Pre operative care-at_hospital_kachinga_sichizya

Kachinga Sichizya, FCNeurosurg(SA)

Beit-Cure Hospital,

Lusaka, Zambia

CHALLENGES IN AFRICA COMMUNITY

Ignorance of problem

Lack of acceptance by parents

Stigmatization by community

Witchcraft suspicion

Ignorance of available medical help

Poor/unhygienic enviroments

Financial constraints

Late presentation

CHALLENGES IN AFRICA MEDICAL CHALLENGES

Lack of knowledge/understanding of problem

Fear of likely poor outcomes and suspected poor

QOL

Lack of surgical expertise to manage SB/H

Lack of facilities

No ultrasound facilities for antenatal diagnosis

CHALLENGES In the third world, we still have a long way to go before

we can manage SB/H properly

The biggest challenge is knowledge and understanding of the condition of SB/H

There is lack of emphasis in training of medical personnel at all levels: TBA, nurses, CO and even doctors. This must change

There are no facilities for ante-natal diagnosis, so we are not prepared for such a birth

Most of these children are born in unhygienic conditions and are exposed to unhygienic practices such as applying cow-dung to the lesion

COUNSELLING FOR FAMILY Inform/educate family about condition and prevention

Create realistic hope

Parents don’t know what has hit them. Take time to

explain the condition of the child and how to prevent

recurrency

Tell them: treatment will help the baby but not cure.

Child may need other operations(VP shunt, correction

of limb deformities etc)

Child will need CIC management

Give info in leaflet

ON ADMISSION Assess general condition of the patient:

The majority of patients present late

They are not ready for surgery

They are septic, dehydrated and with very dirty

wounds

Some are anemic

Pre-op assessment CLINICAL EXAMINATION:

Head circumference/start chart

Brain ultrasound if need be

Body temperature

Nutritional status, weight, hydration

Other deformities: weak limbs, club feet, open

anus

General condition of baby

Pre-op management Rehydrate the patient

Workup the patient for sepsis and anemia

Do pus swab of the lesion for M/C/S

FBC

If Hb is low, either transfuse pre-op or cross-match to transfuse on the day of surgery

If the child is septic, start on broad spectrum antibiotics until sensitivity results are ready

In case of severe sepsis, there may be need for debridement before closure can be contemplated

Pre-op management WOUND CARE:

Keep baby in prone position(on tummy) to avoid

pressure on the wound and to prevent stool coming

onto wound and avoid the pain

keep the lesion clean

use normal saline for cleaning open wounds

cover with sterile dressings

Only give antibiotics when signs of sepsis appear

Many thanks for the attention