GULU UNIVERSITY MEDICAL JOURNAL

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Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. In 1997, war by the Lords’ Resistance Army (LRA) is ravaging throughout the whole of northern Uganda but about 350km away, in Kampala, there are no signs that such a thing is happening anywhere in the country. Despite the fact that the war had already lasted over a decade by then, people of northern Uganda, both in the region and away, had the belief that one day home would be safe again. The people in Kampala knew very well that a war was going on down north but one wonders how they were able to put it out of their minds for most of the time. Well, they did that the same way a person goes to bed at night, closes his eyes well wishing to open them later the next morning when things are better. Human beings go out to do something with the belief that their desired goal(s) will be achieved at the end of it all. In difficulty circumstances, one closes his eyes to sleep hoping to open them the next morning to a better world. After 6 years of college, we apply to medical school knowing very well that admission depends on results to come in a couple of a months’ time and that the competition is high for the few available slots in all the medical schools in the four universities offering the course in Uganda. But we do this hoping to excel in the exams and make it to the prestigious medical schools. Even when we get to medical school, we have faith that we will eventually complete five years of reading difficult books and passing hard exams to become doctors…….HOPE! By the same principle a man walks up to a woman and asks her out on a date knowing very well that the possibility of her saying no is well over 60%, but he does it anyway with the hope that she will say yes. Even better, a man goes down on his knees and asks a woman to be his wife for life knowing the probability of her saying yes is minimal. But he does it anyway, because he is human enough to wish for the best. In 2001, when the Americans announced that they would be invading Afghanistan, the Afghans did not beg for mercy but simply said bring it on ignoring the American superior weaponry because they had hope that they would make it through the war and overcome Hope Man’s best strength Okello Innocent, MBChB IV 2009/2010. their invaders. The same thing happened in Iraq. In 1971, when Idi Amin Dada, staged a coup and took over the presidency from Dr. Milton Obote, Ugandans jubilated because they thought things would get better after undergoing a lot of economic hardships. Months later they discovered that life was actually better before Amin’s take over. Driven by hope for a better life, a new struggle to dislodge the Amin administration from power started and this was finally ‘rewarded’ in 25th January, 1979. When a woman gets pregnant, she takes good care of herself so that after nine months she can be a proud mother of a healthy and happy baby. It is even with greater faith that she hopes her child will grow up to be important to her and her country. When it comes to maternal and child health, by giving the women hope for a better future, a good deal of the job is already done. Programs like prevention of mother to child transmission (PMTCT), free Antenatal care and saying no to domestic violence, all go a long way in showing that things can get better for the mother and her child. We are simply human, with no powers of fortune telling about what tomorrow will be but we always know what we want tomorrow to be like. Just as a man with a hangman’s noose around his neck has hope of living to see the next few minutes of his life, so do you of seeing your grandchildren grow or of her saying yes to a question you asked two months ago. As human beings we are only defeated when we have lost hope of achieving our goals and for those we love, however far or close, we are to achieve them. So the next time we hear something about promoting maternal and child health, it becomes our duty to give these women and their children the idea of a better tomorrow for her and her child. Gulu University Medical Students’ Association (GUMSA) Passion for life 58
Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. PART 1 Lamunu a one year old Acholi female toddler from Amuru district Northern Uganda was brought into Dr Doreen’s office by her mother who reported history of (h/o) difficulty in breathing (DIB) for 4 days and fever and cough for 3days. Although these were about the only statements she could articulate in English, she resented Dr. Doreen’s suggestion to use an interpreter. “English no problem to me!” She exclaimed. History taking was technical but Dr. Doreen gathered that the patient was not growing as the mother expected and is always crying in addition to the DIB, fever and cough. The DIB was moderate, of sudden onset, constant throughout the day, aggravated by attempt to play, move around, lying flat or breastfeed with history of gasping for air when breastfeeding and mildly relieved by rest. It was associated with fast breathing but not noisy. A day later she developed a dry cough which was of sudden onset with no aggravating or relieving factors. There is no known h/o TB contact or anyone at home coughing. There is history of easy tiring while moving around and breast feeding, however, no reported body swelling. She developed a low grade fever too which was of sudden onset, intermittent, relieved by tepid sponging with no aggravating factors but associated chills however, no convulsions, loss of consciousness or vomiting. Questions 1. Is it possible for Dr Dorine to come up with a diagnosis at this point? Which ones could you think of? 2. Support your answer. PART 2 There was no significant finding on review of other systems. This is the child’s third admission. Index admission was at 2 months of age at a private clinic with similar symptoms. With a provisional diagnosis of pneumonia, she received O2 therapy and other unspecified medication on which she slightly improved 2 days later, however, had regular visits to various clinics Gumj Quiz with similar symptoms. The second admission was 4 months ago at a referral hospital. Mother says she was told, her daughter has a “hole in the heart” though she had no medical documents to support this. She is too concerned about her child’s unchanging health because during her last visit to the hospital the Dr informed her, the “hole” would close on its own. The infant has frequently been on unknown medication, however, with no h/o drug or food allergies and is of unknown HIV sero status. She has not been diagnosed with any chronic diseases like sickle cell disease. She was transfused with half a unit of blood during the last admission but no h/o surgical operations. In the prenatal, natal and neonatal history, mother conceived at 20years old, had 4 Antenatal Care visits, was screened for syphilis and HIV infection (results not given), and received folic acid tablets but not malaria prophylaxis. She reports no h/o febrile illness, rash-like illness, smoking cigarettes, taking alcohol, other drugs of abuse or unprescribed drugs during the pregnancy. She has never been diagnosed with any chronic disease like Diabetes Mellitus (DM) or Hypertension (HT). Labor lasted 6hrs, membranes ruptured spontaneously and delivery was preterm (7 months) at home, by spontaneous vertex delivery (SVD), assisted by a traditional birth attendant (TBA). The cord was cut with a razor blade from a nearby shop and tired with pieces of thread from a clean cloth. Child cried immediately and the weight taken 2 days later was 2.2kg. No history of yellowing of body or eyes or any admissions during the first 28 days of life. Mother says the child has lost weight. She was breastfed exclusively for 5mo. Breastfeeding (B/F) was on demand though her poor health would frequently interfere with desire to B/F. Complementary feeds were introduced at 5mo due to insufficient breast milk. They comprised of bean and fish soup with smashed Irish potatoes. Currently she takes both breast milk and complementary feeds including millet porridge with milk, green vegetables, simsim, beans and sweet potatoes. Meals are thrice a day prepared by mother or siblings and eats about a handful. The child received BCG (scar was observed) 2 days after birth, but schedule was completed. Growth and development had a slow progress. She can laugh, bubble and make unspecific noises. She doesn’t Gulu University Medical Students’ Association (GUMSA) Passion for life 59
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GULU UNIVERSITY MEDICAL JOURNAL

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