MTRH NICU   Leave a comment

Moi Teaching and Referral Hospital Neonatal Intensive Care Unit

Impressions and Thoughts

When a baby is born that is in need of special medical attention, they are admitted to the NICU.  In the states, the sick neonate is placed in a crib or incubator and attached to series of tubes and wires.  Temperature, respiratory rate, fluid balance, heart monitoring, and weight are analyzed on a constant basis.  A fleet of doctors, nurses, technicians and students pore over the data and assess the wellbeing of the child.  It is an intense environment that must seem as alien to the new parents as the world appears to the newborn.

The NICU I walked into in Eldoret this week bore little resemblance to what was just described.  After changing into hospital scrubs and donning communal slippers we entered the first of several rooms.  We were greeted with a wall of heat.  The babies were placed nude in a row of plastic bassinettes on wireframe stands lined with a black mattress covered with a hospital sheet.  There were no wires, no monitors, no tubes.  Some of the babies had a fine plastic oxygen line fixed to their nose at one end and spliced together with other lines leading to a lone O2 tank.  The heat was produced by a series of rusted electric coil heaters haphazardly placed on the floor.  Metal bowls of water were placed in front of the heaters to provide humidity.  Why heat a room in a cinderblock building just miles from the equator?  It dawns on us that the room itself is functioning as a giant incubator.  Body temperature; 98.6 degrees.  Necessity breeds innovation.

There is no relief from the heat in the next room.  This room harbors some of the sickest babies in the hospital.  Some are awaiting surgery they may never get.  Some lay blindfolded under the hum of a fluorescent bili-light to combat their jaundice.  One baby was born with externalized intestines with little chance of survival.  There is a single nurse assigned to each of these intensive rooms.  There are no monitors.  The nurses’ charting consists primarily of paper cards where weight and temperature are listed and little else.  Inevitably, the power fails leaving us temporarily in the dark until the large diesel generator belches to life outside the NICU window.

The final room is larger and houses the healthiest newborns still requiring some degree of medical attention.  The plastic bassinettes line the walls, each one containing a naked baby.  In the center of the room is a pair of rough hewn wooden benches where the mothers congregate.  The women are clothed in hospital gowns tied at the waist.  Most sit with their breasts exposed.  (Breast feeding is by far better accepted in Kenya than the states and it is not uncommon to see a woman breastfeed in a restaurant.)  The hospital has some interesting rules about when a baby should be allowed to breastfeed.  Before starting breastfeeding, many mothers are told to cup feed their infants.  These women sit on the benches and use their hands to massage milk into small containers.  They then hold their babies at arm’s length in blankets pouring the milk from the containers into the babies’ mouths.  It is shocking that more of them do not aspirate milk into their lungs.

Dr. Lemons, director of neonatal medicine at Riley Hospital in Indianapolis, arrived at the hospital this week.  He has been instrumental in arranging the funding to make the MTRH NICU a reality and continue to improve the conditions here.  The hospital administration elected to post a framed picture of Dr. Lemons in each NICU room whereas the rest of the rooms in the hospital display a portrait of Kenyan president Mwai Kibaki.  The morning Dr. Lemons arrived, the unit was swarming with doctors (called consultants and usually hard to find on the wards).  A blue ribbon was hung from the NICU doors for Dr. Lemons to cut.  As he entered the ward, he noticed his portraits.  He was obviously uncomfortable with the celebrity attention he was receiving.  With him were two Riley NICU nurses here for their first visit; both trying to conceal their surprise at the state of the ward.  Their job will be to assess the conditions in the MTRH NICU and determine areas in need of improvement.  They have one week.

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Posted April 25, 2009 by chrislux in Travel

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