The new year signaled a new MSF project in Monrovia - the first ever dedicated paediatric surgery programme in Liberia. The babies and children of Liberia now have access to free emergency and elective procedures carried out by experienced paediatric surgeons and anaesthetists.
The first MSF paediatric surgeon in Liberia, Dr John Lawrence in the new operating theatre – picture courtesy of Sylvia Curtis (OT nurse)
One girl who benefited from the new service arrived in our ER after accidentally ingesting caustic soda. Mothers here sometimes make their own soap at home to sell on the streets. The caustic soda looks like water before it sets and unfortunately when it is left within reach, small children sometimes drink it, mistaking it for water.
Once swallowed, the damage is irreversible, with intense pain and burning of the oesophagus (food pipe). The real problem occurs with the subsequent inflammation that can cause narrowing and blockage of the oesophagus. As with this girl, she was unable to swallow anything other than small amounts of water, food just made her vomit. Inevitably, she quickly became a bag of skin and bones by the time she arrived in our hospital.
24 hours later and, thanks to the surgery team, she has a gastrostomy tube – a feeding tube that goes directly into her stomach and bypasses the blockage in her oesophagus, allowing her to take in milk. The transformation in her appearance is dramatic after a few days of feeding. The long-term damage and her future ability to swallow food remains to be seen.
Post-op: A newly placed gastrostomy (feeding) tube. Photo: Mark Lee / MSF.
The hospital has also had to adapt to a big rise in measles cases in our district. The sudden influx of cases has led to restructuring of our triage and emergency area and the creation of isolation wards. Measles is incredibly infective. On average, in a population that has not been vaccinated, one case will infect 12-18 new children, so it spreads very quickly.
Malnourished or HIV positive children and those under three years of age (i.e. a large proportion of our patients) are particularly at risk of developing life-threatening complications of measles with a mortality rate up to 20% in this vulnerable group.
The characteristic measles rash. Photo: Mark Lee / MSF.
Measles has no cure, but we can work to manage complications like dehydration, that can make the disease so deadly. The emphasis is on prevention: this month a mass vaccination campaign is planned with MSF providing social mobilization support.
The isolation ward for complicated measles cases. Photo: Mark Lee / MSF