PAEDIATRIC CLINICAL UNITS

Paediatric Units

Paediatric Cardiology Unit (UAH)
Paediatric Oncology Unit (UAH)
Paediatric Neurodevelopment Unit (UAH/PTH)
General Paediatrics UAH Unit (UAH)
Critical Care Unit (UAG/PTH)
Neonatology Unit (UAH/PTH)
BCIC Occupational Therapy Unit (UFS)

Bongani Hospital

Manapo Hospital

Dihlabeng Hospital

Pelonomi Hospital

Paediatric Cardiology Unit

The Department of Paediatric Cardiology at Universitas Academic 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 seven million people, many children are misdiagnosed or referred when their disease has advanced. Factors contributing to this problem include poor referral, primary health systems, and transport problems. Peripheral hospitals and clinics are understaffed and serviced by junior doctors. Neonates are often also incorrectly diagnosed with "respiratory" disease and never reach our cardiology clinics. Our statistics and population base numbers show that many patients pass on due to misdiagnosis and inadequate follow-ups.

Echocardiography is essential to deliver a comprehensive paediatric cardiology service. All children have the right to basic medical care. Congenital heart disease (CHD) is the most prevalent congenital disability and is commonly misdiagnosed. Echocardiography confirms a definite cardiac diagnosis and monitors disease progression and follow-ups. Advanced echocardiography diagnoses complex lesions, and early treatment programmes are followed to ensure the best possible outcomes.

Our state-of-the-art portable echocardiography apparatus was acquired for paediatric cardiology to enhance outreach projects of the division. The programme expanded during the COVID-19 period to 2022. We also expanded our services in the Eastern and Northern Free State hospitals (188 patients) and the Kimberley Hospital in the Northern Cape (54 patients). The Pelonomi outreach echocardiography service grew substantially from 2021 to 2022 (723 patients), with several more children being screened in 2023.

Research

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

Research includes:

Regular publications
PhD and Master students
Contract research etc.

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.

Paediatric Cardiology

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.

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 connected to the University of the Free State. It is registered with the Health Professions Council of South Africa (HPCSA) as a training unit for the certificate in Medical Oncology.

Every year, more than 100 new children with cancer from the Free State and Lesotho are referred to the unit. Referrals are received from both public and private healthcare facilities.

Clinical Services
Our clinical services cover the diagnosis, treatment, and care of all forms of childhood cancer and leukaemia. This includes 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 with haemophilia and other bleeding disorders, haemoglobinopathies such as thalassaemia major and sickle cell disease, severe aplastic anaemia, Fanconi anaemia, and haemolytic anaemia.

A vital service that the treating oncologists provide is the education of the parents/families of our little patients in the wards. We also focus on educating healthcare professionals and the UFS undergraduate and postgraduate students, offering palliative and supportive care and actively participating in research activities (harmonisation of national treatment protocols, palliative care, etc.).

Our Team

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 a ward-social worker who supports the families and assists healthcare professionals with communication, educating parents/families on oncology, 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 and Dr M Jonas

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

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.
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.
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).
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 PROGRAMME

We do outreach programmes 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.

General Paediatrics, Ward 10A, UAH Unit

Purpose

To render a comprehensive tertiary-level service to paediatric patients from the Free State province and referred patients from the Northern Cape and Lesotho.

Ward 10A admits complicated general paediatric patients that require advanced diagnostics or tertiary-level treatment and subspecialty patients in the fields of neurology, pulmonology, gastroenterology, rheumatology, endocrine, genetics and metabolic diseases.

Statistics

There are 22 beds in Ward 10A and three isolation cubicles. The patients we admit are mostly medical, but quite often, we co-manage complicated paediatric surgical, neurosurgical, urology, otorhinolaryngology, dermatology, and ophthalmology patients in other units. Other departments may admit patients to the ward if they are young (<3/12 age) or need beds because of an overflow of patients from their wards.

Annual admissions are 400-450 patients. Up to 75% of these are medical, with the rest being surgical or other. The mortality rate is low as most patients are stable and require workups. Patients are referred to the intensive care unit (ICU) if high care is required.

Our Team

Two registrars are allocated to Ward 10A – one for Neurology/Nephrology (NN) and the other for other patients. The NN registrar must attend outpatient department clinics three mornings a week. The general paediatric registrar is also responsible for consulting referrals over the phone and relieving the PICU registrar post-call. This registrar also does consultations on outlier patients in other wards and does sedation for MRI and CT scans if needed. There are no intern doctors or permanent medical officers allocated to the ward.

The 10A team of consultants consist of five full-time and one sessional paediatrician, Professor Griessel, a Neurodevelopmental Subspecialist and Head of the Neurodevelopmental/Neurology Unit. Dr Alexander is the Head of the General Paediatrics and Ward 10A Subspecialties Unit and has an interest in Paediatric Endocrine, Diabetes and Metabolism. Dr Pitso is a Paediatric Pulmonologist responsible for Respiratory, Allergy and Immunology patients. Dr Moodley is responsible for general paediatric patients and has an interest in Rheumatology and Gastroenterology. Dr Tabane is the HIV and Infectious Diseases consultant, and Dr Cronje works part-time and oversees the nephrology service at Universitas Academic Hospital.

