PAEDIATRIC UNITS

Paediatric Units


Cardiology Unit
Oncology Unit
Neurodevelopment Unit
General Paediatrics UAH Unit 
Critical Care Unit 
Neonatology Unit 
BCIC Occupational Therapy Unit





Bongani Hospital
Bongani Hospital



Manapo Hospital
Manapo Hospital




Dihlabeng Hospital
Dihlabeng  Hospital

Pelonomi Hospital
Pelonomi Hospital

Paediatric Cardiology Unit

The Department of Paediatric Cardiology at the University of the Free State serves as the referral center for all children born with CHD in central South Africa (Free State, Northern Cape provinces and Lesotho). The department delivers a comprehensive paediatric cardiology service, including diagnostic, interventional, preventative and outreach services.

Diagnostic equipment, including electrocardiograms (ECG) and echocardiography, plays a critical role in delivering these services. Echocardiography is used to confirm a definite cardiac diagnosis, monitoring disease progression and allow regular follow-up. With advanced echocardiography, complex lesions are diagnosed early, and optimal treatment programs are planned for. Cardiac arrhythmias and post-surgical ECG monitoring are essential for patient survival.

The Department's focus is to deliver comprehensive paediatric cardiology services to all children in central South Africa (Free State, Northern Cape provinces and Lesotho). The services include early diagnosis and treatment programs, teaching and training opportunities for clinicians, pre-and postgraduate medical students, clinical technologists and nursing staff.

The Department of Paediatric Cardiology at Universitas Hospital is the only dedicated referral unit for all children with congenital and acquired cardiac disease in central South Africa. With an estimated population of 7 million people, many children are misdiagnosed or referred at an advanced disease stage. Factors contributing to this problem include poor referral and primary health systems. Peripheral hospitals and clinics are understaffed and serviced by junior doctors. Neonates are often incorrectly diagnosed with "respiratory" disease and never reach our clinics. According to our statistics and populations base numbers, many patients get lost due to misdiagnosis and inadequate follow-up.

Comprehensive services consist of the following:

a) Tertiary Hospital services

  • diagnostic (echocardiography, ECG)
  • complex cardiac catheterizations (Catheterization lab)
  • teaching and training

b) Primary care at peripheral hospitals

  • outreach clinics (echocardiography, ECG)
  • teaching and training
  • service delivery, follow-up etc.

Outreach 

The Department of Paediatric Cardiology has an active outreach program visiting three peripheral hospitals quarterly.

Outreach hospitals:

  • Manapo Hospital - Phuthaditjhaba
  • Dihlabeng Regional Hospital - Bethlehem
  • Bongani Regional Hospital – Welkom

These outreach clinics link to patient education, onsite training of nursing staff and doctors. The clinics are more accessible to patients and reduce the parents' financial burden (missed employment days). Due to the deteriorating referral systems and the difficulty for patients to travel to Universitas Hospital, patient clinic attendance and follow-up sessions improved.

Benefits of outreach clinics:

  • Comprehensive patient care
  • Training of nursing staff
  • Improved patient clinic attendance and follow-up
  • Positive cost implications for both the peripheral and referral hospitals.

Training 

Training of staff is essential for recruitment and sustainability of staff numbers and delivery of quality services.

The Department is involved in training at all levels:

Training of medical students:

  • Training of medical students, registrars and subspecialist
  • Training of clinical technologists (Our department is the only unit involved in training in the field of paediatric cardiology)
  • Rotation of nursing staff
  • Training of staff at peripheral hospitals.

 

Paediatric Cardiology
Paediatric Cardiology

Research 


The Department is involved in various research programs and has a history of regular publications in accredited journals.

Research includes:

  • Regular publications
  • PhD and Master students
  • Contract research etc.



Cardic Catheterization
Cardiac Catheterisation

Echocardiographic Service at Pelonomi and Bongani Hospital


Due to the increasing need for echocardiographic service at the Neonatal ICU, Paediatric ICU and Children wards, we included Pelonomi Hospital in the outreach project since August 2019. By using mobile equipment, we increase the clinic’s flexibility and treat more patients. Most importantly, you help reduce maintenance costs and long-term expenses while helping to prevent infection.

Staffing

The Department of Paediatric cardiology has a dedicated team to deliver a comprehensive service. Our team exists of experienced senior staff on all levels.

