The precious baby

One of the worst experiences of my medical life. 

This happened about a month ago – but I couldn't bring myself to put it down on paper due to the hurt and tears it caused me.  It is a good representation of the difficulties we face here.

A mum bought in her child to me…. 6 days old….born with no problems..  however day 4 of birth the babies skin started peeling off.  Literally the whole epidermis was peeling leaving red raw areas exposed.  There were also areas of superficial infection on the raw areas, and it looked a bit greenish.  The baby had slightly decreased feeding but was otherwise alert and vigourous.  When I saw the baby I thought the baby looked in pain, so decided to treat it with pain relief, some very strong IV antibiotics to get rid of the infection, regular feeding, and treat it like a burn; wrapping to keep warm, dressing, and IV fluids because it was losing fluid through the loss of its skin.

The next day I came in – more of the skin had come off including the babies hands and finger nails which looked like loose gloves.  The baby was making a constant whimpering sound which seemed like the baby was in extreme pain.  Oh even as I think of the sound it makes my heart cry.

I charted the baby a tiny whiff of morphine so the nurses could do some dressing changes…. After about half an hour the nurse ran to my room to say I urgently needed to come.  I arrived the baby was blue …. Blue…. Not breathing, heart rate about 20.  So I called for help and started CPR (thank god for my Advanced Paed Life Support training!).  It was the scariest thing I have ever done – anyway after a period of time of mouth to mouth and some oxygen the baby came back. 

Anyway the baby was placed on oxygen and I sat with her all day.  She continued to have these blue spells where her heart rate dropped and she needed CPR all day. She had overwhelming sepsis from the secondary skin infection that meant she needed support to maintain her physiology.

The fourth time she stopped breathing her heart rate no longer dropped she just kept having long spells where she couldn't initiate a breath....she could go 15 mins or longer without a breath, when this happened we would push the oxygen through a bag and mask, which would start a breath again.  She remained on oxygen which was helping her and then……………suddenly …….the oxygen ran out…….. and there was none in the whole hospital.

I looked at the other doctor who was with me and my eyes welled up – surely she is not going to die because we ran out of oxygen!  He got into action and started bagging her (which means a mask and a bag attached – so essentially we were pumping in air which has less oxygen in it).  The pressure of the bagging of air maintained her heart rate and we continued like this, one by one, for about an hour.  Until finally she started breathing by herself. 

Rightio – this is about 5 hours later and she was finally stable enough to be sent by ambulance to the Regional Hospital where they had oxygen. Called the ambulance….”oh sorry doc the ambulance, it’s travelled for servicing”…… called ambulance number two….”sorry doc it is not running today…”  WHAT!

When finally we found an ambulance that was running from the Regional Hospital, and it arrived quickly...but without oxygen and sirens!  "doc the sirens have spoiled"... sigh... ok I will take it in my stride.   I sat in the back with the 6 day old baby and watched her constantly, while the ambulance was beeping it's horn trying to get bicycles, goats, pigs, cars out of it's way.

Nearly at the hospital... baby stopped breathing, turned grey and I couldn't even hear a heart rate with my stethascope.... argh ....started CPR and continued it until we arrived at the maternity area of the hospital.  Now, when I got there the baby was still not breathing so I ran with this limp doll in my arms - up the corridor, around the corner, up another corridor .....(where the hell am I!!!!!) until I finally reached maternity.  I kept with the cardiac compressions and mouth to mouth when I found a bed and kept yelling "HELP!".

The midwives found me and directed me to an area where the ladies give birth, and I started bagmasking the baby until she pinked up.

NOW..... we are here at the Regional Hospital, it's 6pm and the baby is still alive and on oxygen... whew!  

