Liberia noon conference 8.3.10


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Liberia noon conference 8.3.10

  1. 1. LIBERIA::HEARTT<br />Health Education And Relief Through Teaching<br />Emily A Hartford, MD<br />Pediatric Resident R3<br />Global Pathway<br />Emily A Hartford, MD<br />R3 Pediatrics, Global Pathway<br />
  2. 2. Outline<br />Background: Liberia<br />Admission data: June<br />Typical pediatric case<br />HEARTT<br />Current projects<br />Opportunities for involvement<br />
  3. 3. Context::Liberia<br />1847-1980: Americo-Liberians <br />(Congo people) and Country people<br />1980-1990: Military dictator<br />1990-2003: Civil War<br />2003-2005: Interim government<br />2005: Democratically elected President Ellen Johnson-Sirleaf, Africa’s “Iron Lady” <br />)<br />
  4. 4. Context<br />Population: 3,685,076 <br />(July 2010 est.)<br />Religions: Christian 40%, Muslim 20%, indigenous beliefs 40%<br />Development Indicators:<br />-85% unemployed<br />-80% poverty<br />-76.4/1000 infant mortality<br />-56.5 yr life expectancy<br />Extreme “brain drain” and instability<br />1980-2003<br />Now: Intense rebuilding<br />
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  6. 6. Pediatric Resourcesover time…<br />Pre-war: premier hospitals for W. Africa,<br />Accredited medical school<br />1990-2003: MSF opens hospitals in many of Liberia’s 15 counties <br />2003-2005: MSF begins handing over hospitals to MOH<br />June 2010: final MSF hospital closes<br />60 practicing doctors in Liberia (population = 3.6 million)<br />ONE Pediatrician<br />MOH hospitals trying to keep up with demand<br />
  7. 7. Pediatric Access to Care2010<br />40-50 Pediatric+NICU+ED beds<br />Dr. Emmanuel Okoh<br />2-3 Interns rotating<br />2-3 Physician Assistants<br />10 medical students<br />Visiting HEARTT physicians<br />3 other hospitals<br />(90-130 beds)<br />
  8. 8. Setting: JFK Hospital<br />Monrovia, Liberia<br />Built in 1968<br />600 beds <br />Opened in 1971<br />US funds until 1978<br />Now main referral center and only academic institution<br />Full service hospital: Inpatient wards, ED, Maternal-infant care, Surgical services, Outpatient Center<br />
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  10. 10. February 11, 1990<br />TROUBLES PLAGUE LIBERIAN HOSPITAL<br />By KENNETH B. NOBLE, Special to The New York Times<br />MONROVIA, Liberia— The John F. Kennedy Memorial Hospital, once the finest in West Africa, recently announced on the radio that its morgue could no longer accept ''dead-on-arrival bodies'' until relatives claimed the ones that were already decomposing. The hospital said the morgue's refrigerator was broken. Hardly anyone here was surprised. Twenty years ago the 600-bed hospital, built and equipped with American money, was a technological marvel. Today, even by the relatively modest standards of medical care in sub-Saharan Africa, the Kennedy hospital is regarded by most Liberians as a destination of last resort.<br />''Things have become so bad there we wonder if we can still call it a hospital,'' said the Rev. Walter Richards, a Baptist minister and former Government Cabinet member. He said one of his church members who had been hospitalized told him she would rather die than continue suffering there. <br />
  11. 11. Ward Admission Diagnoses: June 2010<br />
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  13. 13. Case fatality<br />
  14. 14. NICU Census: June 2010<br />
  15. 15. JFK NICU<br />
  16. 16. Case fatality<br />
  17. 17. ED Case : <br /><ul><li>Chief complaint: “hot skin and jerking”</li></ul>10 mo PH carried to ER with 2-3 days of hot skin, especially at night, not eating, vomited 2-3 times, no diarrhea, also coughing and breathing fast. <br />
