Day 15: Makeni Government Hospital

After all the clinic visits where healthcare workers told us that they just sent their suspected sickle cell patients to the Makeni hospital, today we finally got to find out what happens next. Although the hospital itself is only located about 10 minutes away from the World Hope headquarters, we weren’t able to visit until today because we had to wait for the required approvals.

At the Makeni government hospital, we were first able to visit the lab. Adaba, the deputy lab officer, showed us around and introduced us to some of the 20 people working there. As you can see in the picture below, the lab offers many different diagnostic tests as it is considered a level 3, regional referral hospital.

Although the hospital is supposed to offer all of these tests, and has a lot of expensive (donated) equipment, they apparently frequently run out of reagents and even had some devices which had broken down and never been fixed.

In terms of sickle cell diagnostics, the Makeni regional hospital only offers a sickling test. For this test, sodium metabisulfite is added to a blood sample and allowed to sit for around 1 hour. Then, a lab technician must check the sample under the microscope to see if any of the red blood cells have taken on the characteristic crescent shape of a “sickled” cell. If the sample is still negative, they wait another hour and check the sample again before confirming the negative diagnosis. A positive result cannot distinguish between sickle cell trait and sickle cell anemia; however, a diagnosis is usually determined based on the sickling results and the patient’s symptoms.

After visiting the lab, we were able to speak with some nurses from the pediatric department. They told us that they had lots of sickle cell cases; however, the majority of these cases were kids in crisis, and not individuals who had been referred from the PHUs. For the kids in sickle cell crisis, they have set protocols in place in order to treat them (including oxygen, pain management, and occasionally transfusions). Unfortunately, however, they don’t have a set program for providing long term treatment for patients with sickle cell.

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