Specialist Clinics
District level hospital guidelines applicable for interns and comm service doctors. Published in 2016
Rainbow Clinic for Abused Children
Referral to other specialist services
There are a number of specialist clinics run at Rahima Moosa Hospital. Most of the clinics are staffed by the local consultants. Part time consultants assist in the running of some of the clinics. Some clinics are run by other departments e.g. Orthopaedics, ENT and Genetics. All clinics apart from HIV, Orthopaedics, ENT and Rainbow clinic are run from the Specialist Clinics Area which is situated on the Ground floor in the building adjacent to the main hospital building. The telephone number of the clinic is 011 470 9360. Unbooked patients will not be seen at any clinics. Please refer to the section on each clinic to see how to book.
Rainbow Clinic for Abused Children
This clinic that operates from rooms situated in the Antenatal Clinic area is run by Dr Linda Cartwright and is assisted by a social worker and psychologists.
The Rainbow clinic is currently working with various Child Protection Units and the Dept. of Child Welfare as well as developing a relationship with the private sector (Netcare).
Clinic hours are Thursdays 08:00 – 12:00. Bookings are made with Specialist Clinic at 011 470 9360. Patients will not be seen without a booking.
All non-acute cases (assaults > 72 hours post incident) are to be assessed by the attending doctor to rule out need for admission (especially if safety is in question); all treatable conditions must be treated and may be booked for Rainbow Clinic.
Urgent/acute cases (<72 hours post incident) will be seen by Dr L. Cartwright Mondays – Fridays 08:00 – 12:00 hrs, ext. 9102 and after 14:00 hrs by the most appropriate available doctor. Evidence collection and management of acute problems (PEP, collection of swabs and clothing, psychological therapy for child or parents etc.) must not be delayed on account of not being able to find the appropriate doctor.
ALL doctors are required to be able to manage abuse cases.
Direct referrals to the ward are to be seen by the Unit on call and all paperwork to be completed by that Unit. The clinic offers on-going training on child abuse to registrars and medical officers. A guideline on the approach to Physical and Sexual Abuse has been compiled and is recommended reading for all paediatric staff.
POPD is a good place to learn how to deal with sexual abuse. Make use of the opportunity, see the cases and discuss them with Dr Cartwright.
Dr Cartwright is available for telephonic advice after hours if necessary on 082 709 7452.
IT IS STRONGLY RECOMMENDED THAT YOU HAVE A COPY OF THE RAINBOW CLINIC’S STEP BY STEP MANAGEMENT OF CHILD ABUSE BOOKLET. Contact Mrs Karen Marshall for a copy.
Neurology clinics
Acute neurological problems should be admitted and not booked for a developmental clinic appointment (which has a waiting list).
Convulsion clinic (TUESDAY MORNINGS)
Uncomplicated epileptics can be managed at POPD/local clinic /Unit Follow-up level. The following should be referred to convulsion clinic:
children less than two years, uncontrolled epilepsy, complicated or atypical epilepsies.
EEGs must only be done if
the result will change your management uncertain diagnosis
atypical seizures
children less than two years old suspected epilepsy syndrome, etc.
Similarly not every epileptic needs a CT scan.
Neuro-Developmental clinic (WEDNESDAYS ALL DAY)
Older children with learning problems are assessed by the psychologists (>10 years). Those younger than 10 years or with other neurological problems will be seen at developmental clinic.
Empilweni clinic
(Tuesday, Wednesday, Thursday MORNINGS)
After disclosing the child’s status to the appropriate caregiver and post-test counselling, the child needs a baseline CD4 count. Start all infected children on co-trimoxazole and refer caregiver(s) and child to Empilweni clinic (fourth floor). For HIV+ infants, please make sure they get an appointment within two weeks.
Do NOT do a viral load or LFT before referral unless advised to do so by the Empilweni team.
Please make sure that all referrals are accompanied by the hardcopies of the results (HIV ELISA, CD4, and FBC)
Bookings to Empilweni can be made by calling the clerks (Vusi or Vincent) on extension 9424, and accompanied by the completed referral/consultation form (in files in all wards/OPD areas)
Cardiac clinic
(FRIDAY MORNINGS and MONDAY MORNINGS)
Children with suspected cardiac problems will be booked here. Please make sure patients have had a recent ECG and CXR. DO NOT REFER PATIENTS FOR A CARDIAC SONAR ONLY
Suspect “Cardiac” Problem if:
All types cardiac failure
Cardiac murmur for assessment
Radiologic “cardiomegaly” – please ensure good quality CXRs
Systemic and Pulmonary Hypertension
Syncope – but PLEASE take adequate history to rule out CNS problems like seizures
Chest pain
Family history or Dysmorphic child, with possible congenital cardiac or rhythm defects
Heart rhythm disturbances – please try get a rhythm strip in addition to standard ECG
Recurrent chest “problems”, without adequate historical or clinical explanation
Childhood stroke
Other: Auto-immune disease etc.
