The Rotary club of Kampala South held a Rotary Family Health Day at their Kikandwa Health Centre, on 9th June 2018. The event also doubled as a day for commissioning of the Maternity Ward (Phase II of the project).
The medical team was led by Rtn. Dr. Richard Kalungi and Dr. Doreen Bakyenga, working closely with clinicians from our very own Kikandwa health facility and International Hospital Kampala. Our partners and colleagues from Drake University and Rotary club of Des Moines AM, also joined us.
Services offered included but not limited to dental, optical, Ultrasound scan, Laboratory, Antenatal, Pharmacy and nutrition services.
It was during the course of the day that an 11 year old was brought in by his sister, He was apathetic, irritated, disturbed and obviously fed up. He was dressed in a dirty ‘kanzu’ that had since become his signature attire, and it easily revealed his grossly swollen abdomen. He became a centre of focus as everyone kept staring at him until one of the clinicians ushered him into the outpatient department emergency room. We later got to know him as Musisi Mohammed.
Medical team - Dr Richard and Dr Doreen carrying out assessment
It was at that point, that we realized he had actually struggled with the same state for the past 10 years! He lived about 7.5km away from Kikandwa with his father, who was reportedly unable to support him to receive definitive medical assistance for his problem. He had complaints of discomfort, constipation and spent most of his time lying on his chest for relief especially when he passed flatus. The family used to perform routine ‘soap enemas’, as taught on earlier hospital visits (before he turned 5) to relieve his on and off constipation and then chronic intestinal obstruction.
He was obviously sick, wasted and his overly distended abdomen stood out. Part of the team thought it could have been kidney disease, liver disease or even heart disease as we thought he was having ascites (fluid in the abdomen)! But here we were with an 11 year old, who had been in this same state for close to a decade! On examination of the abdomen, it was evident the young boy had huge amounts of air (gas) in the abdomen further confirming the intestinal obstruction! We therefore couldn’t perform a peritoneal tap (injection onto the abdomen to get rid of fluid hence reduce discomfort) as earlier anticipated as it was now clear there was no fluid in the abdomen like we had thought!
A decision was made through Rtn Rita Tinka, to support him and link him to specialized care and given the kind of family he came from, we chose to have him managed at a nearby facility, Naggalama Hospital as opposed to taking him to Kiruddu or Naguru.
Recovery in the ICU after operation
Luckily, we were informed that Musisi had a sister who stayed just meters away from Naggalama Hospital and we thought this would be a great opportunity for us to have him easily treated and followed up! We were however also able to perform an abdominal fluoroscopy on 14th June, 2018 which revealed massively dilated or enlarged bowel loops of the large intestine, and there we made a diagnosis of Hirchsprungs disease! Strange, because this is usually diagnosed and fully managed or corrected by 2 years of age!
On Friday June 15th (Eid Day), working closely with Dr. Benon Mugerwa, a medical officer and Dr. Titus Opegu, a Surgeon with the hospital, we booked Musisi for an exploratory laparotomy. The operation lasted 4 hours, and we were able to relieve his chronic obstruction by giving him a colostomy. He spent the whole night and part of the next day under close supervision in the high dependency unit but ably made it through and was sent to the ward where he was further monitored. Musisi continued to improve and was responding well to medication and his new state of a much reduced abdomen, the incision wound and having to get used to colostomy site/bag. He was later allowed to take tea and oral sips, then later soups, small amounts of food till he was now feeding normally. His appetite was perfect!
The members of the Rotary club of Kampala South were then informed of these proceedings and estimations totaling to up to UGX3.1M made of how much it could cost us to fully care for Musisi’s medical and feeding expenses till his 2nd surgery (reversing the colostomy), 3-6 months later depending on his nutritional status. The members responded positively and generously, giving in monies for this cause that we had now undertaken. The hospital was equally very supportive in reducing costs on surgery (costing just UGX 320,000) and total medical bill ending at just UGX1.3M. The rest of the Rotarian contributions would then cater for colostomy bags (5 Re-usable bags per week, @UGX7000), feeding and uptake@UGX50,000 per 7 days.
Musisi quite malnourished but very relieved after being discharged
Rotarians Rita Tinka and Dr. Richard Kalungi visited Musisi in hospital to provide the said items but also engage family members, understand their expectations and fears but also fully involve them in the out-of-hospital care for Musisi, during which the family agreed to offer full support to him and have him stay at his sister’s place for easy access of the hospital.
In a bid to address his low weight and malnutrition(as a result of his long standing intestinal obstruction), Musisi was discharged on 22nd June, 2018 through Noah’s Ark Hospital, a non-profit hospital which is just 15 minutes away from Naggalama Hospital for assessment and specialized nutritional support, and he was started on therapeutic food. He continues to improve. If you are willing to help please do get in touch with Rtn Rita Tinka