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PDF The Life of a Village Child: An Autobiography of a Medical Doctor

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Primary Care - Suite 207

Our mission is to provide the full spectrum of life-enhancing care and services to create and sustain healthy, vibrant communities. What can you make possible? Join Us. What are you looking for? I sat back. A sense of complete helplessness descended upon me.


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I managed to pull myself together though. I had little time left on my hands to ask further questions. I sat on my motor-bike and rode through the bush to the community where the volunteer lived. I asked if he could send me to the parents of the child about to be killed.

I had often heard how such children were killed in such bizarre circumstances but never did I for once imagine that I would one day be called in to help save a situation of such kind. He looked at me straight in the eye and managed to force a smile. He was completely convinced that his daughter was a bad omen to the community considering that severe malnutrition was a curse to the community. He resorted to traditional herbs and still there was no change. He went on to explain that he had to seek the help of a witch doctor who consequently told him his child had been cursed by the gods and that she posed a bad omen to the community and needed to be done away with.

My job as a Nutrition Officer is certainly not a lofty one especially working in a setting where all odds seem to work against you; where clean and portable drinking water is perceived as luxury; where children are not allowed to eat eggs and meat for the wrong reason that they would eventually grow up to become thieves. To have a truly flourishing career in such environment, you need to have a high sense of professional decorum and maturity that will foster a deep trust to allow sometimes very difficult partnerships to flourish.

In lieu of this, I have often combined a strong cultural understanding as well as tough negotiation skills that has allowed me to forge alliances and reach consensus with communities whose leadership has long been suspicious of modern approaches and solutions to community nutrition. The dose of carbamazepine should be adjusted to the individual child.

Depending on how well it controls the fits, it can be raised to 30 mg. Primidone Mysoline For all fits.

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Start with low doses and gradually increase to 10 to 25 mg. May cause sleepiness, dizziness, vomiting, or rash. Ethosuximide Zarontin First choice for 'minor fits' with blank staring, eye-fluttering, and perhaps strange motions - especially if the fits occur in groups in the morning and evening. Give 10 to 25 mg.

Rarely causes liver damage. Valproic acid Depakene Used alone or in combination with other anti-fit drugs, for 'minor fits' with blank staring or 'absences', especially when the fits occur in groups. Start with 5 mg. Few side effects. Mephenytoin Mesantoin Used like phenytoin but much more dangerous. May stop the body making red and white blood cells.

Regular blood checks needed. We mention it here mainly to discourage its use. Corticosteroids or corticotropin These are sometimes tried for 'baby spasms' and 'jolt fits' see Page that are not controlled by other medicines. But long-term use of these medicines always causes serious and possibly dangerous side effects see Page They should be used only with highly skilled medical advice when all other possible medicines have failed.

Diazepam Valium Sometimes used for 'newborn fits' or 'baby spasms' see Page , but other medicines should be tried first. May cause sleepiness or dizziness. Mildly habit forming. Give about 0. Also, some of the drug goes into breast milk. Therefore, pregnant women should use these drugs only when fits are common or severe without them.

Women taking fit medicine should not breast feed if they are able to feed their babies well without breast milk. Phenobarbital is probably the safest anti-fit medicine during pregnancy. Children years. Children under 7. Children under 2 years. NOTE: These medicines do not work as fast or well when they are injected into a muscle. If you only have injectable or liquid medicine, put it up the rectum with a plastic syringe without a needle.

Dr Ramana Rao's Village Clinic with Tricog

Or grind up a pill of diazepam or phenobarbital, mix with water, and put it up the rectum. If the fit does not stop in 15 minutes after giving the medicine, repeat the dose. Do not repeat more than once.

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Note: This information is for rehabilitation workers and parents because many doctors and health workers do not treat fits correctly. With care, perhaps you can do better. However, correct diagnosis and treatment can be very difficult. If possible, get advice from a well-informed medical worker. Ask her help in using this chart. Often not typical of later fits. May show sudden limpness or stiffness; brief periods of not breathing and turning blue; strange cry; or eyes roll back; blinking or eye-jerking; sucking or chewing movements; jerks or strange Movement of part or all of body.

With cerebral palsy in the newborn, the baby is usually limp. Sudden opening of arms and legs and then bending them - or repeat patterns of a strange movement.

North Chatham Pediatrics and Internal Medicine | Chapel Hill, NC | UNCPN

Spasms often repeated in groups when waking or failing to sleep, or when very tired, sick, or upset. Corticosteroids may be tried-but are dangerous. Try to get help from an experienced doctor or health worker. Valproic acid or diazepam may help. Usually 'big' fits see next page that happen only when child has a fever from another cause sore throat, ear infection, bad cold. May last up to 15 minutes or longer. Often a history of fever fits in the family. A child who has had fever fits on several occasions should be treated with phenobarbital continuously until age 4 or until one year after the last fit.

Fits usually do not continue in later childhood. Sudden violent spasms of some muscles, without warning, may throw child to one side, forward, or backward. Usually no loss of consciousness, or only brief. Try phenobarbital, with valproic acid. If no improvement, consider trying corticosteroids as in baby spasms, or other medicines with medical advice.