Asthma clinic
(THURSDAY MORNINGS)
Uncomplicated asthma can be managed at POPD/local clinic/Unit Follow-up level. Make sure to check every child’s inhaler technique, use of a spacer and what to do in case of acute “attacks”. Children whose asthma remains uncontrolled by steroid MDIs must be referred to asthma clinic.
Renal clinic
(TUESDAY MORNINGS)
This clinic will see children with nephritic/nephrotic syndrome, recurrent UTIs, structural renal abnormalities, etc. Simple enuresis can be treated in POPD, but secondary enuresis, and primary enuresis in older children can be referred here. Feel free to discuss cases with Dr Fredericks or Dr Reubenson.
Endocrine clinic
(TUESDAY MORNINGS)
Diabetes, all thyroid disorders, ambiguous genitalia, rickets, growth problems and obesity not responding to dietary interventions and exercise.
Genetics clinic
(FRIDAY MORNINGS BY APPOINTMENT)
Known genetic disorder in the family or family history of intellectual disability, slow development, hearing or visual impairments
Couples that have had a child with or have a family history of a birth defect e.g. neural tube defects, cleft lip and palate, clubfoot, congenital heart disease
Feedback of abnormal genetic results Child with a suspected syndrome
Child with a recognizable syndrome/ single gene disorder (for further investigation if available and counseling)
Child with multiple congenital abnormalities Child with unusual/dysmorphic physical features Child with ambiguous genitalia
Child with unexplained mental retardation Familial cancer pattern
Blood testing
Chromosomes and FISH analyses
Green top (heparinised): 1 -2 ml for newborn, 5 ml for all others
DNA extraction and analysis
Purple top (EDTA anticoagulant): 3-5 ml newborns, 10 ml all others
Sample jar with saline – tissue samples other than blood (skin, muscle, liver, kidney etc)
Serogenetics
Yellow top (ACD anticoagulant): 6 – 13 ml (1 -2 tubes)
Purple top as alternative: 0.5 ml (microtainer) for galactosaemia Yellow top tube for certain enzymes
FOR SERO-GENETIC TESTS CHECK WITH LAB FIRST: 011 489 9220
Gastroenterology clinic
(THURSDAY MORNINGS)
Patients with liver disease, gastrointestinal disease or nutritional disorders can be seen. Please do not refer children with functional constipation or uncomplicated reflux disease unless they are unresponsive to therapy. Feel free to discuss cases with Dr De Maayer
To consult Dr De Maayer on a patient please complete this on-line form before giving him a call.
http://www.123contactform.com/form- 1701916/Paeds-Gastroenterology-Referral- Form
Referral to other specialist services
ENT: There is an ENT clinic at RMMCH every Wednesday and Friday mornings. Bookings may be made in POPD. All non-urgent cases may be booked here with a referral note. I
If you want the child to be seen sooner , please discuss with a senior doctor in POPD or contact an ENT consultant on 083 309 2253.
Orthopaedic: Non-urgent orthopaedic cases (e.g.Talipes equinovarus) can be booked for the Thursday morning orthopaedic clinic. Again, urgent cases must be discussed with the orthopaedic Dr on call.
Paediatric surgery: PSOPD is held in area 256 at the CMJAH (Ex JHB Gen). Please write a referral note and make a booking on 011 488 3256.
Dermatology: Most dermatology can be treated in POPD, severe or uncontrolled cases to be referred to dermatology clinic on Mondays 08h30 – 12h00 (bookings to be made in POPD). Ophthalmology: Patients will be seen at the Helen Joseph hospital on Tuesday, Thursday (squint clinic), or Friday. No need for booking but please write referral note.
Paediatric Urology: Contact Dr Ahmed Adam on 0723252955, aadam81@gmail.com Use the following on line form for Paeds Urology Referrals (for all
patients) http://www.123contactform.com/form-1575093/Paeds-Urology-Booking-Form
Plastic Surgery: This clinic is on Fridays from 8am-12pm. Book cases for this clinic via POPD