“Could one of you come and see this child?” Jacques asked Audrey and I. The child was breathing fast and was very pale. He is 7 months old, 6kg (about 13lbs), and has a huge anterior fontanelle which is very sunken in (a sign of severe dehydration). His hematocrit was 6% (normal 45%). He had just vomited blood-tinged fluid. As they placed an IV in his arm he did not move or cry. He had pneumonia from all the vomiting and aspiration of the stomach contents, giving him low oxygen. He needed oxygen!
Six days ago the workers emptied the water tank to patch and paint it. They scraped the insides, patched the holes with a tar compound, welded a few spots and then repainted it. This took about 4 days to complete. The fourth day the electricity went out. So we have been “functioning” without water in the hospital for many days now and with no electricity. Two days ago I wanted to do a hysterectomy on a woman that needed it and when we tried to start the large generator the batteries were dead. So without power I decided to put off the surgery till we have power again, and when my OR schedule is open, 3 weeks. So with all this we are out of power when this child is in need of oxygen.
We have started the small generator of the lab and decide to transport the patient into the lab waiting room so that we can use the electricity there to run an oxygen concentrator (there is no bottled oxygen here). After placing a bed in the waiting room and hooking him up he breaths slightly better but needs blood. The mother is the same blood group so she gives to her child. The day passes and it is time to turn off the generator for the lab. The child has received the blood but is still very hypoxic (low oxygen) without the oxygen. Should I run the generator over the weekend for him? How long will he need oxygen? Will the oxygen actually help him survive, or will he die anyway? Should I tell the family that since the generator is running only for their child they would have to pay for gas? If I say this will they refuse treatment? I ask Aud what she thinks. We decide to keep the generator going and not talk to the family about gas for fear that they will refuse treatment.
At midnight I am called because the generator is stopping every 45 minutes. Apparently it is plugging up with gunk in the lines and for air vacuum in the tank. Baya, the nurse who is in the ER, is somewhat mechanical. So I offer tools and ask him to try to fix it. I don’t get called for the rest of the night.
It is Sabbath (Saturday), I plan on sleeping in. I wake up at 7AM to the sound of chickens and immediately think of the child. I can’t sleep any longer because I continue to think of him. I get up and head into the hospital. He is still alive! I have prayed for him a number of times through the evening and night. I am thankful God has spared his life. The generator worked all night after Baya tried a few things. I take him off oxygen and his oxygen stays above 92%. I transfer him to the ward. Our chaplain, papa Sidi, has just prayed for him again.
I see another girl that is 16 with severe headache and neck pain overnight. I do a lumbar tap (take spinal fluid) to evaluate for meningitis; I also treat her for cerebral malaria.
I leave the hospital hopeful for the child who has survived the night. Greg
My frustration know no end as I write this addendum. It is Saturday evening. The nurse on today did not observe my patient well. He calls me when the child is really dypnec (short of breath). They put him back on oxygen to late. He died.