Hello from Mpigi, Uganda. My name is Mandy Gordon, I am a 33 year old American nurse practitioner who arrived in Uganda two weeks ago, with the intent of volunteering for a number of months at the Double Cure Medical Centre (DCMC). I learned of the DCMC while fulfilling clinical hours requirements for my family NP degree with Dr. Stephen Gluckman at the University of Pennsylvania. He subsequently introduced me to Nereida Gordon, the tireless founder of the ECHOES foundation, and the Serunjogi family, who are the Ugandan founders of the clinic and three schools in the greater Kampala area. After a rather breathless stretch of months in which I finished my family NP program, took the certification exam and prepared to live abroad for a while, I am here in Mpigi at the DCMC.

The clinic is staffed by two physicians, Dr. Lydia and Dr. Faisal, a clinical officer (less time in medical school than the full MD's, as I understand the position), as well as a midwife, nurses, a pharmacist and a dentist. The scope of what they all can do and what they have witnessed clinically is incredibly impressive, and I am in constant awe of the way in which they handle the challenges of medical practice here in Uganda.

Yesterday evening, a 20 year old mother presented to the clinic with her 3 week old daughter. The baby had developed a pimple on her leg about a week ago, followed by fevers.  She was seen at a local health clinic and was prescribed antibiotic syrups. Her mother brought her to DCMC because despite this treatment, the baby continued to feel hot to the touch.

Upon examination, the infant was indeed feverish,  as well as lethargic. Unwrapping her blankets, we discovered a 3x4 cm blackened patch of tissue on the side of her very swollen right thigh. Immediately below this gangrenous area was a deep sinus tract, which was draining a small amount of pus. The baby's parents had reportedly noticed these lesions, but didnt recognize them as significant. The fever that they had noted was symptomatic of the baby's systemic infection. Dr. Lydia determined that the gangrenous tissue would need to be removed in order to determine how deep the infection went, and thereby whether or not the leg could be spared fro  amputation. Dr. Lydia placed an iv in the baby's tiny arm for infusion of antibiotics and sedatives prior to the procedure. There was a bit of scrambling prior to the procedure, as only a few rooms in the clinic had overhead lightbulbs in place, and the procedure room was not one of them.

Once a lightbulb had been brought in from another room, a small amount of valium was given to the baby. The infant lay quiet as Lydia repeatedly squeezed the leg to force pus to drain from the sinus tract. Once finished with that, she cut away the black, leathery patch of gangrenous tissue from the baby's leg. The infection did not penetrate muscle or bone; Lydia was optimistic that no amputation would be necessary and that the baby would recover. The wound was packed with gauze and wrapped; the baby and her mother were sent to the pediatric ward for observation and treatment throughout the night.

This morning, the baby was without fever and was appropriately fussy. Dr. Lydia changed the wound dressing and washed the exposed tissue with an antibiotic solution. She suggested that the family would be able to go home for the night, and return to DCMC tomorrow so the baby's progress could be monitored.

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