Masanga- They just keep coming

Day 5 began with the shortest on-call meeting of the week that didn't mention any deaths overnight, except we knew there had been one tiny baby who certainly had breathed his last during the hours we'd been away.

I started the day rounding with the doctors in the paediatric ward, happily seeing one of the small malaria boys from two days before, well enough to discharge back to the village. It felt like a small triumph amidst the constant battle.

Paediatric ward

Back up in emergency the doctors had started a lecture for the medical students in a conference room, taking all but one away. When I headed up to emergency there was a small boy lying in a bed, sick with malaria. From the documentation I could see he had not yet been weighed and before any medications could be given we needed to know this. With permission from a nursing aid, I took the boy and his mama to the paediatric ward, to use the baby scales. While we were there another set of parents came in with their equally small boy, also about 18 months old (11kg), who was clearly very sick and in severe respiratory distress. Realising that they had been sent from somewhere for admission in the paediatric ward, I knew that he need to be in emergency and seen by a doctor immediately.

After weighing him, I took them up to emergency and had the medical student see him while Steph went to get a doctor. The boy was tachypneoic, febrile, lethargic and had a blood glucose level of 0.9mmol/l (16.2mg/dl for the Americans). We needed to raise his glucose level immediately.
As we searched for a vein to give him IV glucose, I ran down to the mini shop and bought a Fanta since we couldn’t find any IV 50% glucose anywhere in the emergency ward or in pharmacy. Using a 10ml syringe I fed him like a little bird and he sucked thirstily.

After the IV glucose was finally sourced and given and an action plan written, the boy vomited a dark fluid. Not long later he passed blood rectally and was noted to have bleeding in one eye. Suddenly the two British doctors present looked at each other, eyebrows crossed. Concern for this patient rose as we realised this case would be more complicated than we originally thought.

Dr David in the emergency, writing up a plan of care

After things settled down a little and each patient was getting their treatment, Steph and I walked back for a late lunch and to pack a bag for the weekend in Freetown, visiting with friends. Our ride to Freetown was with these doctors and colleagues. As we sat at the hostel waiting, we knew something must have been going on with this little boy since they were already running late. By the time they arrived, they just drove through to say they had to decontaminate and they'd fill us in after they picked us up.
Putting our bags in the car we waited to hear the story. After we had left emergency, the boy had bled again rectally, begun to bleed from his nose and vomited more blood. After reading a few chapters in the tropical medicine textbook they connected the haemorrhaging to a possible viral haemorrhagic fever.
As the doctors were discussing this small boy's case and he was bleeding from all these places, his little body stopped working and he arrested. CPR was attempted but ceased quickly as he continued to bleed and bleed. Another little life gone...

Now they were sitting in the car looking up viral haemorrhagic diseases to know if it was a true possibility and whether we had all been contaminated by coming into direct contact with him. A blood specimen had been sent to another town, Kenema, for a diagnosis. If the results ever come back we might know for sure. (The results did come back a week later and it was negative for Lassa fever.)
The car ride to Freetown was fun, hearing stories of our new work colleagues and answering a lot of questions about our lives on the Africa Mercy.

We were dropped off in Waterloo and took a poda poda from there to Forebay road, Freetown, just past the corner were we would turn to go down to the port. It was an area very familiar to me after 11 months of walking that street in 2011. From here we walked to the eastern police station until we could find an okada (motorbike taxi) to get us through the horrible Freetown traffic to Aberdeen.
After a successful ride through the city to Aberdeen Women's Centre, we met our friends Anna, Tiff and Greta and dropped our bags, overjoyed to be in more great company and the addition of power, running water and air con.