Ward 10A Paediatricians, UAH: Left to Right (standing): Prof Griessel, Dr Pitso, Dr Cronje
Left to Right (seated): Dr Moodley, Dr Tabane, Dr Alexander

Achievements

The development of Ward 10A and the subspecialties unit has been a great achievement in 2023, with the appointments of a pulmonologist and a general paediatrician to assist the head of the unit with clinical workload and developing subspecialist services. The unit is growing academically, and service delivery has improved greatly. Previously, only one consultant had to manage all the 10A subspecialties, together with the administrative work of the general paediatric unit, which consists of Ward 10A and the paediatric outpatient department.

Undergraduate and postgraduate training in the unit advanced with academic-driven teaching and learning.

A monthly outreach plan to the Free State referral hospitals (Dihlabeng, Manapo, Boitumelo and Bongani) has been established and commenced in February 2023. The Ward 10A specialists will do outreach in these hospitals, provide academic support and extend clinical services.

Challenges and Future Goals

Further development of a specialised diagnostic unit offering specialised services with excellence in level of care is planned. There is also a need for subspecialist neurology, nephrology services, and a clinical geneticist.

Teaching and training workshops with clinical updates are planned to support general practitioners and paediatricians.

Publications and quality research output within the unit are also goals to achieve.

Dr Deepa Alexander

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.

Paediatric Critical Care Unit

Our Team

The Paediatric Critical Care Services are staffed by teams of intensive care nurses, paediatric intensivists, Dr LJ Solomon and Dr MA Pienaar, a paediatric pulmonologist, Dr B Pitso, a paediatrician, Dr M Buankuna and a full complement of allied health practitioners. The core ethos of the Paediatric Critical Care Services is to provide effective, efficient, and cost-effective care to the maximum benefit to as many patients as possible within the limitations of the resources available in South Africa. This is achieved through a collaborative approach emphasising team, patient, and family participation, system-based interventions, supportive scholarship, and clinical evidence. The current aspiration within the service is to expand capacity to increase access to the PICU by opening high-care beds. The service is at two hospitals within the Mangaung Metro, Universitas Academic and Pelonomi Tertiary Hospitals.

Universitas Academic Hospital

The Universitas Paediatric Intensive Care Unit is gazetted for eight beds and currently has the capacity for five patients. This unit provides tertiary and quaternary services for children in the hospital and serves regional hospitals in the Northern Free State, Lesotho, and the Northern Cape.

This Unit supports specialised paediatric medical and surgical services via specialised medical care, which include Pulmonology, Nephrology, Neurology, Endocrinology and Gastroenterology, and surgical disciplines such as Orthopaedic Surgery, ENT, Neurosurgery and Plastic Surgery. Medical staff also work closely with the Congenital Cardiac Diagnostic and Interventional team, including Paediatric Cardiology and Cardio-thoracic surgery.

Pelonomi Tertiary Hospital

The Pelonomi Paediatric Critical Care Unit is equipped with 13 beds. However, it only has five beds that provide tertiary-level critical care services to the hospital's seriously ill and injured children. 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 (with 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 general paediatric services.

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, Prof Pienaar is the co-convenor of the Ethics and Governance Group of the Interdisciplinary Centre for Digital Futures and the UFS.

Achievements

The Paediatric Critical Care team strives 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 was accredited as a training site for the paediatric critical care subspecialty certificate under Dr Lincoln Solomon in 2020. Prof Mike Pienaar was promoted to associate professor in the Department of Paediatrics and Child Health early in 2023.

The need to improve the care of seriously ill children enabled him to receive his PhD. Prof Pienaar, a lecturer from the University of the Free State (UFS), says the need to improve the care of seriously ill children is vital to reducing preventable deaths and diseases, leading him to investigate using artificial neural networks.

Dr Solomon and Prof Pienaar are active researchers interested in advancing the academic footprint of paediatrics and paediatric critical care. They also participate in several ongoing interdisciplinary collaborations.

International outreach

In May 2023, Prof Danie Buys and Prof Mike Pienaar visited The Children’s Heart Centre at the University of Ghana Medical Centre in Accra, Ghana, West Africa. The objectives of the outreach were to provide access to interventional cardiology procedures in underserved paediatric populations with congenital disabilities, including ASD II, VSD, PDA, aortic coarctation, and congenital and rheumatic valvulopathies. The secondary objectives were to develop congenital and paediatric interventional cardiology and capacity-building programmes at the UGMC.

From 13-19 May 2023, several international specialists and experts attended this event. The Global Heart Care Team Europe Paediatric Interventional Cardiology Mission and visiting teams from Leiden University Medical Centre (LUMC), Cardiovascular Interventional Centre, German Heart Centre Charité Berlin (DHZCB) and the UFS Paediatric Cardiology Specialist Unit. Attendees included Dr Regina Bokenkamp, Prof Dr Nana-Akyaa Yao and Prof Dr Charles Yankah from Global Heart Care-PASCaTS.

Prof MA Pienaar, Critical Care

Critical Care Dr L Solomon
Dr L Solomon, Critical Care

Dr M Pienaar, Critical Care

Paediatric Neonatology Unit

Our 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.

BCIC Occupational Therapy Unit

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

The Bloemfontein Child Information Centre (BCIC) celebrates 38 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 38 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 38 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. The Toy Library, with educational toys, is still open to the public. Third-generation members are part of the Toy Library at present.

It is also a hub for other occupational therapists' motivation to prepare and assist them with our challenging work. We need to empower parents with a holistic approach and help them become active parents.

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.

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

Back to top

Occupational Therapy play group

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

We use cookies to make interactions with our websites and services easy and meaningful, to better understand how they are used and to tailor advertising. You can read more and make your cookie choices here. By continuing to use this site you are giving us your consent to do this.

Accept