A tiny bundle, just surrendered by her mother who had already lost 2 children in 4 years. She couldn’t take another fight, another desperate rising wave of hope followed by the crush of despair. So at 6 weeks she withdrew. I don’t blame Mommy, she has to survive. And babygirl is here now, in our hands, fragile as they are.
This little bundle was seizing, and cold. Horribly cold. Icy fingers in contrast to the prevalent humid heat, and a heart that sounded as though it was racing at over 200 beats per minute. Very little blood flow to the fingers, her veins shrinking streams at the end of dry season. And the tell tale rhythmic movements of baby’s tongue and arms signalling a seizure.
Chaos when I arrived. Almost certainly this is meningitis. Lots of people clustered around, oxygen flowing, trying to gain IV access, the sheets covered in blood all around from previous efforts. Some of our best people on the case and no way in still. My first thought was that this looks like an Intraosseous need. Grabbing a needle I looked straight for the tibials, welcome flatbone surfaces just under the baby’s knees. No joy, someone has had a go at both and neither worked. This child is septic and losing fluid fast. There is no way he is going to make it out of here without some serious intravenous fluids and antibiotics.
At 6 weeks everything is tiny. Normally this is a mess, but this time it was a blessing. The femur is a huge challenge, but there is no other way in here and we have to do something, or this little one is out and gone. There is far less muscle around the femur in a baby of this size so OK, hold my breath and here we go. I’ve done so many IO needles out here that by now I know the feel of it, the hard bone, the sudden release, the eventual slow backflow into the syringe with saline. Somehow we are in.
Thankfully the saline starts to flow nicely and the team immediately clicks back into action. Boluses in, 1, 2 and 3 or them and we have some circulation. Antibiotics squeezed straight in as the welcome sound of her crying showed some returning life.
Unconventional but we found a way in.
Sometimes that’s all we can do.
Find a way in, find a way to get IV access, find a way to get children into the hospital, to get plumpynut to ELWA and Bong County, to get new centres open in the villages. Find a way to do a ward round of 50 children safely. Find a way to fund the operation.
Some days thinking about the situation at ELWA, and now at JLM in Gbanga I’m amazed that the work continues at such a high standard amidst so many health challenges. There are protocols and practical steps which we follow that have a proven evidence base. But often we look after children who fall outside of the script. That’s when we draw on whatever we have to find a way to help, whether it’s each other’s experiences, a borrowed plan from another African country, a flash of inspiration, a prayer.
Sheer persistence some days, knowledge other days, compassion and love on our best days. Please help us find a way in to help more Liberian children.