BUT....... where is the doctor?  Apparently it's protocol to arrive at outpatients department and see them there.  Oh well I thought, I will go down to the OPD and discuss the emergency situation with the doctor on call.  Walked all the way there (approx 500m) and found the consulting room.  I introduced myself, and explained the situation, and that he needed to come immediately to assess this baby.  Anyway, he said NO, he said he was not going to attend to the baby and that he wanted to finish off the 'well' patients  who were waiting.  WHAT???  I then asked him his name, and if he was a medical assistant (which he was), told him he was making a grave mistake because this baby is going to die, and walked out.  As soon as that door slammed behind me....I balled!  I couldn't believe it that the one person consulting would not attend to this baby....AND it turns out he was the only doctor in this useless hospital!  (all the cuban doctors that work here had gone away on a conference!).

I was then stunned.... what do I do???  I walked to the paediatric department where I knew a nurse who was working and stood there crying.... in front of all the nurses.... what do I do??? The nurses just stared in disbelief... a white doctor crying for a local baby...

Luckily though the nurses where empathetic enough to call in one of the doctors who was on call and at home, which is totally not allowed, it is meant to be the Medical Assistant who calls them in.  He kindly agreed to come in, so I waited for him to arrive.  Whilst waiting the nurses were wonderful enough to move the baby to ICU (a bear room with oxygen...that's pretty much it), the baby had one more episode of cardiac arrest which we managed with bagging, but became stable on the oxygen until the doctor arrived.

About 8pm, exhausted I went home, and cried and cried......cried with frustration of the lack of caring of the MA.... cried for this baby who would have died if I hadn't been a boshie whitey..... cried because we ran out of oxygen..... cried because doing CPR on this baby felt as if I was holding a limp grey doll in my hands....

Next day I heard the baby had started taking NG feeds of expressed breast milk and was stable, I felt relief but also a degree of numbness.

.....sadly the baby died two days later.  All I know is the feedback from the midwives, apparently it was a technical difficulty in ICU.....something to do with the oxygen.....sigh

Some photos :)

The town with no vegetables

I don’t think I would have ever believed I would be in a town that was in a famine.  However because of the wonder of global warming – Bolgatanga has found itself to be nearly there.  The people here live off their land, and mostly work as farmers.  The grain, millet, corn, vegetables etc is then harvested and traded in town at the market or used for the family.

Again I reiterate… because of global warming – the rainy season has not yet come, it is about a month late.  Normally at this time it will be raining daily and the crops will all be about 1 metre high, but our reality is the rain is very sporadic, the crops are only 1 cm (if that) and the land is as dry as a raisin. 

To be honest for me the rain is a bit of a hassle, it means I can’t bicycle around and will be late to work, but for families this is an absolute tragedy, it means they simply cannot survive; their kids will only eat one meal a day, (that is plain rice), and the family will not have food.  Even NGO’s have to go into preparation mode for this disaster, when normally they work in preventing poverty, and strengthening communities, now they have to find a way to support those in extreme poverty, with no food, to live.  In fact Oxfam sent an emergency email out to raise funds as this is happening right throughout Africa.

Also because of the drought there is no fresh vegetables….none!  Seriously, I haven’t eaten a vegetable for over a month now.  Ok…… I exaggerate (slightly) I have had a yam, an onion, and maybe garlic …… that’s it!  I’m craving vegetables….i dream of salad, courgette, brocolli, asparagus….sigh.

Mama Laadi

I thought I would take this opportunity to talk about where I’m staying while I’m here in Bolgatanga.  I live in a Foster Home which is run by an amazing woman called Mama Laadi.  Afrikids met Mama when she was living off nothing and had a one bedroom shack full of children from the streets or orphans that she had taken in to care for.  AfriKids and Mama are now in a partnership called Operation Mango Tree.  There is 35 children who live here and she also cares for another 85 in the community that come to visit her regularly for money or food.

She is such an amazing women – she has devoted her whole life to caring for these kids, she is the most giving person I have ever met.  In fact she normally goes without to make sure the kids have enough.  An example from just last night: she wears 1 dollar jandles which have broken and as one of the straps have snapped and she was going on how she was going to fix them with a drill rather than buy new ones!  Ha ha … you can also hear her coming from a mile away dragging her one broken jandle!