Our team:

Paediatric Cardiologists

  • Prof SC Brown
  • Dr DG Buys
  • Dr A Ferris

Six Clinical Technologists, nursing staff, dedicated physiotherapist, occupational therapist and dieticians.

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Paediatric Haematology and Oncology Unit

The Haematology/Oncology Unit of the Department of Paediatrics and Child Health at Universitas Academic Hospital is a tertiary referral unit attached to the University of the Free State. The Unit is registered with the Health Professions Council of South Africa as a training unit for the Certificate in Medical Oncology.

Up to 100 new children with cancer are referred to the Unit each year from the Free State and Lesotho. Referrals are received from both public and private healthcare facilities.

Cinical services


Our clinical services cover the diagnosis, treatment and care of all forms of childhood cancer and leukaemia. They include a dedicated inpatient ward for acute care, Ward 10B (Oncology inpatient care), an outpatient treatment service for ongoing management and support care, regular multidisciplinary meetings between paediatric oncology, paediatric surgery, radiation oncology, haematology and other disciplines when indicated for optimal care. Other supporting services include social work, occupational therapy, dietetics, speech therapy, orthopaedic surgery, ophthalmology, and other sub-disciplines of Paediatrics.

The Unit also treats children suffering from haemophilia and other bleeding disorders, haemoglobinopathies such as thalassaemia major and sickle cell disease, severe aplastic anaemia, Fanconi Anaemia and haemolytic anaemia.

Another vital service that our Unit provides and which is a passion of the treating oncologists is education of the parents/families and health care professionals (under- and postgraduate students), palliative and supportive care, as well as participate in research activities (harmonization of national treatment protocols, palliative care etc.)




Oncology Unit Prof Stones
Prof Stones from the Oncology Unit 

Support from CHOC


As is the case with other paediatric oncology units in the country, our Unit receives support from CHOC, the childhood cancer foundation of South Africa. CHOC provides free and comprehensive support to families of children with cancer and life-threatening blood disorders. The foundation provides the Unit with the services of a ward-social worker, who provides support to the families and assists the health care professionals with the breaking of bad news, communication, education of the parents/families, and palliative care support. CHOC also provides the families with accommodation (located just across the street from the hospital) where the children and families can stay during their treatment.


Dr J Du Plessis
Dr J du Plessis caring

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Paediatric Neurodevelopment Unit

One of the saddest phrases in any language is ‘‘tis, but ought not to have been.’  The avoidable plight of children who do not reach their optimal potential falls within the ambit of that sentence.

Once we have moved beyond strategies to improve infant mortality rates, we would be relinquishing our duty of advocacy if we did not meet this challenge and do everything possible to avoid the intergenerational transfer of poverty.

A recent article series, published in the Lancet, made the point that the 6 million preventable child deaths in developing countries are only the tip of the iceberg.  They estimated that 250 million children in the developing world fail to reach their potential because of poverty, stunted growth and inadequate care.

Recent advances in neurosciences have emphasized the complex interaction between genetic potential and the environment, enabling the shaping of a child’s brain by experience-dependent synapse formation. This involves pruning of some pathways and progressive myelinization.  It is a complex interactive dance that can be disturbed by pre-and perinatal under-nutrition, stress, insufficient stimulation and poor social interaction.

These negative factors may be a toxic mix leading to lifelong problems in learning, behaviour, and physical and mental health.

It is an inconvenient truth that the fabric of society may be disrupted by children incapable of reaching their potential.  The health and well-being of each successive generation ensure the future of communities.

We want to improve the quality of early childhood stimulation by disseminating the new knowledge about the first 1000 days of life in the community, identifying children at risk, early identification and providing therapy, parent support, and advice on education.

Prevention of developmental-behavioural conditions

There are several programmes available for the prevention of developmental-behavioural conditions which are appropriate and scalable in a South African context

  1. Because the contact between families and health care workers are at clinic level, the new Road to Health book is a valuable tool to empower parents/caregivers. The recently launched Side-by-Side campaign aims to build partnerships between parents/caregivers and health care workers. It is shaped by the five pillars of care as outlined in the figure 1 below. There are also pages in the book that enable us to monitor development and advise what to do when delays are identified.  FIGURE 1-c
  2. This approach dovetails with the Nurturing Care Framework, launched by the WHO in 2018, including an early child development country countdown profile, a significant attempt to reach consensus on the best indicators for tracking progress in this area.
    FIGURE 2new
  3. The World Health Organisation incorporated a Care for Child Development Programme into their IMCI (integrated management of childhood illness) programme. They identified elements necessary for an effective programme. This includes focussing on children most at risk (impoverished and undernourished), combining interventions and involving parents and caregivers).
  4. There is currently an initiative by the Department of Social Development to support the Caregiver training initiative in South Africa. This secondary prevention programme focuses on children between 2 and 9 years, with a developmental delay, prior to a diagnosis. It can be delivered by non-specialists and involve home visits; it has also been adapted for local culture and shows promising results on its effectiveness. We have been trained in this method and hope to be involved in the first research in the efficacy and effectiveness of this intervention.

