Loss

I have been thinking a lot about the two weeks I spent in Masanga, Sierra Leone in 2013. I felt like I was working in a disaster area because multiple children arrived every afternoon with severe malaria that were half dead. It was there that I did CPR on a baby and child for the first time. It was there I saw a child haemorrhage who died while I was away eating lunch. It was a shock to my sheltered nursing career and love of people. I thought it might be unique to that area because it was remote. There were still wild monkeys jumping around the trees. But I have realised this week that my experience in Masanga, Sierra Leone is not unique to that area.

It is currently malaria season and you know the season is upon you when there is multiple small children lying in beds in emergency or ICU, febrile and severely anaemic. These patients are very lethargic and flat. Some have advanced cerebral malaria to the point of seizures. Yesterday a baby seized for over an hour which could not be reversed by medications. His nurse came to me for advice since she is not a paediatric nurse. She told me his respiratory rate has dropped significantly and she was worried. I could see from the monitor at a distance that his heart rate was close to 200. I told her that if his respiratory rate was dropping then he was probably going to have a respiratory arrest so to be prepared. (Unless children have a previous cardiac history, they will have a respiratory arrest before a cardiac arrest.) She went and told the doctor the baby’s vitals and then got the appropriate equipment- simply a paediatric bag-valve-mask (ambu bag) and age-sized face mask. That is all we have. The saddest thing to me is that I didn’t even have time to help her because I had 3 premie babies (all weigh less than 1.5kg/3.3lb), 2 3month old twins who weighed 1.4kg and 1.52kg with malaria and malnutrition and a toddler with malaria who had barely moved. I didn’t have time to get heavily involved with a baby potentially needing CPR. There were multiple reasons for me not volunteering to assist. Firstly, the staffing ratio to patient numbers are often barely manageable because people need care so come to the hospital, but we only have so many staff to work. On Saturday I had a nursing student help me in the morning (he was supervised by a Togolese nurse) but after lunch my patient load was 6 babies that weighed less than 2kgs each, all feeding every 2-3 hours and 3 children. We always have a nurse-aid caring for our patients who are super helpful but there is only so much they can do. More children were admitted who I should have taken care of but I physically and mentally couldn’t pick up any more than I was carrying.
Secondly, I wasn’t sure I had the mental strength for potentially doing CPR on a baby. After losing the 6yo girl earlier in the week due to malaria, the following day I had worked really hard with another severe malaria baby boy. He looked ok but I came back to work 2 days later and the night shift nurse told me he had coded overnight. They had managed effective CPR, but then he died a while later. Oh how I wanted to burst into tears. His little body was still on the bed and his mama was still wearing the yellow shirt from the day I met her. She picked up his limp little body that fit perfectly in her arms. He was wrapped in her fabric. She had a bewildered look on her face and tears pooling in her eyes and streaking her cheeks. She had to pay the hospital bill before she left but she didn’t have enough money.
Caring for children who are on the verge of dying is mentally, emotionally and physically exhausting. That day I had already helped a team do CPR on a woman who had come in the door and arrested immediately. She didn’t make it either. I was standing at the head of the bed when we stopped doing compressions and the doctor checked the pupils. No reaction to light. The female relative was distraught and quickly covered up the patient’s lifeless face after closing her half open eyelids. I choked back tears.

I know death is a part of life, more so in low income countries than high income. At home we hold on to life for too long sometimes. But I am struggling with how quickly we lose life here. It just feels so fast. I wrestle with knowing God cries with me and more, for the loss of his children but I wonder why He hasn’t answered some of our prayers. Why do these communities suffer with so much needless loss? It is just so unfair.
I’ve been wondering, how is this life sustainable? The only answer I can find is to look for the good. See those who survive because there is a hospital. There are countless patients who come in, get treatment and not only survive but thrive. All those premie babies are surviving and getting fatter and closer to going home. That is beautiful to see and be a part of. Also, the Togolese nurses who work in this hospital are amazing!! They are heroes who deserve so much praise.

For a period today though, I just need to cry and grieve the losses of the week because they are so real and heartbreaking and if I don’t cry now I never will. I put some music on this morning, my favourite album Let There Be Light by Hillsong Worship and just let the words wash over me and sink deep into my soul.
Thank you for praying for me. I can tell you are because some days in the midst of a situation where I might feel swapped and completely overwhelmed, I’m calm. Please also pray for this community, that they would come to know Jesus. Pray that despite severe loss and grief, they would know hope. He is the only one who can truly save them.