small amount of oral intake would be a good idea so hopefully things will start picking up with C and his nutrition/enjoyment of life etc.
M however was not safe on any liquid - not only does she have very limited movement creating difficulty to give her anything orally, she had no swallow on a small amount of water and one day I came in her mum had just given her a small spoon of very thick medicine (like a gel) which is for her oral infection - she had an incredibly delayed swallow with very gurgly, heavy breathing ( a sign things are trapped/going down the wrong way) and the majority of the medicine seeping out of her mouth over the next 10 minutes or so. Considering her condition, her malnourishment, her oral thrush (probably causing pain when things are in her mouth ) and lack of oral movement/swallow it is unbelievable that they took her off an NG tube in the first place - so I explained all this to mum and nurses and got her back on an NG plus told everyone NO ORAL intake and that includes the oral thrush medicine which is a real head-banger as the drugs they use for this at the hospital only come in droplet form (which would be better/good to put onto a linen cloth and dab) or this gel. However the first one they tried for weeks with no results so the only other option is this gel which needs to be coating the mouth and swallowed. Something she cannot do/is dangerous for her.
The other really crappy thing is that the hospital want to discharge both kids as “they have been in beds too long” / “we have done all we can” which I guess how things work out here but there is just simply no way I would condone these kids going home with NG tubes in and relying on parents to clean/take regularly to a clinic to change the tube etc.. I simply don’t see the training being put in place for them. Additionally, just there conditions in general, drug intake, need for support etc.. It’s really really difficult/sad to see these kids be possibly moved out of the hospital when they desperately need the support.
School Training
Most of the schools are shut til January but I managed to sneak in one last training session at a private nursery attached to a school. All 7 staff members, the headmistress and the mother of the child I have seen there turned up and were really interactive and interested in the session which is great. It’s also so important and good for parents to be there with teachers to discuss ideas, know what the teachers should be doing to support etc.. Was actually pretty chuffed with how it went and off the back of it I got an email from the head of the main school who has requested I do a full staff training in January and had 2 calls from kid’s parents (a 4 year old at nursery and a 16 year old in school) asking when they could see me/giving me permission to work with their kids! So next week Weds I’m returning to observe/meet these kids, meet parents for case histories, speak to their teachers and check-in with the nursery staff who came to training.
Home visits galore
I planned to see 12 kids (from ages of 6 up to 19) at home before I disappear on holidays and managed to book in 7 over Thursday and Friday just gone. These home visits are specifically for those parents/children who attended an Autism workshop a few weeks back (some parents came as they wanted to know about communication systems rather than their children have an Autism diagnosis) to see how things were going and to continue/re-iterate/check their understanding of a few communication systems I have started to with certain children. It also is a massive help from my point of view to get to know the children better through observation and informal assessment (many I have only observed very briefly), seeing them in a different environment and observing the toys they may have/play with and the way they interact with family members. Below are some pics of the visits.
And that’s my lot!
Next week I’ll be continuing home visits, working at the hospital and spending two days shadowing a paediatric nurse and a social worker respectively to get a better idea of what they do/how they work here. After which I’m off to Tanzania and Zanzibar from Dec 12th to Jan 3rd give or take so my blog will be taking a hiatus.
I’ll check in next week before buggering off though!
Happy December and wintry times to most of you (am a bit jealous of cold weather at the mo!)
Love you all,
Jon x
Top 3 songs on Itunes shuffle whilst writing:
1. Little Shadow - Yeah Yeah Yeahs
2. Public Pervert - Interpol
3. Fear of Drowing - British Sea Power
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