Shanksteps #83

Shanksteps #83The baby was convulsing.  Her head was arched back towards her toes.  Toes were curled backwards.  The arms were beating a rhythm that could be confused with the drums outside.  Sweat beads formed on her tiny forehead.  And breaths came with long pauses.  Urine flowed all over her mother as she cradled her on her lap.  The nurse was trying to get an IV in the child’s flat rolling veins.  The child’s hair was very short and was straight with a reddish color (malnourished).  Finally the rhythmic beatingof the arms subsided.  As I tried to bend the neck forward it lifted the whole torso into the air.  A lumbar puncture to get spinal fluid was in order.  I prepped the back with betadine, dawned my sterile gloves and swatted at a fly landing in my sterile area.  It was persistent but so was I and finally he left me alone.  With Gods help I was able to get right in and withdrew a very cloudy spinal fluid. (Normally this fluid is clear like water)  I explained to the family the child’s need for IV antibioticsfor a few days then oral antibiotics for a couple weeks.  They were concerned about the price but knew that meningitis (infection around the brain) often kills children.  So we started treatment.A couple hours later I return to the ward and find the child laying flatter but with rhythmic beating of her hands.  I give an anticonvulsant and wait about 10 minutes.  Her brain is still irritated so it takes a second and third dosing.  It stops then returns in the morning before rounds.  After that the IV comes out and the nurses are unable to find another vein that is accessible and they give the medications intramuscular.Today she is starting to swallow milk dripped into her mouth.  And the day nurse was able to get an IV in so the medications are IV again.We are hoping that this year is not as bad for the population.  The first year we were here we vaccinated about 300 people.  The second year about 400.  There are 50 doses in each vial of vaccine.  So the people interested in being vaccinated get a list together, and when there are around 50 people a nurse goes out and vaccinates them.  They are charged 350 francs, about 75cents.  But even with that many don’t want to do it.  Others don’t do it because the local thinking is that meningitis is dueto something magic.  So what they really need to do is when they get meningitis is to get the witch doctor to do some sacrifices (chicken, sheep, goat or combination) and some other things to heal the person.  Also as we discussed before in emails, there is a “devils heaven” where people could go and sell the life of another to buy the life of their loved one with meningitis.  So between these ideas, cost of medications, and slowness of recovery (in general) it combines to make a difficult thingto convince parents to treat their children.  So many die at home without coming to the hospital or they go to a local dispensary that treats them poorly with an equally poor result.  We already have enough vaccine for 500 people this year, and hope that we will be able to use even more.In His Service, Greg