A Simple Request

Photo of the week: The highest blood pressure in the valley - but not on our programme

Highlight of the week: Finally a paediatric ward round at the district hospital. Challenging but worthwhile

Lowlight of the week: Super busy clinic side. Trying to manage sickle cell disease with no resources is not fun.

Maximum temperature: 34 degrees Celsius (lower than North Yorkshire)

Rainfall: A big fat zero

I blog to process. Process is my outcome. Time helps the process. Time can be short or long. When short, the process almost a reflex. When long, the emotions run deep. Please grab your tissues. This all happened a while ago.

Sundays are respected as a day of rest. Not a day for routine care. A day to take stock. We become tourists early doors. Then I play domestic Goddess. Make bread, yoghurt, chutney. But the Sabbath is less than sacred. Stuff still happens. On any day of the week. A threshold can be breeched. And our rest is converted to response.

It's Sunday afternoon. Our morning particularly fruitful. We escape the clutches of elephant trunks. Lions with full bellies choose not to chew our legs. We sit full of lunch at home. Satiated. With no thought of our next meal. We chillax. Calm before a storm? We watch the silent phone. Wary of its potential to change our day. The link to chaos forged over 20 years. The network of access, deep and wide. The ring tone changed annually to temper the triggering response to its call.

And so our watched kettle boils. The doc phone trills. A new tone. Insistent, despite its unfamiliar song. A summons. Selina from the clinic: Sorry to bother you. Do you have any yellow cannulas? I have a sick baby who needs one. A simple enough request. Cannulas are colour coded for their sizes. Grey and brown are stonking. For big people with large veins. Never in use in paediatrics. We prefer the gentler colours of pink, blue and yellow. The code not linked to gender. Solely according to decreasing size. Yellow are my personal favourite. The smallest gauge cannula that we can get here. Cannulation my superpower. I’m not dressed without a little yellow friend in my pocket. I pat my pocket and promise Selina an urgent delivery.

The drive to clinic is our ponder time. A septic baby needing IV antibiotics? Or perhaps severe malaria requiring Artesunate? Options are finite. Selina so self-sufficient. The request rare and significant. We arrive at clinic and head to the maternity wing.

Selina is at the reception desk in maternity. She looks relieved to see us. That precious yellow cannula not the sole agenda here. Selina shares her woes. In need of my superpower and perhaps a little more.

Selina’s voice a little unsure: Mum had been 34 weeks pregnant. The baby born 4 hours ago. Not doing well. She is in oxygen. She needs a cannula before I send her to the District Hospital.

Selina leads us into the labour ward. An oxygen saturation monitor bleeps ahead. Not a happy bleep. Low and slow.

A tiny baby girl lies wrapped up. A little dot. Weighing just 2.2kg. Pale. Blue. Sick. Her eyes closed. Her breathing slow and intermittent. At best she gasps 24 times in a minute. Nasal oxygen is running. An oxygen saturation in her boots explains the low pitched noise. 46%. Less than half the pass mark. Her heart is switching off. Just 60 beats each minute. A failing baby's rate. Bruises and petechiae cover her. Her belly is big and full of unhealthy organs. An oversized spleen and liver betray her deadly disease. Little dot won’t make the grade. 

At 4 hours of age the writing is on the wall for the little dot. Sharing that with Selina brings no real news to her. She is an old hand at this. An antenatal infection with rubella or cytomegalovirus most likely to blame. But we have no way of proving that. Nor of fixing her. Hypoxia. Hypothermia. Hypoglycaemia. Out of sorts. Not distressed. But out of time. Grand mum stands guard. Mum unable, or unwilling, to comprehend what is going on with her fading daughter. Dad nowhere to be seen. As per the cultural norm.

We weigh the options with Selina. Charting a path for baby, mother, family. Respectful of local customs and traditions. The yellow cannula has no role. Traumatic to site. Ineffectual and wasteful. Two ways are open. But both have dead endings. The first is to continue the oxygen, the monitors, the lip service. To stay amongst the other mums. Listening as the bleeps slow down until they stop.

The second is to take away the oxygen and the monitors. Leave equipment to one side. Support mum to hold her wee one. Even to take her home. In the knowledge that she can’t pull through. Selina’s words careful and caring. The family needs to be allowed to choose from 2 short straws.

We leave Selina and the family with Hobson’s choice. Our Sunday peace now broken. Broken spirits. The drive home silent. No words of solace. But the words come nonetheless. Well into the evening and the following day.

Our medical mentors don’t argue with our approach. Hippocrates pipes up first and likes our stance. First do no harm. He shouts. But we step gently and awkwardly. Our language skills poor. Our knowledge of local culture lacking. Delegating hard conversations to Selina feels limp. And yet we abdicate and defer to Selina’s instincts.

It’s Monday morning. I seek Selina out. To support her and to catch up. The last chapter in our little dot’s life now written. The family finally decide to take the monitors and the oxygen off. They go home with the baby wrapped up in Mum’s arms. Five hours later our little dot comes to a full stop.

Stories often end with a full stop. But not this one. This tale has a nasty sting in it. A disturbing narrative soon develops. The plot mired in half-truths and misquotes. A healthy baby born early in clinic needed a little oxygen and was to go to hospital for more care. But the mzungu doctor took off the oxygen and stopped all of her treatment. She sent her home to die. Fake news. Written and hard to scotch. Selina does her best to set the record straight. My offer to see the family falls on stony ground.

My blog both process and outcome. My words chosen carefully. To heal and move on. A contrast to these careless rumours, scattered without insight. Words lashing my vulnerable underbelly. Scarring me, without prospect of repair. Selina salves my sores with kindness and her sanguine outlook.

Time has healed something now. There has been no community backlash. If anything we are held more tightly as part of this tangled settlement. I still don’t know how I could have helped little dot and her family more.

The hippos still call me at night. I strain to hear what they say. First Do No Harm. They grunt. The Hippocratic oath.

Bush cam photo of the week.

Slender mongoose waste to height ratio is certainly to target

Do you like my new pyjamas?

And so the therapy continues