Case of the Week: 3rd September

September 3, 2018

This week we would like to tell you about an interesting case we had in the children’s ward at Kivunge. According to the notes this young boy had been admitted with fever and vomiting and the local team had started him on antibiotics. However as you will hear, finding out a bit more about his history can be of great help when trying to identify the problem.

 

The local doctors see a few conditions frequently, such as pneumonia in children, and are generally good at treating these. However, sometimes we find that patients can be diagnosed with a condition a little too quickly, without enough investigation of other potential diagnoses. One of the key roles of the HIPZ volunteers is to support the local doctors to keep improving how they examine and treat patients. We have been particularly working on taking a full history and this case is a great example of why this is important.

 

On the ward round, the HIPZ doctor and local doctor found a slightly confused mix of information in the notes of this young patient. On talking with the boy’s mother we found out that he hadn’t had a fever (as recorded) but had in fact been been yellow (jaundiced) on admission. He was now feeling much better and didn’t look yellow, but we investigated further about what had happened as jaundice can indicate a serious problem and is unusual in children of this age.

 

Speaking in rapid Swahili the local doctor questioned the mother and then turned to the HIPZ doctor with a sceptical look that suggested the mother had said something a bit strange and unlikely. Apparently the boy turned yellow every time he ate beans. This brought an immediate knowing smile from the HIPZ doctor because there is in fact an unusual condition that causes exactly those symptoms! By asking the mother for a bit more information we worked out that he probably had a condition called G6PD (also called Favism). As it’s genetic we checked if anyone else in the family turned yellow after eating beans and were informed that his sister did it too. Luckily this problem has a very simple solution – don’t eat beans. In fact it’s only one type of beans (fava or broad beans) that you should avoid. With a little help from Google we showed the mother what beans she should watch out for.

 

This case shows how talking and recording a full history can make all the difference to properly treating a patient’s problem. Also to think outside the box and consider alternatives to the common conditions we see every day. In order to help the local team and create a consistent approach to admitting patients a previous HIPZ volunteer introduced an admission proforma at Kivunge. This form simplifies the process of admitting a patient properly and makes sure nothing gets missed. This way patients can hopefully get the correct treatment straight away.  It also provides vital information to the future doctors looking after the patient. The proforma has been adopted well at Kivunge and has now been introduced at Makunduchi as well. This is part of the HIPZ vision to create sustainable change, often through simple interventions and working alongside the local team.

 

 

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