Salama: a heart surgery case from Sudan

Salama, a one-year-old from a small Sudanese village was very sick when they met Dr. Ellen Little in a hospital in northern Uganda. Ellen mentioned she would see the child if they were ever in Kampala. Sure enough, they took her up on the offer and came looking for her months later.

Salama was missing an entire septum between her atria, not just a defect. Ellen didn't hear a murmur since the entire septum was gone, but the clinical presentation gave her a clue that the child was suffering from heart failure: failure to thrive, enlarged liver from hepatic congestion, displaced spleen and liver, diaphoresis, tired easily, tachypnea. An echocardiogram confirmed the diagnosis, but pediatric open heart surgery was not available in East Africa, so Ellen could only offer to write doctors in the U.S.

People in the states agreed to raise money and doctors agreed to the surgery. Salama's parents could not accompany her because they could not get visas as Sudanese citizens, and her father could not get a passport since he was fighting against the government of the North. Ellen took the child on plane to the states, and it was a miracle that the baby survived the trip (especially since Ellen couldn't nurse her!). They performed the operation, but in the process destroyed the SA node, the pacemaker of the heart. So an artificial pacemaker was installed and Salama returned to her war-torn village after an intense surgery.

Now she is three years old, and we received a call that while on digoxin she had overdosed: she was vomiting. Ellen advised them to get her to a hospital, but because of the distance, they took her to a small clinic that did not understand what was going on. Then next morning they got to the hospital with Ellen's urging, and were transfered to a heart hospital. However, they were lost in the shuffle and never made it there either until Ellen found them. She has been released from the hospital and we'll see them tomorrow.