  18. 18. History:<br />PMH: vaccines UTD, no issues at birth, exclusive breastfeeding until 6 mo, healthy weight for height<br />FH: only sibling died with similar symptoms 2 yrs ago<br />SH: Single mom age 22, grandparents/uncle died in the war, dad’s whereabouts unknown, no bed nets <br />
  19. 19. Vitals: 8 kg<br />T 40 HR 155 RR 52 Sat 94% RA<br />Gen: minimally responsive, agitated with a weak cry, withdraws from painful stimulus, low tone, no sz activity<br />HEENT: conjunctiva pale<br />Lungs: crackles bilateral bases, tachypnea/severe retractions<br />Abd: spleen palpable 2 cm<br />Ext: cap refill 2 sec, warm ext<br />Physical Exam<br />
  20. 20. Differential and Studies: SCH<br />What studies?<br />CBC, Bldcx, CRP, lytes, glu, BUN, Creat, LFTs, gas<br />CXR<br />UA, urine cx<br />Head CT<br />LP<br />Malaria<br />Pneumonia<br />Gastroenteritis<br />Meningitis<br />Sepsis<br />
  21. 21. Resources at JFK:labs and studies <br />Malaria smear<br /> (takes 1-2 hours)<br />Hb (2 hrs to 1 day)<br />CBC (1-2 days)<br />Lytes, BUN, creatinine (machine broken)<br />Glucose (out of strips for glucometer)<br />Cultures (not available)<br />Urine (no bags, only 8 french catheter available)<br />CXR (1 day)<br />LP (no supplies, no ability to culture) <br />
  22. 22. Resources at JFK: management<br />Antibiotics available: Ampicillin, Gentamicin, Chloramphenicol, Amoxicillin, Cloxacillin, Penicillin, ?Ceftriaxone, Ciprofloxacin, Erythromycin, Cotrimoxazole<br />Malaria protocol: Quinine, Artemether available<br />IV access: expert RNs<br />Fluids: NS or D10 <br />
  23. 23. For our patient: management<br /><ul><li>HB and Malaria smear
  24. 24. Antibiotics: Ampicillin, Gentamicin
  25. 25. Malaria protocol: Quinine
  26. 26. IV access: expert RNs
  27. 27. Fluids: NS or D10 </li></li></ul><li>HEARTT:: health education and relief through teaching<br />Founded by Liberian-American ED physician<br />Goals:<br />Support improvement of medical system<br />Educate new and existing providers<br />Encourage and promote sustainable practices<br />Continue long-term relationship and communication<br />Emphasis in Pediatrics and Emergency Medicine<br />Associated with Mt Sinai and U Mass (UW?)<br />
  28. 28. Visiting Physician Role<br />Clinical support on a rotating basis: <br /> ED, NICU, wards, chronic care clinic<br />Teaching: interns, medical students, RNs, PA students<br />Protocols<br />CPI<br />Tropical disease<br />
  29. 29. Current HEARTT projects<br />Neonatal Resuscitation <br />Pediatric HIV clinic<br />Chronic Illness Project<br />Chemotherapy Regimens<br />Medical school curriculum<br />Pediatrics GME – Liberia’s first residency!<br />
  30. 30. “Mama Africa”<br />Bed nets campaign<br />
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  32. 32. Liberian Wisdom<br />“Monkey works, baboon draws”<br />the person who does the work should get the credit<br />“Your child cannot poo-poo on your lap and you cut your legs off, you just have to clean them”<br />don’t walk away from your responsibilities<br />“You can’t be sitting on someone’s head and say their hair stink”<br />be thankful for what you have <br />
  33. 33. Interesting cases…<br />
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  40. 40. What next?<br />Email me and Dr. Ellie Graham for more info,<br />HEARTT website<br /><br />Read more about Liberia!<br />House at Sugar Beach by Helene Cooper<br />This Child Will be Great by Ellen Sirleaf-Johnson<br />
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  43. 43. Many thanks!<br />Ellie Graham<br />Georgietta Oliveira<br />Emmanuel Okoh<br />Suzinne Pak-Gornstein<br />ManeeshBatra<br />The Chiefs<br />Wilfred Jordan<br />Patrician McQuilkin<br />Ryan Hartford and my family<br />Gracious and inspirational people of Liberia<br />