FIRST PART

HOSPITAL GUIDELINES
Cottolengo Mission Hospital, Chaaria (Kenya)

FOREWORD

Cottolengo Mission Chaaria was founded in 1984 by the congregation of the

St. Joseph Cottolengo brothers under supervision of brother Lodovico
Novaresio

In the beginning it was a home for disabled boys, together with a busy
dispensary. After the arriving of brother and doctor Giuseppe Gaido, the
mission grew over time to a hospital where nowadays the patients find it
worth, to travel far for.

The developing and maintenance of the hospital did not only depend on the
contribution of sponsors, the Cottolengo congregation and the local staff but
the most contributing factor of this all is the endless dedication of the
missionaries.

LOVE BELONGS TO THOSE WHO THINK OF OTHERS..

Claire Nolte
 TABLE OF CONTENT

General information:
Glossary of Abbreviations:
Frequently used medication:
Laboratory:

INTRODUCTION

The manual is intended to provide guidelines for the treatment of common

diseases and problems seen at Cottolengo Mission Hospital, to set out
hospital treatment policy, and to establish standards of care. But as there will
always continue to be changes and developments in the practice of medicine,
comments and suggestions are welcome.

This is not a textbook; reference books must be consulted for further

information.

All the drug dosages listed have been checked, but these should be
confirmed before use.

PRESCRIBING GUIDELINES:

The drug formulary at Cottolengo Mission Hospital is based on the use of

essential drugs, a limited number of safe, effective and cost-effective
medications for the treatment of the common diseases seen here.

Oral medication should be used whenever possible; both the cost and the
risks are greater with parenteral drugs.
Injections should be reserved for patients unable to take oral medicines, and
changed to oral as soon as possible.

LOCATION INFORMATION
 Room 26: Female
 Room 28: Male
 Room 19: Pediatric
 Room 20: Maternity
 Room 23: post-operation
Male
 Room 22: Post-operation
Female
 Room 9: Clinical Officers
 Laboratory: Down the hall
 Discharge: Down
 The premises
STAFF INFORMATION:
 Dr. Gaido (Beppe)
 Dr. Ogembo
 Anesthetist: Jesse
 Head Nurses: Sr
Florence
 Clinical officer: Kaberia
 Clinical officer: Nyaga
 HIV/TB Counselor:
Mutthuri
 Store manager: Kathira
 Theater manager:
Makena
 Laboratory manager:
Mugambi & Justus
 Maintenance: Br
Lorenzo

WEEKLY ACTIVITIES:
• Thursday at 8 AM: Lesson by Dr. Gaido
• Sunday at 9 AM: Mass for staff and patients
• Every 1st Wednesday of the month at 8 AM: Mass for staff

GLOSSARY OF ABBREVIATIONS:

ARV = Anti-retroviral drugs

ATT = anti-tetanus toxoid
CXR = Chest X-ray
BPH = Benign Prostate Hyperplasia
CCF = congestive cardiac failure
CO review = Clinical officer to review
CS = Caesarean section
D = Discharge
DD = Differential Diagnosis
DIB = Difficulty in Breathing
Dr’s review = doctor to review the patient
EUA = Examination under Anesthesia
GBM = General Body Malaise
HOB = Hotness of Body
HSD = Half strength Darrows solution
HTN = Hypertension
I&D = Incision and drainage
IPD = In Patient Department
MU = Mega Unit
PUD = Peptic Ulcer Disease
PID = Pelvic Inflammatory Disease
NGT = Naso-Gastric Tube
OGD = Gastro-scopy
OPD = Out Patient Department
POP = Plaster
PCP = Pneumocystis Pneumonia
PMCT = prevention of mother to child transmission of HIV
POD = Post Operation Day
US =Ultrasound
UTI = Urinary Tract infection
WHO = World Health organization

FREQUENTLY USED MEDICATION

SCHEDULE:
OD Once Daily (1x)
BD Twice Daily (2x)
TDS Tree times Daily (3x)
QID Four times Daily (4x)
STAT One time / Right now
x/7 X 7 days
x/52 X weeks
x/12 X 1 month