Service delivery

Our services include weekly clinics with approximately 1500-1800 patients per year with complex medical needs.

CLINICS
  • Monday: A clinic for young children under five years and the Epilepsy clinic.
  • Tuesday: A Neurology clinic where school-age children are seen, with a service for children with learning disorders, attention-deficit disorder and co-morbidities.
  • Friday:A Speech and language clinic.

Our clinical model is unique as the patient is seen simultaneously by a developmental paediatrician, therapists, and students in medicine and allied fields. This makes the transdisciplinary approach real and is time and cost-effective for families. A support programme is generated and communicated to the referring institution directly after the consultation.

First 1000 days of life


Since the initial Jamaican studies from the 1980s, it has been confirmed repeatedly that the best return on investment a society can make for its citizens is intervening in the first 1000 days of life, and even very intensive programmes demonstrated positive economic advantages. Follow up programmes in childhood and adolescence maximises these effects. To only measure monetary gains is to cast a narrow net because increasing the capability of any individual child is worthwhile. In the current climate, it is challenging to convince policymakers to procure financial resources that are pro-poor and use a system transformation approach to measure success.

It is an auspicious time for early childhood development, as yearly publications (The South African Child Gauge since 2013) have focused on the importance of the first 1000 days of life to improve society's wellness, and there has been a move to shift the attention to this period.

The focus on the first 1000 days of life is based on knowledge acquired from diverse fields like neuroscience, infant mental health and epidemiology. This is a time-sensitive gap, where the beneficial effects of interventions are amplified. The National Integrated Early Childhood Development Policy adopted in 2015 adopted a multi-sectoral approach to this problem.

The South African government recognised the importance of an intersectoral approach. Health, education and social development enhance one another’s capacities. A long-term perspective that acknowledges the normative aspects of early childhood development and its far-reaching influence on human capability would contribute to the alignment of social arrangements to this end.

South Africa is one of a few countries recognised to have a child and adolescent mental health policy at a national level. The provincial departments of health are then responsible for implementation and monitoring. Unfortunately, many of the interventions focus on a later stage in children’s lives, when interventions may be less effective.

However, much primary care still occurs in silos, with a focus on diseases like tuberculosis and HIV and early child development is often still seen to be about centre-based programmes for children 3-5 years old. There has not been a consistent and effective translation at a Provincial, District and community level to ensure this necessary shift in focus. There is a need to reframe child development as a primary health concern, as has been the case with other initiatives such as vaccination, HIV and tuberculosis. It will take strong political will to ensure that the message is not diluted or side-tracked.

Priority interventions should include a mandatory time spent at each contact session to make caretakers aware of the developmental advice sections in the new Road to Health book. Clinics should have resources available like the information videos mentioned later and the one-page advice available from UNICEF.

OUR TEAM

The team consists of:

  • A Developmental Paediatrician, a Neurologist,
  • Two Paediatricians who are fellows in training in developmental paediatrics
  • Occupational therapists,
  • Physiotherapists,
  • A speech therapist (at Universitas hospital)
OUTREACH PROGRAM

We do outreach programs to:

  • Pelonomi Tertiary Hospital
  • Trompsburg, in the Southern Free State
  • We render a supportive role to Martie du Plessis, Pholoho and Lettie Fouché schools
  • We also support resource centres and schools for learners with special needs.

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General Paediatrics, Ward 10A, UAH Unit

Purpose

Rendering a comprehensive tertiary service to paediatric patients from the Free State province and referred patients from the Northern Cape and Lesotho.

Ward 10A, therefore, admit all non-surgical patients with the exclusion of oncology patients and neonates. Neonates who had been home after birth and required re-admission will also be admitted to ward 10A.

