The Special Care Baby Unit

(Apologies in advance for all the medical terminology.)

I’ve now moved on from Outpatients and TFC to the Special Care Baby Unit. Confusingly known as “S-C-B-U” here, it’s a far cry from any neonatal unit I have worked in before. No ventilators, CPAP machines, vapotherm or noisy alarms going off. No blood gas machine, centrifuge, bilirubinometer, blue phototherapy lights. No SHO running around taking blood gases and TPN bloods and going to deliveries. No TPN for that matter. And no potassium to add to the fluids.

What we do have are radiant warmers, oxygen concentrators, bag and masks, NG tubes, IV fluids and antibiotics and mothers who produce the greatest quantities of expressed breast milk I have ever seen.

Most of the admissions are a product of poor or non-existent antenatal and obstetric care so it seems clear that without interventions in these areas we will never reduce neonatal mortality in Sierra Leone. The current inpatient mortality in SCBU is 27% (overall hospital mortality was 13.9% in May).

The pathology is certainly interesting; presumed septicaemia (no blood cultures so I have no idea which bugs), congenital malaria, meningitis (the most turbid looking CSF I have ever seen. It was actually pus. This baby is still alive thankfully), birth asphyxia (a term we no longer use in the UK but is used frequently here) and two cases of neonatal tetanus in the last week.

It is frustrating, knowing that most of these problems are preventable. If these babies’ mothers had received tetanus immunisations during pregnancy, had received antibiotics during labour, had presented earlier in labour to medical care or if the baby had been monitored during labour and born by assisted delivery or caesarean section when fetal distress was identified then these babies would not have the problems that they do. There is little I can do as a paediatrician for many of these babies. Prevention is much better than cure.

Its also here I notice the lack of investigations and equipment the most. Without blood cultures its hard to know how long to continue with antibiotics. I tend to play it safe and probably give them longer than necessary (thereby further contributing to antibiotic resistance…) Neonates is very equipment intensive in the UK. Most of the babies in SCBU here would be ventilated if they were in the UK. You don’t need a blood gas to tell you that. I find it frustrating because I know what can be done. But until we can do basic things well here (e.g. making sure the babies get their medications, get fed regularly, observations done and everyone has good hygiene) there would be no point in having any more advanced equipment.

I am very much enjoying the team spirit in SCBU – something I missed whilst in outpatients. Doctors, nurses, nursing and medical students all on ward rounds together; everyone learning from each other. The house officer and medical students doing lumbar punctures (surrounded by an infestation of flies – no, not the most sterile procedure you’ve ever seen. But when I arrived at ODCH no children were getting LPs at all). The nursing students watching and learning why it so important for babies to receive their antibiotics.

I learned this week that I’m going to work in the neonatal unit when I go back to Oxford. It’ll be a world away from here.