Malaria

I walked over to her bed with the malaria meds prepped and ready to inject through her IV. I set my little tray of medications on the table near the trolley she lay on in emergency. I had seen her from a distance while I was in the nurses’ station but hadn’t been a part of her bedside care yet. It had been a busy nursing shift but I’d caught up and was helping out my friend and co-worker Vivian.
The papa was sitting by her side on a heavy wooden hospital chair. This 6 year old girl had been admitted with severe malaria and her colour was terrible. Malaria destroys your red blood cells causing death if untreated and children are especially vulnerable. I could see the pale soles of her feet, her pale face and lips and identified immediately that she was terribly anaemic and needed a blood transfusion. Viv was just preparing it as I came to give these meds. Her papa had previously taken her to another hospital but they were unable to give a blood transfusion which was what she really needed, so he had brought her to us.
As I neared, I noticed she was staring straight ahead, eyes half open, not blinking. Her face was a terrible greeny-grey colour. I glanced up at the cardiac monitor. Her heart rate was only 35. I recognised the signs immediately and tried stimulating her by sternal rubbing but she didn’t respond. I called out for Viv and placed the palm of my hand on her chest and started pumping like I have done so many times in practise, but this was a girl who had very much been alive a few minutes ago. She was not a manikin. Her skin was warm and the contours of her ribs showed through her skin. Her eyes, half open, had beautifully curled black lashes. Her ears were pierced and adorned with gold earrings as per the custom here for girls. I kept pounding her heart with my hand while consciously thinking of the rate and depth of compressions. Right then I wanted to cry. We train for these things but never really want to do them for real. I grit my teeth, swallowed back the tears that threatened to spill and I concentrated on compressions while a team formed around me, airway, suction, squeezing the blood transfusion in and more IV access. The trouble is, we are in a low income country and our hospital doesn’t have a ventilator or intubation gear. We have an oral airway and can bag her with oxygen but that is it.

I continued compressions. I swapped to airway. I changed back to compressions and back to airway while the team gave adrenaline and put down and NG. I’m not sure where her papa had gone, but I continued to concentrate on pushing the little blood she had around her body.
After some time passed and there was no response in the girl, I kept looking up at the doctor. She was trying to decide when to stop. I could see her hesitation. No one wants to be making that decision but this little girl’s spirit had already gone leaving behind a washed out body.
The doctor called us to stop. We took our hands off her small, still body and I looked around at the 3 other white faces, all were streaked with tears. The Togolese who were helping, cleaned up and moved on to their other jobs with stoic emotions. No doubt this was another of uncountable deaths during their time in healthcare (which doesn’t mean they don’t feel it, they just don’t tend to show their emotions outwardly like we often do).
Her papa walked forward from where he had been watching us and asked if she was dead. “Yes she is.” The doctor replied in French through her quiet tears. “Bon courage,” her papa said to the tear streaked faces surrounding his daughter’s body.
We removed the IV lines and things from her body and wiped her clean. She was wearing just a skirt so one of the nurse-aids got a small child’s gown to put on her and once they were ready, papa picked her up and her head rested on his broad shoulder as if she were just asleep. And then he walked away with her body. The very opposite of every hospital admission I hope for.

The strange thing is after that situation you just have to carry on with caring for your other patients, even though your heart is crying. It cries for every parent, sister or brother who loses a child or sibling to malaria or sickness that is totally treatable or preventable. It cries for the injustice and disparity here and across many countries in the world. It cries, hoping and praying that next time we’ll be quicker and can save them.