Anaesthetics at Chaaria;a Kenyan Bush Hospital

Dr Michelle Hamer

21/05/15

History

1983: Start of a mission by the Cottolengo Brothers, in Chaaria, south east of Meru town

1984: A dispensary & a home for handicapped boys Buoni Figli open.

1993: Start of a mobile clinic

1998: Br Beppe Gaido specialist in HIV & infectious diseases arrives and out of necessity a hospital starts to evolve under his leadership

2002: Cottolengo Sisters arrive

Now cheapest hospital in the area. It treats mostly the very poor; patients turned down by & with complications arising from; other hospitals.

Facilities

160 beds (2015): 1 male & 1 female ward, maternity and paediatric beds

2 Operating theatres (1 in good condition)

Outpatients including ante natal care

Endoscopy Ultra sound - ECG

Dentistry Immunisation

Pharmacy Laboratory

Physiotherapy

Radiology: C arm

Outpatients

Female ward

Male ward

Paediatric Ward

New labour ward

New maternity

Staff

98 staff including all clinical & non clinical

Cottolengo Brothers and Sisters

1 permanent medic/surgeon (Br Beppe)

1 government funded doctor for 1 year

2 anaesthetists (18/12 training, experience ++)

5 clinical officers: 3 yrs training (outpatients)

1 visiting local surgeon from Meru Hospital

Volunteers (medical and non medical)

Br Beppe Gaido

Dr Khadija & Br Beppe

Jesse & Mbabu: Anaesthetists

Makena, Theatre Matron

The Brothers

Activity in 2014

60.000 outpatients

8000 inpatients

1400 deliveries

650 Caesarean Sections

2900 operations

An enormous amount of work done by very few people

2015 may be even busier!

Preoperative preparation

Anaesthetic visit the evening before

Blood tests inc HIV, very rarely ECG

Children weight +/-

No premedication

NBM from midnight

Antibiotics: Ceftriaxone +/-

Most patients are cannulated +/- IVI

Consent

Consent

Typical operating list

Anaesthetic set up

Induction and recovery done in theatre

Oxygen / N2O cylinders

Halothane vaporiser

Oxygen concentrator

Gambro Anaesthetic machine & ventilator

Monitor: HR, BP, Saturation, alarms & trends

No ECG, no end tidal CO2

Suction unit

Airway equipment

Rubber face masks, Guedel airways (re used)

A few LMAs (re used)

Laryngoscopes, ETTs (not re used)

Hudson mask x1, nasal cannulaes x4 (re used)

Bougies, NP airways, Aintree catheters (UK)

Note to self: next time; bring front of neck and paediatric equipment, filters, Yankauer suckers Hudsons masks, nasal cannulaes

Drugs

Diazepam / Ketamine for all GAs Heavy Marcaine Suxamethonium, Pancuronium Atropine, Ephedrine, Adrenaline Lignocaine plain & with Adrenaline Diclofenac IV, paracetamol suppositories (100 mg

only) Pethidine: occasionally intra op, mostly post op Metoclopramide, promethazine Frusemide, Aminophylline

Victoria, 6/12 old

Osea, age 3

Brian, age 11

Martin, age 13

Log Book 05/01/15 23/01/15

80 cases.

ASA not reliably determined

Age range: 4 months 75 years old

27 children under 16

41 spinals (6 in children 8 13 years old)

38 GAs +/- block

1 LA; umbilical hernia (Mbabu)

Mangoes season!

Casemix

11 Caesarean Sections

10 gynae laparotomies inc TAH

3 open prostatectomies

7 general laparotomies

29 T&O cases

2 Panga injuries

1 thyroidectomy

1 evacuation of subdural haematoma (thio) etc...

The patients are different!

They are often very poor with extreme pathological conditions and malnutrition

Easy spinals, more difficult cannulation

Very high pain threshold

Many are HIV positive

Appear to tolerate well chronically low levels of haemoglobin

Ephedrine used only twice in 3 weeks!

Very accepting, non complaining & grateful!

The hospital farm

The volunteers

Rinaldo, Gracia & Max

Luciano & Francesca

Ania & Michael

Making pasta

Francesca, Antonella, Sr Joanne

A Chaaria orphan

Around Chaaria

Chaaria village

In summary

Chaaria is an exceptional and inspiring place to work at, one of the best experience in my career

One of the hardest, mostly due to establishing relationships and communications

It needs funds to recruit more permanent staff to be able to respond to the growing needs and remain sustainable

It still needs volunteers... Anyone interested?

More about Chaaria

http://chaariahospital.cottolengo.org/

http://chaariahospital.blogspot.com/

https://it-it.facebook.com/pages/Chaaria-Mission-Hospital/47488569530

/http://chaariahospital-foto.myblog.it/

http://www.ehealth.or.ke/facilities/facility.aspx%3Ffas%3D11977