Improving child mortality

Our Medical Coordinator, Dr Emily Spry, is writing for the BMJ about her experiences at the hospital...

http://blogs.bmj.com/bmj/category/emily-spry/

A relatively newly-posted medical officer told me how she resisted returning to the children’s hospital after her three month stint here as a house officer last year. “It was so awful when the children died, and they died all the time. I went home and cried every night.”

If you believe the stats (which are certainly not bulletproof but hopefully skewed in a fairly consistent way), the inpatient mortality rate has fallen from 15-20% in previous years to less than 7% last month. A large part of the credit must go to German charity Cap Anamur, which has implemented free drugs and basic disposables for all children admitted as inpatients. I’m hoping for further improvement this first month of our Emergency Room, though there are also seasonal variations; we should expect less mortality now that the rains have finished.

The medical officer was pleasantly surprised by how the hospital has changed in the past year, but it’s still tough on those days where several children die. She was particularly frustrated and upset the other morning, when it emerged that a child with meningitis who “passed off” had not been given his antibiotics overnight.

We discussed the different ways of addressing how this had happened and how to prevent future mistakes. Partly as a result, we’ll be restarting the lapsed “medical meetings” next week, which will look at difficult or troubling cases.

But when it came to the issue of trying to establish the details of who had done what on this particular night, she drew back. “I don’t believe in it myself,” she said, “but there are some people here who have special powers. There are people in this side of town where you can pay just ten thousand Leones [less than 2 GBP] and have a curse put on someone. I don’t want someone to have a reason to hate me.”

She related a tale of a friend who developed a severe skin condition that no conventional doctor could diagnose or treat. When she sought the traditional healers’ opinion, he was able to diagnose a curse and cure it with a special potion.

“As I say, I don’t really believe in it myself, but you have to be careful in this country.” She seems to believe it enough to avoid causing problems for a nurse whose neglect or mistake contributed to this child’s death.

Is this a cultural expression of something rather more familiar? No one wants to be seen to rock the boat, to point a finger of blame, because of the potentially dramatic social consequences.

Somehow we need to create an environment and a process through which we can examine what happens and raise the standard of care. It’s just, as always, a bit more complicated than I thought.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.