At the moment she is paying a lot of money for some kids from the community to get operations – one child has ambiguous genitalia and his lower abdomen is basically all open with his intestines hanging out – he is now 5 and been like this all his life with no one helping.  She raised enough to send him to Kumasi (one of the bigger centres), so now he is down there with his mum… unfortunately they are still begging on the streets… but mama has given them money for medicines, and enough for nappies so he doesn’t leak faeces everywhere.

There is also another child who has retinoblastoma (cancer of the back of the eye) usually this is caught early, but this child’s eye was actually hanging out of his face and no one could afford to help him.  Mama gave them about 1000 of her own money to go to Accra and get surgery from the cancer specialists.  He had his surgery on Monday.

Every day I see new children come here and she will give them money for books and food.

The kids that live here come from varied backgrounds.  Most of the stories I don’t actually know but sometimes Mama will tell me and it makes my heart break.  Little one 'P', now 7 and an absolute darling… Mama found him in the market with his mum and grandma – they were begging, and the mum has mental health problems… she covered him in faeces from head to toe – he was only 7 months old, so Mama took him in and raised him.  Another child who is my special friend 'M'– she is 5, her mum got stoned to death for being a witch, and the community left her to die, mama found out and stormed in with all community watching, picked the child from her death bed….. and now – she is the boss of the house!

Yet as tragic as each of their stories are – there is so much love and laughter and singing and dancing in the house.  The children are just wonderful and playful and full of love.

Malaria and how fluids can cure everything

I have been here 20 days exactly and wo-behold I got myself malaria!  I have been doing better than ever with my preventative medicine; taking it everyday like clockwork, been using insect repellent, sleeping under a net and definitely not going outside after sundown!  But I got it! Grrrr

I knew as soon as I got it too – I was feeling quite good in the morning and biked to work… then the headache came….and didn’t leave.. despite panadol and brufen.  I also felt very strange and heavy in the head, which then became accompanied with a side of nausea.  Got the test and the whole lab laughed at me for about half an hour! Ohhhhh malaria!

I found out about 2pm and decided to close early.  I told the other medical assistants etc but people kept coming and coming and coming!  And of course I ended up closing last out of everyone – how?

I even dealt with two emergencies with my malaria on board; a one year old boy bought in in shock and unconscious.  Thank god for APLS – the drummed in A.B.C   He was peripherially shut down and cold and his capillary refil was about 7 seconds – I pumped him full of fluids and went to check on him in 2 hours and  he was up and breast feeding….. whew.

Because all the other doctors had gone I also dealt with an adult emergency – a lady 25 bought in because she couldn’t breath.  Her hands were all flexed up and stiff.  I knew as soon as I saw her she was hypocalcemic and was breathing fast due to acidosis – so pumped her full of Ringers Lactate and WA LA – hands and breathing became normal!

After that I called it a day – slowly managed to bicycle home and crawled into bed for 5 days solid!  My head just felt weird the whole time, dizzy and heavy and the nausea was ongoing!  I just slept and read books and slept and watched movies and sometimes sit with the kids quietly.  Even now when I’m writing this on Day 5 of malaria I’m feeling ready for another sleep and it’s lunchtime!  Ha ha – nighty night

Anniversary of being here for 2 weeks!

I celebrated my 2 week anniversary by having a night at Mama’s Guest House.  This is essentially a nice hotel at the edge of Bolga, where there is air conditioning, a working shower and some peace and quiet away from the kids.  Mama’s Guest House is part of AfriKids sustainability projects, where the money that gets made here goes towards Mama Laadis Foster Home kids.  I think it is fantastic and seems to be working well for everyone. 

I have been working every day since I have arrived and seriously in a state of exhaustion and frustration which I’m trying to get rid of.  Change my attitude and start tomorrow like it’s a wonderful day.

