I am lucky: I have never before seen
someone's life leave their body. That changed today.
When I arrived at the clinic around mid
morning, something seemed off. I didn't see any of the staff except
our registrar who was busily registering our day's patients. I walked
down the hallway of doors, peeking inside each one. When I reached
the in-patient room, I saw three of our staff inside. They were
crowding around a 10-month old girl child who was laying naked on the
bed, her chest heaving up and down with labored breath.
I asked what was happening.
“She's dehydrated,” they told me.
I stood in front of the bed, my coffee
thermos in hand and still sweating from the walk down to the clinic
from my house, trying to make sense of my surroundings. An array of
needles in their packages were splayed across the table, and I
overhead our CM (certified midwife) saying the baby was so fat that
they couldn't find a vein.
This was true; she was covered in
healthy-child fat rolls with thick legs and adorable chunky arms. The
nurses tried repeatedly to find a vein in her plump wrist, but to no
avail.
Not knowing the protocol they must
follow or even what can be done for a child in this state, I stood
back and watched the scene unfold, asking questions occasionally.
The child's breath came rhythmically,
her chest heaving as if every inhale was a struggle. The CM gave the
child an enema of glucose and some other liquid that is suppose to
lift a child from unconsciousness (yes, she was unconscious). We were
to wait thirty minutes to see if it worked. She checked her eyelids
and saw that they were very white—apparently a sign of anemia.
As we waited and observed, the child's
breathing changed slightly. She was rolled onto her back. She had a
fever, but her malaria test had been negative. They placed a wet
lappa over her stomach in an attempt to cool her down.
More details from the story were
divulged. She had been toileting (experiencing diarrhea) and
vomiting. She had also been jerking (seizing). The family bought
medicine from a “black begger,” someone who walks through the
village selling boxes of various tablets (you never know if they're
real, expired, or stolen). They had given the girl ORS and zinc
tablets, they told us.
“These people lie! They can say
anything! They might have overdosed her with malaria medicine, but
they can't tell us that now,” our nurses insisted when I asked.
It was a touchy issue.
Her mom had gone someplace to look for
a motorbike to transport her to Cestos City to the hospital. The
guardian who remained, who sat outside the room peeking through the
doorway and occasionally coming inside to stand over the bed,
explained that the girl was her 'husband's brother's child,' but that
the little girl stayed with her grandmother.
We continued to monitor her, checking
for any signs of consciousness. At this point her arms were rotating
back and forth with every breath as her chest rose and fell
dramatically. I kept asking whether her change in breathing and
occasional exhaling muffled with a small moan meant that she was
waking up or getting worse. They told me they weren't sure.
They listened to her lungs with the
stethoscope. They pinched her legs and arms to see if she would
react. They shined a light in her eyes to see if she would response
by closing them slightly.
At one point her eyes were flicking
slightly. They rolled back in her head slightly a few times. I called
the CM; my counterpart checked her again. Her leg, which had been
straight out, pulled into her body. One of her arms did the same
thing. I thought she was gaining consciousness.
Then her chest stopped moving. I stared
at her intensely, waiting for it to rise again.
I looked at my counterpart and
whispered, “Did she just stop breathing? What is happening?”
After about 6 seconds, she pulled air
in again. 'Ah, she's still alive,' I
thought, relieved. Then it stopped again.
The CM
came inside. No one said anything. She called the girl's guardian in
and told her ,“You should come be here. But don't cry.” Our
dispenser walked in and our eyes locked as she passed me, “Yes,”
she responded to my questioning face. She already knew my question:
Is she really gone?
There
was no clear verbalizing that the girl had passed. The guardian,
shocked, placed her head and arm on the wall, curling into a
sorrowful stance. I saw her back shake as she tried to fight off the
emotions and sobbed silently. I didn't know what to do.
I
walked over and put my hand on her back trying to console her. “I'm
sorry,” I gasped. I felt tears stinging my own eyes. Our dispenser
began to wrap the small body in a lappa. When she finished; I had to
remove myself from the grieving energy in that room before it
completely washed over me too. I wanted to maintain composure like
all of my colleagues.
Patients
waiting outside knew something dramatic was happening, and every time
someone walked out of the room they scanned faces for clues. I sat on
the bench outside trying to come to terms what I'd just witnessed. I
managed to keep my shit together.
I went
to find the other nurses who had dealt with the case. I assumed they
would need to fill out some sort of death report. I found the three
of them in another room discussing how there was nothing else that
could've been done. The girl had been too far gone when she'd
arrived. They'd done their best. In an effort to support my staff, I
agreed, “You did all you could.”
There
was a knock at the door.
Last
week our CM had delivered a premie baby—she was born early, at 7
months, because her mother had suffered from malaria not once, but
three times during her
pregnancy. The baby girl, Favor (named so because her survival had
been God's favor), was born at a weight 1.4 kg. All weekend, our CM
had been monitoring the child, and they'd just been okay-ed to go
home seeing as how they live right in our town. Her mom had brought
her back for a vaccine.
“There's
my little survivor,” our CM exclaimed when the ma walked in
carrying the itty bitty lump in her arms. She sat down on the bed
next to me and began to unwrap the body from the two lappas engulfing
her.
Her
head was smaller than my palm. The onesie she was dressed in
completely swallowed her tiny frame. When the ma pulled her bare legs
out so they could inject the vaccine in her bottom, I couldn't stop
staring at them. Impossibly narrow, like a candle stick or a broom
handle, I was dumbfounded at how this infant had survived birth and
her first 5 days outside of her mother's womb. But there she was,
breathing, yawning, and even crying a little bit as they woke her up
before giving her the vaccine.
I
questioned why they needed to fully wake her up before the injection.
“Do
you want to become a nurse or a doctor?” my counterpart asked me.
“No,”
I responded.
She
shook her head at me, probably exasperated with my constant stream of
questions this morning, and said, “you must wake the child up
before giving the vaccine to make sure the child isn't unconscious.”
A few
minutes later she looked at me and asked, “You crying before?
You can't cry at every death or you will be crying every day. This is
Africa. These things can happen on a daily basis. You must be brave.”
And
that, my friends, is the lesson I learned today: to be “brave.”
Working
in this setting, at a rural health center, I have been lucky to not
experience this kind of trauma on a daily basis. I would not choose
to see these things if I had the choice; I know that I'm not able to
detach myself emotionally from people enough to work as a physician
(well that in addition to the fact that I can't stand the sight of
blood, needles, and all of that stuff). But now that I've seen these
occurrences, I am thankful. I am thankful that I am able to learn
something from such unfortunate situations and to see the devastating
effects of the behaviors that I am here to educate others on how to
prevent. It brings about a sense of reality and urgency to the issues
that are surely and presently out there.
It's
easy to become jaded by peoples' lack of interest in health
prevention and to lose motivation. These kinds of events, as
upsetting as they are, remind me that our work in the communities way
out in the bush is important and potentially lifesaving. We must 'be
brave' and forge ahead.
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