Saturday Call



 

 

My first call here at Mukinge was on Saturday. During the day all was quiet. Rounded on Maternal Child, we have a set of 28 week twins and another singleton who is also about 28 weeks as well (0.9kg). Amazingly they continue to hang in despite all odds against them. After rounding the admissions started to role in, first there was an elderly gentleman with RUQ pain and a 10 cm cystic structure in his abdomen, then a 50 year old female with splenomegaly and ascites, the suspected etiology is  likely parasitic. Then a couple of children with malaria. One is a 3 and ½ yo boy named Nickson. He appeared very ill; pale, diaphoretic, with a bounding pulse. He is struggling to breath. He had already taken a course of antimalarial medications provided by an outlying clinic, but these had failed to resolve his infection.

Malaria here is almost exclusively falciparum. Of the types of malaria this is the deadly one. While mosquito netting is provided, most people do not use it, not sure why.

 

Anyway Nickson was started on quinine IM and IV fluids. As I said he appeared very pale and I’m guessing he was profoundly anemic, it is not uncommon to see Hgb of 2-3, normal is 12-16. The cause is multifactorial; malnutrition, chronic intestinal parasite infection, recurrent bouts of malaria. Unfortunately the hospital is out of blood for transfusion.

Shortly after admitting him I go back to recheck on him, his breathing is labored, he is vocalizing incoherently, and he appears worse. While working on another admission for malaria, the nurse calls me back to Nickson’s bedside. She says his condition has changed. I wasn’t sure what that meant, but I figured she wasn’t calling me back to tell me he has improved. I now know that what she meant is that he has passed away.

The under five mortality rate here is 89 per 1000 live births. That is 9% of children die before they reach their 5^th birthday. The majority of these deaths are a result of diarrhea, malaria, pneumonia, HIV/AIDS and malnutrition. Illnesses that are treatable, preventable or non-existent in the US.

Just because something is common doesn’t make it easy to process both for the parents as well as the nurses and physicians taking care of these patients and children. The night would bring a few more deaths, a young boy with malnutrition and an elderly female.