Innovative Journal of Medical and Health Sciences

Alphonsus N. Onyiriuka*, Matthias M. Okposio, Louis C. Onyiriuka

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This paper reported a case of a six-week old Nigeria boy with persistent hyperinsulinaemic hypoglycaemia of infancy (PHHI) who presented with typical clinical and laboratory features and in whom some management challenges commonly seen in developing countries were encountered. The clinical diagnostic features included: at the time of hypoglycaemia (blood glucose level 1.6 mmol/L), serum insulin level of 6 mU/ml; absence of ketonuria and acidosis; and elevated level of serum C-peptide and a high glucose infusion rate (12 mg/kg/day) with persistence of the hypoglycaemia. Management challenges encountered included non-availablity of a long-acting somatostatin analog (octereotide) for treatment, lack of investigative facility for distingiuishing between diffuse beta-cell hyperplasia and focal beta-cell microadenoma, paucity of surgical expertise for pancreatectomy and lack of fund to pay for medical treatment abroad in the event of referral.

Fred Spiring*

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The ultimate customer in healthcare is the patient who may be undereducated and easily overwhelmed by the complexity of healthcare. The patient becomes the final customer of healthcare services only after a long line of other customers’ needs have been met. An internal system of customer/supplier relationships must be used to augment feedback provided by the undereducated final customer. Assessment from the final customer is necessary, however by paying more attention to the internal customer/supplier scenarios fewer situations for poor quality will arise.