Statistics

There are 24 beds in Ward 10A, of which five belong to paediatric cardiology; this leaves 19 beds for neurology, pulmonology, allergy, hepatology, gastroenterology, rheumatology, endocrinology, nephrology as well as neurosurgery infants < 3 months of age.

The following departments also occasionally admit to Ward 10A; dermatology, ophthalmology (especially young infants for whom surgery must be done in Universitas Hospital) and complicated or sick infants from Paediatric Surgery or Urology.

Annual admissions (excluding cardiology patients) are 450-480 patients with deaths < 10. Many of those deaths occur after withdrawal of active treatment.

Our Team

Two registrars are allocated to Ward 10A – one for Neurology and Nephrology (N&N) and the other one for all the other patients (except Cardiology). The N&N registrar has to attend outpatient department clinics on three mornings during the week. The general paediatric registrar is also responsible for relieving the PICU registrar post-call and do consultations on surgical patients in other wards. Mostly (90% of the time), there are no interns allocated to Ward 10A.

There are two consultants in Ward 10A, and as Dr Griessel is the head of the Neurodevelopmental/ Neurology Unit, he will give information about his task and his unit. (See Paediatric Neurodevelopment Unit)

Other consultants (apart from Neurology and Cardiology) who admit patients to ward 10A are doctors Cronje and Jardim (Nephrology), Hallbauer and Alexander (Endocrinology) and De Waal (Allergy). Unfortunately, a paediatric pulmonologist, whose services was very relevant in the unit, did not stay long, and the work had to be taken over by the paediatrician in Ward 10A.

Therefore, the services to be rendered by the remaining consultant become a bit of a herculean task, especially if one considers that Universitas Hospital is a tertiary hospital. Apart from managing a variety of patients on a tertiary level, that person is also responsible for doing the statistics, attending CHIP meetings, and doing the general management of the ward.


DR J KRIELGPU
Dr J Kriel, General Paediatrics, UAH

Achievements

Achievements are a challenge with only a single consultant to try to develop expertise on so many subspecialties.

The most significant part of the workload applies to Gastroenterology/Hepatology, and possible achievements include work-up and nutritional rehabilitation of patients for living donor liver transplants (done in Donald Gordon Hospital).

Over the years, it was also possible to establish a Paediatric Rheumatology Clinic at Universitas because rheumatology disorders in children are rare and complicated. Because paediatricians only infrequently encounter these diseases in private practice, children with medical aids also attend the rheumatology service.

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Paediatric Critical Care Unit

Pelonomi Secondary Hospital

Our Purpose

The Pelonomi Paediatric Critical Care Unit is a five-bedded paediatric intensive care unit that provides tertiary level critical care services to seriously ill and injured children within Pelonomi Hospital. This Unit provides services to the Southern Free State and advanced trauma services to the entire province. Services include intensive nursing care, advanced monitoring, life-supporting therapies (such as cardiovascular support, mechanical ventilation and peritoneal dialysis), diagnostics (including point of care ultrasonography) and specific treatment of underlying conditions. The intensive care unit is also an essential support structure for surgical disciplines; anaesthesiology; burns and the general paediatric service. We attend to approximate 200-250 children per year.

Our Team

The Unit is staffed by a team of intensive care nurses, a paediatric critical care fellow (Dr M Pienaar) and a paediatric intensivist (Dr L Solomon). The core ethos of the Paediatric Critical Care Unit is to provide effective, efficient, cost-effective care to the maximal benefit of as many patients as possible within the limitations of the resources available in South Africa. The current aspiration within the Unit is to expand capacity to increase access to the PICU through the opening of three high care beds.

Community involvement

The core involvement of the Unit in the community is through its work – supporting the general social good of rescuing those in danger or distress. Outside of the Unit, the team was involved in the COVID BASIC ICU training course during 2020 in collaboration with the Chinese University of Hong Kong. This training in basic assessment and support in the ICU was provided to various health professionals across the country.

Achievements

The Paediatric Critical Care team continues to strive for excellence in all aspects of our role. This includes ongoing efforts at quality improvement and dedicated hands-on involvement in holistic patient care. The Unit has recently been accredited as a training site for the paediatric critical care subspecialty certificate under Dr Solomon – Dr Pienaar is the first trainee in the Free State in paediatric critical care. Both Dr Solomon and Dr Pienaar are active researchers interested in advancing the academic footprint of paediatrics and paediatric critical care. Dr Pienaar was awarded the prestigious Thuthuka PhD Grant for his ongoing PhD study in 2020.

