Adebo

So here is mid (ok, actually late) morning and I’m sitting at my computer staring off into space again.  I’m thinking how much I miss bedside nursing but actually that topic is for a different  post.  I’ve managed to put in something like 3 hours of work already today. I order to vent my full frustration I need to back up to yesterday or even further back. Several months ago I met a little girl, Adebo, who clearly had some problems. (http://atimeasthis.blogspot.com/2011/01/6-chronically-ill-mentally-and.html)  I had promised to follow up with them but was having a hard time locating them. No one seemed to know exactly where they had come from. Anyway, I was picking up another child yesterday and word had gotten to the Adebo’s mother that I was looking for her and she was waiting for me at the home of the other child. Her daughter looked terrible. She is about 6 months old now but weighs only about 6 kilos (13 pounds). Her breathing was appalling, well over 60 breaths per minute, she had sternal retractions deeper than I’ve possibly ever seen (maybe looked so bad due to the marasmus), was hot to the touch and in trying to console her, her mother put her to the breast but she just absolutely couldn’t drink. So I packed everybody up in the car and set off.  I needed to bring the first child to an “epilepsy clinic” (I use that term very loosely) though I wanted nothing more than to race back home for my neb machine. Figuring a few more pieces of the puzzle would be nice I stopped in the best doctor’s office in the city. Friday- no doctor there, only a medical officer. I considered leaving right then, but still wanted a chest x-ray and maybe a CBC. What a joke. I had to convince the MO that the baby had pretty serious pneumonia and not malaria (fever = malaria in EVERY situation don’t you know?!) and that a chest x-ray was really called for. The only labs that that lab could do was the malaria film and honestly I didn’t care about that anyway. Meanwhile, I can’t stop counting her respirations. On the way out the door I privately asked one of their nurses to put in an IV for me. (Cindy- I still HATE putting IVs in kids, especially malnourished, dehydrated ones!). She took one look at the baby and did it so I know she saw what I did.  I took them back to my house, sat them in the shade of my mango tree and started a little albuterol and atrovent, hung an IV with some ceftriaxone and pushed some hydrocortisone. The neb worked wonders and soon we were both breathing easier. At this point in the day I left them sitting under the tree and headed for the burial of Robert. When I got home, pt’s mother reported that Adebo drank some and she was now soundly asleep. Her little body was still burning up but resps were within normal. They have an uncle who lives in the military barracks and they said they could stay in town with him  tonight. That worked well for me as I could give a dose of abx at that time, bring them there and go back early in the am to give another instead of driving out to the village over and over. I had hoped at that time to switch her over to PO meds and get them back to their family in the village. But this morning didn’t look good. Retractions back, abd painful and distended (what is that about?!), fever higher than before. So I gave another neb with good results again and continued with the IV abx. I’ll head back in a few hours to see them again. This all just seems so silly. This kid belongs in a hospital! Instead I’m giving meds to a 6 month old baby in the army barracks! On top of all that I’m sure that there are some key medical pieces that I’m missing. Why the extreme wasting and failure to thrive? What if she’s got an empyema or effusion going on in there? There are so many things. I am not a doctor! Ugh.