[NOTES FROM A SIX MONTHS VOLUNTEER MISSION AS MEDICAL STAFF IN A DISTRICT HOSPITAL IN UGANDA].

INTRODUCTION: In December 2014 my husband and I flew for a stay of six months in Uganda. We went there in order to volunteer in the district hospital of Kiboga, one of the most impoverished districts of this poverty stricken country. A district in which over 60% of the population lives off less than a dollar and twenty five cents a day, in which the average life expectancy is 46.7 years (9.1 years lower than the national average expectancy). Kiboga's district hospital serves the 300,000 residents of the district, of whom 20,000 live in the district capital, while the rest are mainly farmers and cattle keepers, scattered in small villages that have limited and weather-dependent access. The hospital houses 120 beds, which are divided into four wards (maternity, pediatric, male and female), and is manned routinely by one on-call local physician, who (when present) is almost exclusively occupied by emergency cesarean sections. Therefore, the majority of hospitalized patients are not inspected by a doctor at any point of their stay. The hospital functions with no running water and in the absence of a reliable power supply. The nursing staff, composed largely of people with limited or no training, is always desperately understaffed, and many of the means needed for a patient's stay (starting with a bed pan and linens and ending with many of the medications prescribed) are not supplied by the hospital. Perhaps it would have been appropriate to continue by describing unsettling data about the health infrastructure in Kiboga (such as the fact that infant mortality rate is a staggering 15%, or that nearly 10% of the districts population have HIV), however, it appears to me that it would be more educating to learn from the story of the patients we encountered.

Growth parameters of discordant preterm twins during the first year of life.

OBJECTIVE: To evaluate and compare growth parameters (weight, length and head circumference) of discordant preterm twins during the first year of life. METHODS: Retrospective data were collected on 78 pairs of >10% discordant preterm twins. Data regarding short-term neonatal outcome were recorded. Growth parameters were recorded at birth and again at 1 year of age, as collected by phone interview. RESULTS: At 1 year of age, the gap was significantly reduced between the group of smaller twins and the group of larger twins on all the parameters studied. Discordance in weight decreased from a mean of 22% at birth (calculated from the weight of the larger twin) to 8.9%, in length from 6.5% to 2.5% and in head circumference from 5.5% to 1.3% at 1 year of age. While length and head circumference (HC) z-scores improved in both the large and the small siblings, weight z-score decreased significantly among the large twins and decreased mildly among the small twins. CONCLUSIONS: The gaps in growth parameters between the smaller twins of preterm discordant twins and their larger siblings are significantly reduced during the first year of life. The impact of the differential growth patterns between the two siblings should be further evaluated.