The other day I was trying to leave my consulting room and had about 20 parents in my face surrounding me and screaming at me…. and I screamed back…..that’s pretty much the lowest of the low.  So I have made a promise…. ‘if I feel like screaming at a parent, then it’s time to take a break’.  Today I have had a day off but unfortunately it means that there is only the one hard working MA left doing my rounds for me as the other doctor has left again.  But I just can’t do another day in the place as I think I would probably go crazy.

Mama sent me off with mangoes and water and lovingly told me that the hotel is my home too.  She told me to come back with a renewed attitude about my work.  She said she has seen many abrunis (white people) not be able to cope with the frustrations of working here and leave.  The most important thing to remember is ‘your in Africa’ she keeps saying.  Yes, this is true, however I can handle and understand things like lack of resources, power, internet etc… but simple things like rostering so everyone can share the load is kinda inexcusable…. No?  Or is it just that because I am feeling the responsibility and working longer hours than everyone that I’m feeling hard done by?  Maybe it’s a personal affront.  I care about my patients and I essentially don’t want them to die, therefore I have to stay late to check my instructions were carried out….. did they get oxygen that I charted...... did they get they get the medicine I charted??   I wonder sometimes if this is the right thing to do, but in my heart I feel it is.

I have three examples of why I worry: a) baby of 13 days with severe malaria, I charted IV Quinine…. it wasn’t given, b) baby of 6 months with pneumonia and very low oxygen saturations.. I charted oxygen… it wasn’t given, c) boy 14 severe meningitis… admitted by a medical assistant, not examined, no medicines charted.. I saw him the next morning– his neck extended… poor consciousness…. I did a lumbar puncture (spinal) and pus came out… he should have had the medicines 24 hours earlier….that’s inexcusable…no?

Worn out on Day 5

I have been working in the medical centre now since Wednesday and already I’m worn out…. am I allowed to say that?  Hmmmmm.  I have been the only doctor with one medical assistant (who is great) out of essentially 7 doctors/Medical assistants since Thursday after lunch… and have been really feeling the long hours.

I am extremely privileged to be solely paeds while I’m here, I am really happy with that.  However the pressure is intense.  I arrive at 8am and start the ward round and usually there are about 100 people waiting in the outpatients department.  I have about 25 kids on the ward at the moment including newborns.  I go around each kid and have about 6 nurses watching me and laughing at how the kids cry when they see me!  They then watch me do my notes.  It takes a while. 

I have been getting to the outpatients department at about 11.30am, by then the kids are screaming and parents are getting upset because they are wondering where I am.  A couple of times I have to run to my room to grab a text book and the patients who have been waiting since 5am scream and beg me to see them.  Of course this gets worse as the day gets on and the pressure increases.

Interestingly the nurse who accompanies me in my room and translates constantly tells me ‘doc, go fast’.  And this is on a day I saw 60 patients!!  I can truly say that every patient I see I take a history, examine, do investigations, and even joke around with them.  I have a feeling she wants me to leave out the examining and joking around bit…. 

We also never stop… when one patient walks out another comes in… and so on.  So you never get a chance to stop and think… or eat lunch…

Where I work there is currently one other dr, and one medical assistant during the day, one in the afternoon and one in the evening.  Sometimes I leave my room and look around to find I’m the only one still seeing patients, yet there are many left!  They all scream ‘dr I beg you see my child’…  but at this stage I haven’t eaten lunch, it’s 6pm… and a tropical rain storm is approaching in which I have to bike 30 mins in….. “of course I will…..”

Then I go to the ward to check on my patients and make sure my instructions were carried out….and they weren’t.  One child is running a fever and not had any paracetamol despite it being charted regularly…. Another baby has low blood sugar which I charted dextrose which has not been given…. Another 2 year old is becoming more and more dehydrated while his fluids are sitting next to his bed….argh

Exhausted I bike home and wonder why I’m here…… yet I choose to come here and do this…. I love the kids here, they are absolutely gorgeous, I love their big smiles and laughter… I do really want to be here.

I know working in developing countries are frustrating, and I’ve been down this road before….. but I need advise on how to make it ok to survive….anyone?