Some Antibiotics available

Amoxicillin 500 mg
Ampiclox 500 mg
CAF 250 mg
Cloxacillin 250 mg
Dapsone 100 mg
Doxicyclin 100 mg
Erytromycin 250
mg
Flagyl 200 mg
Nitrofurantoin 100
mg
Septrin 960 mg
Tetracycline 250
mg

Some Cardio-vascular
Aldactone 25 mg
Aldomet 250 mg
Cardiasa 100 mg
Digoxin 0.250 mg
Frusemide 40 mg
HCTZ 50 mg
Nifedipine 20 mg
Propranolol 40
mg

Pain management
Brufen 400 mg
Buscopan 10 mg
B-complex
Diclofenac 50 mg
Paracetamol 500
mg

Steroids
Dexamethasone
0.5 mg
Prednisolon 5 mg

Bronchodilators
Aminofillin 100
mg
Phenobarbitone
30 mg
Ventolin 4 mg

Sedatives/anti-histamines
Diazepam 5 mg
Prometin 25 mg
Pirition 4 mg
Laroxil 25 mg
Largactil 100 mg
Serenase 1.5 mg
Amitryptiline 25
mg

Supplements
Ferrous 200 mg
Folic acid 5 mg
Multi-vitamin
Pyridoxine (Vit
B6)

Diverse
Loperamide 4 mg
Omeprazole 20
mg
Plasil 10 mg

Oral Anti-malarials
Al (coartem) Tabs
Quinine 200 mg Tabs
 ARV
Lamivir
(stavudine,
lamivudine)
Trio (stavudine,
lamivudine,
nevirapine)

NVP (nevirapine)
200 mg
Efavirenz 600 mg

IV/IM MEDICATION

• Diclofenac 75 mg (to be given IM)

• Quinine 600 mg (in dextrose 5%)  NB Diabetes Mellitus in NS
• Lasix 20 mg
• Buscopan 10 mg
• Plasil 10 mg (to be given in 100 ml H2O)
• Zantac 50 mg (to be given in 100 ml H2O)
• Dexamethasone 4 mg
• Hydrocortisone 100 mg
• Diazepam 10 mg
• Phenobarbitone 60 mg
• Gentamicin 80 mg
• Aminophilline 250 mg
• Ceftriaxone 1 gr
• CAF = Cloramphenicol Sodium Succinate
• X PEN = Benzylpenicillin Sodium
• PPF = Fortified Procaine Penicillin 4 MEGA UNITS (to be given IM)

COMMON LABORATORY TEST:

AAFB (2x) Sputum for TB
kIDNEY Creat, Urea
Brucella test Brucellosis
BS for MPS Malaria
Electrolytes Na, K, Cl
FHG Full Haemogram
Hb Haemoglobin
Liver function tests SGOT, SGPT, Billirubine (T&D)
No3 HIV
RBS Random Blood sugar
RF Rheumatoid factor
Stool for O/C Stool-test
Urine analysis Urine analysis
Widal Typhoid-test

NORMAL LABORATORY VALUES

Haematology
WBC (white blood 3.5-10.5 (x 103 ul)
cells)
SW (LYMPH) 1 – 3 (x 103 ul) 20 – 40 %
MW (MONO) 0.2 – 1 (x 103 ul) 2 – 10 %
LW (GRAN) 2.5 – 7.5 (x 103 41 – 85 %
ul)
RBC (red blood 4.5 – 5.5 (x 103
cells) ul)
HB (Haemaglobine) 11.5 – 16.5 (g/dl) 12.5 – 17.5
%
HCT (Haematocrit) 40 – 54 % 37 – 47 %
MCV 80 – 110 FL
MCH 27 – 32 pg
MCHC 31.5 – 34.5 g/dl
RDW 11.5 – 15 %l
PLT 140 – 440 (x 103
ul)

Biochemistry
BLOOD SUGAR (Random) 6.5– 11.1 mmol/l
UREA 35 – 125 mmol/l
CREATININE 1.7 – 8.3 mmol/l

