FOOTPRINTS IN THE SAND

One night a man had a dream. He dreamed he was walking along the beach with the Lord.

Across the sky flashed scenes from his life. For each scene, he noticed two sets of footprints in the sand: one belonging to him, and the other to the Lord.

When the last scene of his life flashed before him, he looked back at the footprints in the sand.

He noticed that many times along the path of his life there was only one set of footprints.

He also noticed that it happened at the very lowest and saddest times of his life.

This really bothered him and he questioned the Lord about it:

“Lord, You said that once I decided to follow You, You’d walk with me all the way. But I have noticed that during the most troublesome times in my life, there is only one set of footprints. I don’t understand why when I needed You most You would leave me.”

The Lord replied:

“My son, My precious child, I love you and would never leave you. During your times of trial and suffering, when you see only one set of footprints, it was then that I carried you.”

                                                               -- Author Unknown

...AND THE RETURN OF ANOTHER.

Yellow...Colour of Hope!

The past few weeks have been very busy and after seeing pain, death, grief, and despair, I finally witnessed a happy event: the return of a dying child…

Alfred*, 6 months, was admitted a few days ago for severe malaria with neurological complications as well as an upper respiratory infection and removal of the uvula.

Removal of the uvula? « What is that? », will you ask me. It is a traditional treatment. I know that you are probably assuming that given I am in an African country, I probably see a lot of traditional medicine. The explanation for this procedure, according to the local nurses of the hospital, is the following:  The majority of the population does not trust modern medicine, which comes from the western and European societies. As I explained before, the locals often arrive quite late after an illness has started – we are often the last recourse.  In the case of the removal of the uvula, it usually starts with a child suffering from a respiratory infection. The parents then blame the illness on the uvula, this little piece of flesh hanging at the back of our throats.  They then visit a traditional practitioner who proceeds to remove the uvula with the first sharp object he can find – a knife, a piece of metal that is sharp enough, etc. These artisanal tools are quite often dirty and not sterilized.  Thus, the child ends up with his respiratory infection coupled with another infection caused by an unclean instrument. At that moment, the parents usually come and see us, realising that the child is still suffering and not getting better.

In Alfred’s case, the fever was caused by an often fatal combination – malaria, respiratory infection tied with a wound infection. In addition, his little body reacted to the malaria with repetitive convulsions. We had then started a treatment plan consisting of antibiotics, antimalarials, analgesics, anticonvulsives, and oxygen.  Alfred’s condition was stabilizing and it looked like he was responding well to the medical treatment.

That morning, I had simply gone to the hospital to participate in the pharmacy stock count.  This has to be done every two weeks as we have to verify the consumption of medication and medical supplies in the hospital.  Since nothing is computerized, we have to count manually every item.

Our task completed, I was on my way back to our compound as this was a Sunday and technically, it was our resting day.  In passing by the emergency, I briefly stopped to ensure nothing was amiss. I found papa David, the secourist for the day, at Alfred’s bedside, looking concerned.  I ask him what was happening; he promptly tells me that Alfred’s oxygen saturation is low and that he appears in respiratory distress as his lungs were full of secretions. A quick glance at Alfred reveals a child with eyes glazed over, convulsing, and breathing irregularly.

My heart stopped and adrenalin took over.

I hastily threw my bag away, donned a pair of gloves and shouted to David – « Get me the portable suction and find the nurse now! »  A few minutes later, Thomas, John and Wilfred hurried in! I order one to get IV Diazepam, the second to call Dr. Maurice and the third to assist me with the suction. At the same time, David gets the oxymeter on – oxygen saturation at 90%, pulse 156! The respiratory rate is also on the rise at 46. We have to act fast and the team knows it…Everyone moves swiftly!

Here, the suction is not attached to the hospital walls like in our Canadian hospitals – it’s a push-pedal attached to a tube that is connected to a bottle.  A second tube, the suction tube, is also connected to the bottle.  David starts to push the pedal with his foot in order to create the negative pressure that will suction Alfred’s secretions. But the mucus is too thick and we are unable to suction.  I tell David to get the nursing supervisor and ask for the battery-operated suction from the operating room – the urgency of the situation justifies my request. He runs out.

In the meantime, the IV Diazepam is getting pushed in the existing catheter. This medication will stop the convulsions. But they are not diminishing – Alfred’s mouth is so contracted that I cannot open it to suction. If I force too much, I can break his jaw!  I ask for a – an oral canula that will maintain the airway in case of emergency – and the Ambu bag – instrument that allows ventilation of a patient in the absence of breathing. We attempt to insert the oral airway without success. We drain the secretions with clean gauze. The saturation is now 85-88%. Normally, it needs to be above 95%...Things are not going well…On top of that, the Ambu mask is too big – I am getting impatient… « John, bring me the baby’s mask NOW, quickly! »

Everything arrives at the same time now: the mask for the Ambu, the battery-operated suction, Dr. Maurice. Things start to move fast…Dr. Maurice inserts the canula, the suction is turned on and I start suctioning the mucus as much as possible while John installs the correct mask on the Ambu. Once I have removed a lot of the secretions, and with an oxygen saturation of 80%, I take the Ambu and start to ventilate Alfred. Everyone is waiting…80%, 80%, 82%, 85%, 88%, 92% 96% and finally, 100%! We can breathe!

Rapidly, we alternate between suction and ventilation. The respiratory rate slows down slightly, the heart rate calms down and the oxygen saturation remains around 95-97%. The convulsions finally stopped. We have been working for 45 minutes! We now realize that we have lost our IV access – the manipulation of the head to restore the airway has disrupted the existing catheter which was located above the ear, in a cranial vein. We will need a new one…

A new one is then initiated in the lower arm and an infusion is started. Alfred’s breathing is now regular and his vital signs are back to normal.

Another child with severe malaria

I stay a while in the emergency – I want to ensure that Alfred’s condition continues to be stable. John and David come to see me and tell me: « You saved this child. Thank you! » I smile and answer « No, we saved Alfred. Together, as a team… » They smile back and nod…

A week later, I can tell you that Alfred is doing very well. He got better and left the hospital with his parents to go back to his village. 

Thank you for your continued support.

Janique

*The names in the text have been changed to protect the privacy of the patients and medical personnel.