Thursday, 23 May 2013

Masanga- The small ones

Day 4 began with a relatively happy round in the paediatric ward. We looked over a couple of very malnourished children on the ward. One 12 month old can barely even lift his own head. His skin is saggy on his tiny 4.3kg (9.4lb) frame. The Danish nurse told me he’s been on the feeding program since he was one month old and he has barely gained weight past his newborn size, even 12 months later. I wonder how he will survive even if he had intensive feeding. I wonder how detached the mother has become from her youngest son that he is this malnourished and how hard life is for her and the other children at home. What can I, who is only here for 2 weeks, do to help? Is it even possible for me to make any difference?

After the paediatric round I wandered back to emergency and we were called to the delivery room for the resuscitation of a newborn. I was able to jump in and help out after the cord was clamped and cut, to stimulate the baby while we made sure he cried, good and loud. His mother had been in labour for 8 days! He was her fourth child, but until this day, no other baby of hers had survived! Today the victory was won!

After we ate lunch and headed back to the hospital, some patients lying in the emergency ward weren’t doing so well. One small boy admitted with cerebral malaria on the previous day, was having seizures and losing his airway. I don’t think I’d ever seen such a small boy have seizures like this. He was just lying on the table, naked from head to toe apart from the string necklace on his neck and around his small waist. His body was burning up in fever and he just lay there, eyes closed, with shallow but fast breaths. During the seizures we would help to support his airway and give him medications to help him stop seizing, but sometimes it made no difference. His body lay limp on the table. His parents were always close by, waving a piece of cardboard to cool his body and to keep away the flies.

The resuscitation room

Another lady and her sister came with her new baby. She had gone into labour and walked during the night through the village to the nurse. Before the nurse could reach her, she delivered the baby onto the ground in front of the nurse’s house. That was at 1am they said. It was 11am by the time they came to us, saying 'the baby was not breathing fine'. He looked ok to us but further investigation showed he still hadn't breastfed after being born and was lacking the sucking reflex. He hardly cried and began having apnoeic episodes.
After a long, long afternoon of helping with this small baby’s airway and stimulating him to breathe again on his own, many discussions were had about his condition and what it could possibly be and how on earth could we help or save his life, but it was futile. He was going to die. He probably needed heart surgery and he wouldn't survive on his own even overnight. We don't have power past 10pm, so no permanent oxygen device was available to help. The prognosis was explained to the mother and sister and Steph and I sat with them while he stopped breathing and turned a greyish colour and then when we thought he’d given up, he’d breath again. He just kept fighting. The tears of the mother and her sister flowed down their cheeks, dropping onto their precious baby's blanket. This baby was the third and only surviving child, but yet again hopes were dashed for the future. The baby was not even given a name. He died a few hours later.
The elation from saving one baby's life was almost drowned by the passing of another. But still I rejoiced for that mama, for finally she had a baby, alive and well and my heart broke for the other mama, who still had none.

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