Jan-march 2010 report

Tetanus in a newborn.

The work of New Foundations is now based on a delivery of Primary Care services that are Health Care Worker led. Embedded indigenous workers have been shown to be the most effective deliverers of Health programs.(click). From recent experiences and a report from John Hopkins University we are not planning to replace our Doctor, making training of our Health Care Workers an ongoing priority.
To this end we have commenced an educational program devised between the World Health Organisation and UNICEF specifically aimed at rural Health Care Workers.

Educational materials and training camps every three months will deliver this program as we continue to build the programs and develop our diagnostic services at the Clinic. IT training has commenced for collection of health statistics that provide the basis for audit and review of services. A laptop has been provided for the clinic and acquisition of spreadsheet and microsoft office skills has been surprisingly quick following a training camp in late february. Better telephones and e-mail have considerably eased communications with the workers and the Clinic. Developing relations with the Community Council at Enekorogha have helped build a sense of partnership and accountability as we continually drive to better communication and establish partnership in favour of dependancy.

The child above demonstrates graphically when good birthing practice and maternal
immunisation, which provides neonatal protection from Tetanus is absent. This child presented rigid as a board, in extreme distress and was transferred immediately to hospital though survival was unlikely. This was the second child to the mother, the preceding sibling having been lost to tetanus and the mother had defaulted to our vaccination schedule, all needless, and frustrating to witness.

This lady had been travelling to a government TB clinic to obtain drugs that should have been free, but the clinic took a fee for each issue, eventually exhausting her family's finances. She is featured in last July's report and from the early picture her deterioration is obvious. As a result we have commenced a local TB initiative providing free supervised treatment on a named patient basis and within a week she reported an improvement. Her treatment will last at least six months. With a small but growing number of patients we believe this is an important program. With daily visits to adminster the drugs it allows the Health Care Worker to closely monitor compliance and symptom control.

We have restricted satellite camps since the release of our doctor but recognising the appalling conditions that exist in the inner creeks we are looking to establish a small satellite clinic in a small community we visit periodically. Here the team arrive with drugs and immunisations. To be effective we had to visit a week prior to the camp to announce the camp date so these incursions to inner communities are time consuming and with the cost of transportation, expensive. We now have a phone contact and are building relationships in the community to facilitate this new service. With a strong reliance on traditional medicine and disgraceful stories of the provision of more orthodox campaigns (as unable to verify the details it is not appropriate to recount here) we are keen our new service will be effective.

Environmental concerns at Enekorogha reflect much of what is going on in the region.
Cottage inductry oil distillation is prolific and pollution is rife decimating fish stocks and polluting drinking water.

tanks of crude litter the bush

crude from the process flows into the creek

Poor housing and smoky interiors result in a high incidence of asthma and respiratory disease.

Smoke from a cooking fire drifts a hut

Patient with severe asthma

The Clinic provides weekly educational sessions on topics such as nutrition and immunisation,
breastfeeding and hygiene. Home visiting occures daily from where this baby suffering from
marasmus was found, her mother just a child herself, around 14-15 years. Mother and baby were invited to stay at the clinic where the mother was instructed how to prepare a balanced feeding schedule and the baby fed hourly over the next few days until the mother had confidence.
She and the baby will continued to be followed up by regular visitation.

The child was given supplements, a gruel of dried crayfish, palm oil and cassava starch. The mother had abandoned breast feeding and we supplied a tin of baby powder to mix with the feed. Regular weighing, subsequent immunisation and just building a supportive relationship will help avoid the pitfalls in any subsequent pregnancy.

Dirty riverwater remains the drinking water for the majority. On camp, river water is used for
the team to wash in and we noticed small worms, insects and detritus, including faecal traces and even spots of crude oil in the barrel we wash from. Small surprise therefore that so many
children present with diarrhoeal illness and require urgent IV hydration.

A dehydrated child receives IV fluids from a venflon inserted into a scalp vein.

Since december  879 children have been de-wormed, 96 children immunised, 4 deliveries undertaken, and over 500 patients treated, all treatment free at the point of need.