Gimbi bibles..............

January 24th

There is no such thing as anomaly scanning here and so I had been a bit surprised not to see any abnormalities in the babies so far.
That changed overnight last night as there were two babies delivered with problems that in the UK would have been diagnosed before birth thus allowing a plan to be made for management after birth or allowing the parents to consider the option of a termination of pregnancy (depending on the stage of the pregnancy and the nature of the abnormality). Termination of pregnancy for severe abnormality is also legal in Ethiopia although in the absence of any scanning I assume this is rarely undertaken.
The first baby has a cleft lip and palate on one side (they can be in the midline or on both sides which is worse). The problem with this is that babies require an intact palate to be able to create the suction needed to breast-feed and also to prevent them accidentally breathing the milk in (aspiration) during feeding. In the UK this is all addressed by regional cleft lip and palate teams who spring into action when a baby with this problem is born and use a variety of devices to make sure the baby is able to feed. Of course here there is nothing locally- there is a hospital in Addis called the Cure Hospital that specialises in paediatric problems like this and will treat the babies for free but this is only possible if we can manage to keep the baby well enough to travel and undergo surgery, thus the challenge at the moment is to try to get the mother to learn to feed the baby via a naso-gastic tube, simple enough in a clean environment but here the big worry is infection and gastroenteritis.
The second baby has bilateral talipes (we used to call this "club-foot" but the term is no longer considered PC in the UK although it will not surprise you to hear that it is the term most commonly used here). This baby can also be sent free of charge to the Cure Hospital but more is available locally. In a visiting Canadian Orthopaedic surgeon who left just last week did some training on treatment of this condition and the local Ethiopian Surgeon is going to put some special casts on the baby to get treatment started. His baby also has problems with its wrists, which is worrying as it suggests that he may have a more global problem but at the moment he is behaving normally and I have no-one else to consult about him.
This and the other neonatal problems that I have had to manage is a bit of a l like a crash course in neonatology and I am very thankful of the help of one of the other visitors Joyce who is a neonatal nurse, however as she points out the responsibility for prescribing any treatment she undertakes in mine! I have fortuately found a Unicef publication "Management of newborn problems" which is now one of my bibles here.