Orthopedic Hospital

Today we went to the Cheshire Orthopedic Hospital. It was a great experience. The hospital treats children from all over the country with congenital malformations including club foot, cleft lip, cleft palate. They also do physical therapy for these patients and also patients with cerebral palsy. Many children were happily running around with crutches and devices on their legs that are helping their bones heal (usually from osteomyelitis rotting away part of the bones) to a normal length. Ellen sees patients there once a month to give pediatric advice and treat any other problems. It is a great facility: normally a malformation in Africa means that you will be doomed to be a beggar the rest of your life. Many beggars on the street have malformed limbs, cannot get around easily, and are dismissed by their families as a curse. So, it is amazing that this place can offer healing to many malformations that are totally treatable. The stay is usually a long one since the patients receive physical therapy, and families come stay with them. There is a farm and garden that the families can work on to help “pay their stay” and keep all the guests fed.

After a quick tour of the workshop for making casts and walkers and braces we greeted the children. Then we saw some very interesting cases. The first child was 7 months old and had hydrocephalus. A doctor noticed his large head circumference a few weeks after his birth and he was sent to the country’s hospital. However the hospital was backed up and he did not receive treatment for months. Finally a shunt was installed to drain his CSF from being clogged in the brain to his stomach area. When we saw the boy he was comatose and would not follow our fingers with his eyes. He also had a hydrocele (a descended bag of fluid into the scrotum). So I preformed my first real testicular exam on a comatose infant--not a bad way to start! It is a tragedy that brain damage has occurred because the hospital was not able to treat him in time.

The second child really shocked me: the 2 month old baby boy was less than 4 pounds!!! The mother unwrapped this tiny creature that only had one finger on each hand and whose arms were kept retracted because of radial malformation. He was very pale, and Ellen ordered a CBC because she suspected pancytopenia. It is most likely that the mother had syphilis, toxoplasmosis, or rubella early in the pregnancy that effected his growth. The hands are formed by the 8^th week, so her infection was probably before she really knew she was pregnant. We ordered a VDRL on the mother. Syphilis is very common here.

We also saw a boy with cranisynathosis. He had an “egg shaped” head because his skull bones had fused and his brain could not grow with his body. He obviously had brain damage because he was mostly unresponsive. The mother had abandoned the boy, and now the grandmother was taking care of him. This is common in Africa: when a child has disabilities it is considered a curse and a drain on the family’s resources. The local “euthanasia” includes locking the child in a home and leaving until he dies, abandoning him in the street, or anywhere else. Grandparents are put in the role of the family provider if they have the heart to take care of these children. Many grandparents have to adopt the role of taking care of all the children when the parents die of AIDS. There is a neurology hospital in Mbale (where Mrs. Chechanowitz will work), but they would not take on the case. The child was already five months, and even with the surgery he had irreversible brain damage.

The time there was very touching. Despite the sad conditions of some of our cases, it was encouraging to see all the children getting treatment. If not for this hospital children all over the country would lack the attention to overcome their conditions.