i thought i’d write a little bit about the research I’m doing, as some of you might be interested. only read if you are. we are looking at the incidence of post-operative infection in children who have had a shunt inserted for the treatment of hydrocephalus. hydrocephalus is caused by a blockage of the normal circulation of the cerebrospinal fluid (csf; the clear fluid that bathes your brain and spinal cord) - it causes increased pressure on the brain which must be relieved. a hole is drilled in the skull, and another one made into the peritoneum (the cavity in which all your organs reside). a tube is then shoved under the skin, with the help of a blunt metal stick, from hole to hole. one end of the tube ends up in a ventricle of the brain, while the other end drains the excess csf into the peritoneum, where it is resorbed by the body. this is called a ventriculoperitoneal shunt (vps). a doctor who was here before me compiled a bunch of information into a spreadsheet, so we thought it would be rather easy to just figure out how many of the patients had developed shunt infections after their surgery. we decided to define shunt infections as csf infections exclusively, because other infections such as wound infections can be caused by a number of factors other than surgery. we also decided not to include patients who have had spina bifida as well, because these patients all would have had another surgery to close the meningocele (neural sack) on their back, which greatly exposes the csf, leading to much greater chance of infection. normally there wouldn’t be very many cases of spina bifida in relation to hydrocephalus, but because kijabe is a pediatric neural referral center, about half of the hydrocephalus cases here also have had spina bifida. most kids with spina bifida end up getting hydrocephalus - this could be because they have were born with (congenital) central nervous system issues, or because their csf is exposed to infection (because of the defect on their back), which can cause hydrocephalus.
the study includes about 300 cases. what we didn’t realize until after I had written up the paper and everything was that about half of the patients had insufficient follow-up, which we decided should be at least 9 months after their surgery. you can’t really say that you have an infection rate of x% if you don’t even have any information for half of the patients. any critic would just say that it is possible that all the patients that were unaccounted for had shunt infections. this is probably more likely to be the case in africa than in the west. in the west someone would take their child to the hospital if they got sick after an operation. but because many of the children here live sometimes days journeys from the hospital and often have no means of transportation or financial resources, combined with the fact that there are large families living at home who would have to be neglected if the parents had to make the long trip to the hospital, if the child gets an infection they often die and are forgotten. of course, probably most of the patients who don’t come back for follow-up are doing fine, but we have no way of definitively knowing that. there can also be a stigma associated with hydrocephalus here that causes parents to neglect these kids - there are even stories of communities burying alive children with hydrocephalus during times of drought to try to appease their animist gods.
so i had to go about trying to gather more information on these patients. I searched an electronic database that the hospital has, and found some extra information. then I had to pull the charts from the medical records room of the ones who still had insufficient follow-up and look through those for more information that may have been missed. then, i made up a little questionnaire form with some questions about the patient and their phone number, if i could find it, and had nurses call the family to see if the child is still alive and if they have ever gotten a shunt infection. everything seems to be a logistical challenge in africa though. for some reason that I do not understand many of the kids don’t share their parent’s last name. a lot of the patient’s records didn’t have phone numbers. many of the ones that did didn’t work, because most people in kenya just use cell phones, and there is a lot of number turnover. also, there was post-election violence here a few years ago and many people were displaced from their homes so are not able to be contacted because they still live in internally displaced people (idp) camps or have resettled somewhere else. additionally, many of the people who come to the kijabe hospital are somali refugees and don’t speak kiswahili, or have moved back to somalia where they can’t be reached. many of the kenyans are from remote areas and belong to tribes that don’t speak kiswahili. i probably would have called it quits there, but dr. bransford wanted to find more of the patients. the more we find the more viable the results will be. so, we split up all the files of the ones we couldn’t get ahold of into tribes and towns throughout the country, and are trying to get a loose coalition of chaplains throughout the country who are associated with the hospital to go out into their communities and find these people. hopefully this works, although you can probably imagine the difficulties inherent in trying to get someone to get someone else to conscript some other people to go find some other people and ask them some questions… in africa. we’ll see how it goes.
the study includes about 300 cases. what we didn’t realize until after I had written up the paper and everything was that about half of the patients had insufficient follow-up, which we decided should be at least 9 months after their surgery. you can’t really say that you have an infection rate of x% if you don’t even have any information for half of the patients. any critic would just say that it is possible that all the patients that were unaccounted for had shunt infections. this is probably more likely to be the case in africa than in the west. in the west someone would take their child to the hospital if they got sick after an operation. but because many of the children here live sometimes days journeys from the hospital and often have no means of transportation or financial resources, combined with the fact that there are large families living at home who would have to be neglected if the parents had to make the long trip to the hospital, if the child gets an infection they often die and are forgotten. of course, probably most of the patients who don’t come back for follow-up are doing fine, but we have no way of definitively knowing that. there can also be a stigma associated with hydrocephalus here that causes parents to neglect these kids - there are even stories of communities burying alive children with hydrocephalus during times of drought to try to appease their animist gods.
so i had to go about trying to gather more information on these patients. I searched an electronic database that the hospital has, and found some extra information. then I had to pull the charts from the medical records room of the ones who still had insufficient follow-up and look through those for more information that may have been missed. then, i made up a little questionnaire form with some questions about the patient and their phone number, if i could find it, and had nurses call the family to see if the child is still alive and if they have ever gotten a shunt infection. everything seems to be a logistical challenge in africa though. for some reason that I do not understand many of the kids don’t share their parent’s last name. a lot of the patient’s records didn’t have phone numbers. many of the ones that did didn’t work, because most people in kenya just use cell phones, and there is a lot of number turnover. also, there was post-election violence here a few years ago and many people were displaced from their homes so are not able to be contacted because they still live in internally displaced people (idp) camps or have resettled somewhere else. additionally, many of the people who come to the kijabe hospital are somali refugees and don’t speak kiswahili, or have moved back to somalia where they can’t be reached. many of the kenyans are from remote areas and belong to tribes that don’t speak kiswahili. i probably would have called it quits there, but dr. bransford wanted to find more of the patients. the more we find the more viable the results will be. so, we split up all the files of the ones we couldn’t get ahold of into tribes and towns throughout the country, and are trying to get a loose coalition of chaplains throughout the country who are associated with the hospital to go out into their communities and find these people. hopefully this works, although you can probably imagine the difficulties inherent in trying to get someone to get someone else to conscript some other people to go find some other people and ask them some questions… in africa. we’ll see how it goes.
