Friday, August 19, 2011


This blog post has been stuck in my craw since around 3 am so even though I need to be going to bed so badly that it is almost painful I’m sitting here writing….
Put yourself in these shoes for a minute… you wake up to a funny sound around 2 am. Your 2 year old is fussing. Strange, she doesn’t usually do that. You can see her moving in her bed. You scoop her up and take her outside where there is a little light from the moon. She really doesn’t look right. Gasping for breath, stiff in your arms, eyes rolled back in her head. You holler for your husband to wake up. As he starts to stir up the fire for light you are trying to think. What are you doing to do?!? Phone! You don’t have a phone. Neither do 500 of your nearest neighbors. Your baby isn’t responding at all. You are calling her name but she isn’t even opening her eyes. The village health workers?  They never have any medicine and besides they don’t even know what to do for joint aches. Car? There is no transport for miles around! Besides it is the middle of the night. These roads aren’t good in the light, dangerous in the dark. Your baby girl is going to die! She isn’t breathing at all. You have no idea what is wrong. She was fine before supper. Didn’t want to eat much and fell asleep earlier than usual but you didn’t think twice about it. Your neighbors have heard you yelling and came over. One grabs the baby and starts to rub her hard.  The other is holding her mouth open. You just can’t even think, she is going to die and there is nothing you can do….
Unfortunately, this is life for those that live in the villages of Karamoja. This is also where I entered the story. One of the neighbors remembers that Dr. Val is sleeping in the village tonight. The woman rubbing the baby carries her and they come up to the hut where we are asleep. They are yelling her name and several are talking at once. We pull on skirts and step out of our hut to see a bit of a crowd. Val yells for one of the guys to come translate for us. A man is still holding the baby’s mouth open while another is rubbing her belly and chest hard. I’m still trying to clear the sleep from my brain and figure out what is going on when I see this this kid who pretty clearly isn’t moving any air on her own.  Pulse? Nothing in the extremities, skin’s cold, I can find a heart rate in the neck but its thready, irregular and crap.  It is apparent quickly that this person rubbing the baby is generating some type of cardio-pulmonary resuscitation. In my head I’m yelling for a crash cart and calling a code. In real life I’m still squatting on the ground with my flash light in my hand listening to a mother cry in a language I don’t understand over the obvious, pending death of her little girl. Can someone put in an airway and start bagging? Put in a line and leave it wide open, be sure to get a rainbow of tubes for lab. Lets draw some ABG’s and get radiology to do some stat chest films. Crap! I’m still kneeling on the ground with only a flashlight in my hands. Then she seizes. Grand mal, rigid, seems to last forever. Val has her driver warming up the truck. We are translating to the family that we will leave for the hospital right now. Pt’s father was here but now is gone and pt’s mother cries, that she can’t leave, she has a younger baby at home that is still breast feeding. The father comes running back pretty quickly carrying the younger baby and we all pile into the truck. We pause so that Pastor John can pray for the child and the journey and then we are off. The mud is more than a foot thick in places, standing water in other places, long grass, wet, really dark and pretty treacherous, especially at 60 kilometers per hour. 
(Here is a picture of the road several hours later after the sun has dried things out a little.)
We finally reach the hospital. 2 hours and 15 minutes later. Miraculously the child is still alive when we arrive. She has had at least 6 more seizures in the car (though I suspect that she was status epilepticus almost our entire ride- is that even possible?!?) and she still looks like she is barely staving off death but we headed straight into the pediatric ward and got immediate attention. (Walking into this ward needs to be experienced to be believed but I’ll attempt to address it in a coming post.) The nurses put in a line, drew blood and checked her sugar. It was the best response I’ve seen in any situation yet in this country.
Unfortunately this is where this story ends. I wish this story has a happy ending but we have to keep praying. We left the baby and her parents there at the hospital. The seizures seems to have stopped but the child was unresponsive to pain and deep stimulation. She still had a pulse but it wasn’t good. She was breathing on her own which was a plus as this hospital doesn’t have the means to intubate. She has a crap diagnosis of cerebral malaria (Which it is not!!!) and they are running in quinine (Poison!!!)  but at least she is in the best place in all of Karamoja and we managed to communicate to the family that we cared and were willing to try. From start to finish I found the whole thing frustrating. I guess that is why I’m still awake nearly 20 hours after the fact processing. Frustrated with the crummy situation the Karamojung find themselves in. Frustrated that the nearest reasonable hospital is more than 2 hours away. Frustrated with myself for not being more equipped and able to help. Frustrated with the hospital for not being able to offer better treatment. Maybe frustrated most of all with this: My teaching today for the training of the village health workers was on the limitations of medicine and medication and how we have to rely on God. Yet I still want to rely on what I’ve been taught, my skills, medicines and that prayer is a pause I take before jumping in the truck with a sick baby.  How do I balance medicine and good care as God given gifts yet turn first to the One that I know gives life and healing? 
I'm just tired. I need to call it a night before I fall off this chair. But I'm back in Soroti. More posts to follow soon. 

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