Heartbreak

Saturday was overwhelming. I started the day working a half shift at Bottom. The nurses are even more understaffed than usual because half of them are out on a two-week training. Of the remaining few, many are working well over 40 hours a week, so a few more hours of my time is the least I can give. It was a slow morning, even though I attended three deliveries. Unfortunately, the baby of the girl I spent the most time with in the morning needed resuscitation after a very prolonged second stage and failed vacuum; a sad start to the day.

After leaving Bottom I went to Mbewe village to deliver formula to the orphaned baby of the 17-year-old. Deb came along with me this time and I was incredibly grateful for her company. I was planning a quick visit - seeing the grandmother briefly and handing over several large tubs of formula - but, that is not the way it happened. I found the house again without a problem and the baby's aunt welcomed me with a warm smile. Apparently she had been caring for the baby but when I arrived the baby was somewhere with another woman. She urshered us into the house and instructed us to sit on the mat while she went to retrieve the baby.

My heart sunk the moment she placed him in my hands. He was wrapped in two wet chitengis, he was still, and, even though he was a month old on Feb 3, he weighed no more than a newborn. I unwrapped him to examine him in a thin ray of light that filtered though the slats in the wall, and saw greenish pus crusted over his eyes and a lightpink rash sprinkled over his body. I could see his ribs with each of the infrequent breaths he took and touched his sunken fontanells (a sign of dehydration). He was slightly febrile and when I wipped and parted his eyelids all I could see was red. I asked the aunt how long he had been like this. She said his eyes had had pus for three days but he had not had diarrhea. I asked her to prepare some formula which she did immediately (she said the other cans had finished so I'm not sure who was feeding him or what he was being fed). With obvious difficulty he managed to swallow and suck a bit. After he took about an ounce, he wiggled slightly and then unloaded a lot of diarrhea. I told the aunt we needed to take him immediately to the health center. She looked distressed and I have no idea if it was because I was taking her away from other chores and children, or if it was a lack of money, or if she resented this extra-mouth. I can only say that it broke my heart to find this baby so close to death in the village and no one seeming concerned about his rapidly deteriorating health.

As we loaded into the car, the grandmother appeared with bright eyes and a big smile, took the baby in her arms, and also got in. At the health center the nurse told us we would have to take the baby to the hospital in Lilongwe. She weighed the baby, he was only 2.7kgs (5.9lbs). She told me that the prognosis wasn't good. The aunt seemed hesitant about accepting the news of a trip to Lilongwe, but the grandmother said she was ready and I heard the nurse telling the aunt something about being grateful for having care and transport and that the baby was dying. We returned to the house for the cans of formula, the aunt decided to come along, and the four of us set out to Lilongwe.

When we reached the hospital we were able to find a clinical officer to attend to the baby right away (right away after asking a handful of nurses). He wrote out a treatment plan for neonatal sepsis and dehydration, and told us the baby would be admitted to the nursery. Just as a note, there is no clear linear flow or direction given on how to move from being examined to admitted to the treatment rooms to the nursery. There are many benches along the hall outside the ward rooms and by the nursing station and Deb and I just had to keep asking everyone we saw for directions (which were incorrectly given multiple times) and for assistance, which was also reluctantly and slowly given. I am certain that if we had left before the admission process was complete, the family would have remained waiting on the benches for hourse before anything happened. With our insistence we were able to insert a nasogastric feeding tube and took the baby to Children's Ward C for a feeding.

As we rounded the corner to Ward C, I whispered to Deb that we were entering a haunted house. I do think that is a pretty apt description of the ward, low lights flickered on and off while the screams and cries of many children echoed off cement floors, walls, and ceiling. Thankfully, in Ward C we met a very nice accomodating nurse who immediately helped up prepare formula with boiled water (although to my horror, she added tap water to cool the steaming formula). Our little boy finally had a much needed meal and as the formula went down his tube I turned to my neighbor on the bench and saw a father holding his 3 to 5-year-old child (very difficult to determine the age). The child was only a skeleton and the eyes were sunk deeply into the skull. It's an image I'm sure most of us have seen on the television, but it is entirely different to sit next to a child dying of starvation and know that a meal awaits you and that you rarely even experience hunger pains. Of course problems on many levels contribute to and finally culminate in the death of a child from starvation, but to know how little a child requires to preserve life and see (really see) that the world has failed to meet that very humble need is devestating.

From there, and with Clement's help (who joined us along the way), we found the nursery and recruited a nurse's aid to choose which child our little boy would share a crib with. The nursery was full but babies are sometimes placed two and three to a bed; their mothers or guardians sleep on the cement floor next to them. Knowing that they were settled, we left the floor. On our way out we stopped in the ICU to visit Margret, a 19-year-old who had delivered at Bottom via a normal vaginal delivery two weeks before. She had a tear and whoever sutured it left a pack inside her vagina. Several days later she returned septic and then sat on the ward until it was determined that she would need to be transferred to KCH for a laporotomy. Friday got her laporotomy and the diagnosis of sepsis was confirmed. By that point she was so fragile that she was admitted to the ICU and put on a ventilator. The morning she was transferred she gave both Deb and me hugs and kisses and told us to visit her and bring her cold water at KCH. When we saw her Saturday night she was unconscious.

When I finally got home a friend who was visiting from the States called to invite me to dinner but I just couldn't bear the idea, so I stayed home and cried. Clement and I talked for a long while about suffering, hopefull/hopelessness, purpose and many other overwhelming and answerless questions. That put a little softness in-between me and the painful visions of the day.

Sunday, I went to another village to visit another orphaned child. The mother had worked as a housekeeper for a German expat in Lilongwe and he had taken it upon himself to care for the baby as well as to support the family. I went with him to examine the baby. Fortunately the little girl was doing great and the grandparents who are caring for her clearly shower her with love. The problem is once again that her survival depends on the health and capacity of her already frail grandparents, but at least there is hope.

From there I stopped in at Bottom and found the baby I had resuscitated on Saturday still in a borderline state, responsive to touch and sound but breathing too quickly (no fever). After that I returned to KCH and found the little boy screaming in his grandmother's arms (a good sign). I helped her with a feeding, he peed on my leg, and I gave her some soap and cloths. (Once again his cloths were wet. It is quite apparent that the grandmother deeply loves him but I think the problem is with her, her health, and her ability to assess and respond to the ever-changing needs of a newborn). On my way out I checked in on Margaret again. Her condition was about the same, still running a slight fever, now with pneumonia in one lung, but her nurse was hopefully so I tood that as a good sign. Somehow at the end of the day on Sunday I felt a bit better.