Masanga- Later I'll let the tears fall

Day 6 (Monday) working in Masanga started off with a morning meeting detailing a long list of patients who were seen by the on-call team over the weekend. Some of the patients were in emergency, some now in the ward, others had passed away.
I rounded with the doctors in the paeds ward and happily saw that there were not many patients admitted, so I took my time playing with the kids, kicking the football and blowing bubbles, while my physio friend Jo, helped them do their exercises.

After lunch I wandered back up to emergency to find only nurse aids present, as the students and doctors were busy elsewhere. I took the time to ask one of the nurse aids about her job at Masanga hospital in the emergency ward.
During this time a couple of new patients came through the door and I had to convince the staff there that the patients needed to be seen first in emergency before being sent straight to the paeds ward. With lack of training and critical assessment skills in the staff, many patients are passed to the place that their paper says to go without being checked over first. Many patients had suffered unnecessarily due to delayed care from being sent straight in the ward and not seen, sometimes for a whole day.
After that patient arrived, I was really hoping for a doctor to arrive and not long later, to my relief, both  Dr Davids  walked in. As a couple of us began putting an IV in one baby, more and more small babies and children were walked in for admission to emergency. All beds were occupied but we moved children to the end of the bed to make more space. It seemed as we were doing one thing, something else began to happen and we'd switch to whatever was most critical.
A four day old baby (only 3kg), looking much like the one from the other day, was brought in. He also stopped breathing and we gave him his breaths while he paused and then after stimulating him out of his apnoea, he'd begin again. Not knowing what to do and the apnoea episodes were lasting longer, there was really nothing to be done. In a western country we would have already figured out what the problem was. He probably would have already been intubated to relieve his body from stress while scanned to find the problem, but here at Masanga, we have nothing. Just as we were deciding to stop and just let him do the work breathing himself the power went out, so we lost our oxygen supply. It made the decision for us.
As we began to clean up the resuscitation bed around the baby, one of the doctors brought over another baby who needed help. We moved the four day old into his aunt’s arms (the mothers don't want to hold or touch their dying babies) and a nurse watched over him while we worked on the next. The nurse explained that there was nothing we could do to keep this precious baby alive. We were very sorry. He would eventually stop breathing and we couldn’t stimulate him enough to keep him alive.
Before we knew it, this new little 3 month old baby Zainab on the table was crashing. We had slipped an NG tube down and were aspirating air and stomach contents. She had secretions bubbling out her mouth and nose as she struggled to breath. We have no suction, so we were using a syringe and a suction catheter to suck as much as we could away. Her sweet brown eyes were crossed as she used her accessory muscles to breathe. As we worked on her, I saw her little body cease to breathe. As I called it, our anaesthetist friend intubated her and I listened for a heartbeat. No, it was gone too. Chest compressions began and I know my heart was beating wildly and I saw the scene unfolding around me. Her Hb was only 4.9 (49 for the Aussies) and we still didn't really have a diagnosis but we didn't have time to figure it out. As we tried to keep her little body alive with all the measures we had, I surveyed the scene. There were syringes, catheters for suction, oxygen tubing, saturation and pulse monitoring leads, airway bags, and an array of other things spread over the gurney on which we were working. The space was small and people were great in number, the airflow minimal and the sweat abundant and the emotion numbing.
Even with adrenaline, blood transfusion, IV fluids and many other interventions, we lost the battle for little Zainab’s life. We couldn’t get her heartbeat back. After we cleared the table, just her little body remained. A nurse aid helped me to wrap her. I hate the moment the head and face are covered. My heart sank and I wanted to burst for the sadness weighing on me. Her parents were outside the room and everyone else walked away and so I sat there on the bed beside her little body, unwilling to walk away, just wanting to hold her.

There have been many moments in the last few days that I can't believe I have been in the middle of. When did this suddenly become my new reality? How is it that I'm seeing small children dying almost daily? Tears come in the moment that I look around, but I push them down. The mothers wail and scream and take themselves out of the room, throw themselves on the ground in tears and I just feel numb. Numb because I've pushed the sadness away, to deal with later and the physical situation now. Later I'll let the tears fall.