Meet Hannah

The following story is being told with permission from parents of the patient.

BACKGROUND

Hannah is a 14-year-old girl who presented to the emergency unit on July 30, 2016 with an extremely high blood pressure, pulmonary edema and breathlessness. Her oxygen saturation was 55% (normal value for pediatric patients is 95-100%). Oxygen was quickly administered in addition to diuretics and antihypertensive drugs. Once stable, we obtained blood specimen for analysis and concluded based on the results that she had renal (kidney) disease. Kidney ultra sound showed atrophied renal tissue and this was also supportive of the renal injury diagnosis. Her parents reported that she began having symptoms (decreased urine output, weight gain, anemia, weakness) a few weeks before they brought her to our hospital. After several days at the hospital and further assessment, we learned that Hannah had renal failure.

In developed parts of the world, patients like Hannah would have had kidney biopsy (to determine cause of failure), hemodialysis treatment and perhaps, placed on a transplant list (depending on the etiology of the kidney disease). This wasn’t an option for Hannah because biopsies are very expensive and we have few dialysis centers in Ghana. Moreover, each procedure (dialysis) is very costly.  Most patients need to undergo 3-4 dialysis procedure every week. Dialysis centers are scarce and the procedure is not covered by the national health insurance. So, we decided to explore another avenue of helping Hannah. The ER physician (DR. Nkansah) I’ve been working with had participated in a peritoneal dialysis (PD) training 2 weeks before Hannah was brought to the hospital. Participants were given a peritoneal dialysis kit to be used for a patient. So, we decided to use it for Hannah. Our first attempt was unsuccessful, which meant we had to look for another kit. Thankfully we found another one and the second attempt was successful. We had to make the dialysate, a special solution infused into the peritoneal space, in house because it was too expensive to buy one. This solution, working with the peritoneal membrane, “acts” like a kidney.

Hannah

We were able to perform daily peritoneal dialysis using our customized dialysate for Hannah on multiple occasions. Her condition really improved and her kidney function tests showed normal results. She was a happy girl and so were her parents. Once stable, we referred her to a nephrologist at the teaching hospital in Kumasi for further management. She saw the nephrologist on September 9 and while there, they performed more PD for Hannah and referred her back to us with a letter informing us that she had chronic kidney failure and that we should continue to provide palliative care.

On September 20, Hannah was brought in by her parents for another PD. Actually, since her parents couldn’t afford to bring her, Dr. Nkansah went and picked them up then brought them to the hospital. She began complaining of abdominal pain and had multiple episodes of vomiting. She was clinically pale, weak and edematous. So, we took an abdominal X-ray to assess the catheter. We discovered that the catheter had migrated, developed a kink and was the cause of her pain. Unfortunately, we couldn’t do anything to save the catheter. We had to take it out. We realized that once we took it out, we had to find a new one. 

Hannah has been admitted to the hospital so we can administer IV diuretics and proton pump inhibitors (PPI) to manage complications of the kidney failure. We are looking for another peritoneal catheter but they are difficult to come by. Currently, she is stable but we are running out of time. We are working with mission partners in Northern Ireland to get a catheter for Hannah as soon as possible.

CURRENT NEED

Please lift Hannah and her family in your prayers. Her parents have 3 other children they are responsible for and caring for Hannah has negatively impacted the rest of these kids. We need a miracle for her. Please pray that we can find a catheter as soon as possible. In addition, please pray for strength for this family as they deal with this stressful situation.