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Critical Care Dr L Solomon
Dr L Solomon, Critical Care

  Critical Care Dr M Pienaar  
 Dr M Pienaar, Critical Care

Paediatric Neonatology Unit

Neonatology Unit-aOur Unit

The Neonatology Unit at Universitas Academic Hospital delivers care to neonates with complex conditions requiring specialized care. The Neonatal Intensive Care Unit can accommodate 12 patients and is divided into three areas to separate neonates with medical conditions from patients with surgical conditions and those who need isolation due to infections. The High Care Unit has the capacity to admit 12 neonates, and the Neonatal Ward 16. The Lodger Facility provides accommodation for 24 mothers.

The Neonatal Unit at Pelonomi Tertiary Hospital is a 34-bedded unit but can admit 40-50 patients. The Kangaroo-Mother-Care Unit (KMC) has a capacity for 20 mother-infant-pairs, with a further 30 beds for lodger mothers.

Our Staff

Dr TB Mosia (Neonatologist) is the Head of Neonatology, Universitas Academic Hospital. Neonatal consultants delivering services at both hospitals are Dr A. van der Byl (Neonatologist), Dr P Moodley (Fellow in Neonatology), Dr A Jassen (Fellow in Neonatology), Dr JJ Van Rooyen (Paediatrician) and Dr S Simmons (Paediatrician, Fellow in Developmental Paediatrics). Seven to eight registrars rotate through the Units two-monthly to gain experience in neonatal care and are supported by Medical Officers and Interns. A Critical Care Clinical Technologist lends support in NICU.

Our Partners

The Neonatology Unit works closely with other disciplines and subspecialties to manage complicated cases, for example, Obstetrics, Paediatric Cardiology, Radiology, Paediatric Surgery, Neurosurgery, Plastic Surgery, Genetics, Dermatology, and Otorhinolaryngology. The Unit also works closely with Allied Health Services, which include Speech Therapy, Physiotherapy and Occupational Therapy, and Social Work.

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BCIC Occupational Therapy Unit

The Bloemfontein Child Information Centre (BCIC), Occupational Therapy Unit

Purpose

The Bloemfontein Child Information Centre (BCIC) celebrates 35 years since it was first established in 1985 to support the development of children, particularly those with special needs and assisted both children and their parents. The BCIC is part of the University of the Free State’s Department of Paediatrics and Child Health. Dr Dorothy Russell is heading this Centre and has played a significant role over the last 35 years in providing training, support and specialised services to different stakeholder groups.

Our Services

It is essential to know that services are available to patients, parents and professionals.

The BCIC changed over the 35 years, but community service always remained a cornerstone. The BCIC community service is unique since it is parent-child specific. The focus has shifted from telephonic information services to face-to-face intervention sessions. Technology has equipped parents with vast amounts of information; however, personalised support remains vital in the challenges that could accompany parenthood. It is also a hub for other occupational therapists' motivation to prepare and assist them for our challenging work. We need to empower parents with a holistic approach and helping them become active parents. The Toy Library, with educational toys, is open to the public. The first patient with Down Syndrome came for intervention in 1989. The passion for the children and early intervention expanded to the development of a specific early intervention programme called the Developmental Resource Stimulation Programme (DRSP). The DRSP has been a vehicle of survival for many parents and caretakers.

Statistics

  • Toy Library: More than 400 patients and clients have used and visited the Toy Library.
  • Early Intervention:To date, 182 babies and children with Down Syndrome were assisted and helped at this Unit.
  • WhatsApp groups: Afrikaans (41 participants) and English (15 participants)
  • Information and advice (counted items per contact): Telephonic, WhatsApp, Emails, Telehealth and In-person consultations

 

Telephonic

WhatsApp

Email

Telehealth

In-person

2020

315

1689

2304

600

2436

2021

510

1890

1224

912

2088

 

During the Covid pandemic, services continued on the different virtual platforms via emails and WhatsApp groups.

‘Until you have a kid with special needs, you have no idea of the depth of your strength, tenacity and resourcefulness.’ ~ Anonymous

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Occupational Therapy play group-a
Occupational Therapy play group

Occupational therapy in action-b
Occupational Therapy in action


FACULTY CONTACT

Central Information Office
T: +27 51 401 3739
F: +27 86 579 5154

E: StudentAdminFHS@ufs.ac.za

Student Administration
Faculty Administration

Health sciences block next to contact

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