The nurse and I study the baby hopelessly. Just 5 months old she was admitted last week with severe diarrhoea and breathlessness and has been going steadily down hill. She is almost certainly HIV positive and probably has a severe pneumonia related to that. Over the last couple days we have been adding various drugs for the purpose of treating various conditions she probably doesn’t have but there is nothing to lose.
“I don’t think there is anything else we can do,” I say to the nurse. The child is semi-conscious with a heart rate of over 200 and a respiratory rate of 70. She will soon exhaust herself. I could put in a breathing tube but there are no paediatric ITU beds available at our referral hospital.
I sit by the phone and work through the Durban hospitals. “Any paediatric ITU beds?” and it is the same story. None. Sometimes because they are full, sometimes because the beds are closed due to lack of staff. They suggest things I could try (but I have done them already), and if “she doesn’t improve phone me later we might be able to take her then.” But they and I know by that time she will not even survive the journey.
The nurse and I pull up a bench to talk to the tearful mother. She knows what we are going to say. She has been here 24 hours a day for a week and has watched her daughter’s decline. She lets out a loud wail of lament and falls to the floor on her hands and knees sobbing and screaming.
This is what I find the most difficult here: the knowledge that if we were in a city, even perhaps a city within South Africa, these children might make it. Not definitely make it, but might make it. Our referral hospitals want to help – but they do not have enough beds and those they do have tend to be given to the more salvageable surgical problems. Not children like these. These HIV ravaged skeletons of children.
“I don’t think there is anything else we can do,” I say to the nurse. The child is semi-conscious with a heart rate of over 200 and a respiratory rate of 70. She will soon exhaust herself. I could put in a breathing tube but there are no paediatric ITU beds available at our referral hospital.
I sit by the phone and work through the Durban hospitals. “Any paediatric ITU beds?” and it is the same story. None. Sometimes because they are full, sometimes because the beds are closed due to lack of staff. They suggest things I could try (but I have done them already), and if “she doesn’t improve phone me later we might be able to take her then.” But they and I know by that time she will not even survive the journey.
The nurse and I pull up a bench to talk to the tearful mother. She knows what we are going to say. She has been here 24 hours a day for a week and has watched her daughter’s decline. She lets out a loud wail of lament and falls to the floor on her hands and knees sobbing and screaming.
This is what I find the most difficult here: the knowledge that if we were in a city, even perhaps a city within South Africa, these children might make it. Not definitely make it, but might make it. Our referral hospitals want to help – but they do not have enough beds and those they do have tend to be given to the more salvageable surgical problems. Not children like these. These HIV ravaged skeletons of children.
Comments
I made a note to you yesterday, but I must have forgotten to send it.
Sorry man, I can identify with your concerns and frustrations, but still you can't do more than you can. You are doing your best, and you went an extra mile(ten actually) to save that little baby.
I'm glad you have a good social life going for you there, to debrief and destress.
I pray and hope that one day our leadership will be awarded the wisdom to prioritis
take care
thabi