During the first week of our health internships in Zimbabwe, the Pre-Health group visited the Children Rehab Unit (CRU) and the Children’s Hospital at Harare Central Hospital. We had the opportunity to observe doctors, therapists, and counsellors while they worked with their colleagues and the patient’s family to help heal the patient. We visited the medical wards in the Children’s Hospital where we followed a team of paediatricians on their morning rounds and learned about the various conditions they were seeing in the hospital.
At CRU, we sat in on patient visits that focused on developmental disabilities and on physical therapy sessions for children with varying disabilities. One of the most impactful experiences for me this week was being able to sit in on a lecture with medical students from the University of Zimbabwe as Dr. Greg Powell spoke about developmental disabilities in general and disabilities in Zimbabwe. The majority of the cases seen at the CRU are cases of cerebral palsy. Cerebral Palsy, or CP, is a disorder of movement, posture, and muscle tone caused by damage to the brain.
In Zimbabwe, the most common causes of brain damage are jaundice and birth asphyxiation. Jaundice is when the liver is unable to break down the newborn baby’s extra red blood cells causing an excess of bilirubin. The excess of bilirubin, if left untreated, can cause brain damage leading to cerebral palsy. Brain damage occurs days after the baby is born and usually clears itself up after 2-3 weeks. If the jaundice lasts longer than that, then brain damage is possible. Neonatal asphyxiation is when the infant does not receive oxygen within the first few minutes of life. The brain is deprived of oxygen causing the brain damage. Dr. Powell informed us that the likelihood of an infant with brain damage to have either jaundice or birth asphyxiation, can depend on where (the hospital/maternity ward/home) the mother gives birth and the quality of the intrapartum care.
Babies that are born via home birth or clinic birth are more likely to have brain damage from jaundice while babies born in hospitals are more likely to suffer brain damage from birth asphyxiation. Birth asphyxiation-related brain damage is not likely to happen in home births or clinic births because babies that cannot breath at birth often do not survive because of the lack of resuscitation ability, whereas in the hospitals they have the skills and technology to revive an infant.
Increasing the quality of intrapartum care can decrease the number of children born with brain damage and CP. The country of Zimbabwe is currently in the process of creating operating theatres at clinics for Caesarean Section deliveries in the case of high risk patients where the baby needs to be removed as soon as possible. By increasing the number of operating theatres, it can decrease the time it takes for the health providers to reach and help the infant. Cerebral Palsy, or CP, is the cause of 60% of the disabilities seen at the Children’s Rehab Unit (CRU) at Harare Central Hospital. The leading cause of CP is brain damage most often caused by jaundice and birth asphyxiation.
-Sarah Gale