Electrolytes
CHLORIDE (CL) 90 -105 mmol/l
POTASSIUM (K) 3.5 5.5 mmol/l
SODIUM (NA) 135 – 150 mmol/l

Liver function test:

BILIRUBINE (TOTAL) < 1.1 mg/dl
BILIRUBINE (DIRECT) <0.3 mg/dl
SGOT <37 iu/l
SCPT <45 iu/l

CARE OF THE SURGICAL PATIENT

Pre-operative care:
• Take complete history, examination.
• Check:
o Hb
o RBS
o No3
o BP
• Anemia: Transfuse two units if below 8 g/dl
• Correct dehydration and acid/base balance
• Inform Anaesthesist (Jesse)
• Consent
• Fasting from Midnight
• Ceftriaxone 1 gr STAT
• Green blannula
• 1 Litre NS
• Shaving + Catheter

Post-operative care:
• IV X-pen (QID) 2/7  IM PPF (OD) 5/7
• IM Gentamicin 160mg (OD) 7/7
• Pain management:
o 5% Dextrose 500ml + Pethidine 50mg 2/7 (NOCTE)
o NS 500ml + Pethidine 50mg 2/7 (DAY)
o Voltaren 150 mg PRN
• In most cases stitches to be removed alternate on the 7th POD, and all on
the 9th POD

A GENERAL APPROACH TO SYNDROMES/SYMPTOM COMPLEXES

Gastrointestinal presentations

Dysphagia:
Significant recent-onset dysphagia should always raise the possibility of
oesophageal carcinoma.
Oesophageal candidiasis (AIDS-related) is also a common cause.

Abdominal Pain:
• Abdominal tuberculosis
• Typhoid
• Hydatid cyst rupture
• Amobiec colitis
• Amoebic liver abscess
• Intestinal obstruction
• Sickle cell crisis
• Splenic rupture

Malabsorption:
Malabsorption can be a feature of infection with giardia lablia, strongyloides
stercoralis, intestinal TB infection, as well as AIDS

ASCITES
• No tapping, unless there is pulmonary failure
o Don’t exceed > 2 Liters of tapping.
o Albumine infusion not available

DRESSING

Amputation:
The dressing treatment consists first in a wash out with Normal Saline
solution, putting sterile gauzes with Betadine and than a semi compressive
closure with elastic bandages.

Not infective ulcerarations:

• Rains with Normal Saline solution
• Rains with Betadine solution
• Removal of the dead tissue
• In absence of special creams that stimulate the vascular and tissue
regeneration, test the effectiveness of sugar used in association with
Betadine

ANAEMIA
Symptoms:
• Tachycardia
• General body malaise / weakness
• Pale looking
• Splenomegaly

Diagnosis:
• Malaria
• Malignancy
• Chronic disease
• Acute bleeding
• Hookworm

Treatment:
• Hb < 5.5 g/dl OR symptomatic:
o Transfusion
•
• Hb > 5.5 g/dl:
o Ferrous 200 mg TDS 1/12
o Folic acid 5 mg OD 1/12
•
• TREAT THE CAUSE

BRUCELLOSIS

Symptoms:
• Chronic fever
• Sweating
• Joint pain / backache
• Splenomegaly

Diagnosis:
• Brucella (BAT = Brucellosis agglutination test)
• Rule out: Malaria, TB, HIV/AIDS

Treatment:
• Doxycline 100mg BD 6/52
• Streptomycin (20mg/kg) OR gentamycin (7mg/kg) 2/52
• In pregnant females treat with:
o Septrin 960 mg BD 3/52
o Streptomycin (20mg/kg) OR Gentamycin (7mg/kg) OR Rifampicin
(300mg BD) 3/52

Grazie a Claire Nolte

(continueremo la pubblicazione di queste brevi note che speriamo siano utili

come pocket manual, sia agli infermieri che ai medici che si preparano al
volontariato a Chaaria)

Fr Beppe