Mary in Malawi

Yesterday he came again, the reaper... He came together with a beautiful little girl, 3 years old. Yulita was her name. She was very pale and anaemic, I checked her HB and it was around 2, but it should have been around 10.(in sweden: 20. Should be closer to 100). Positive for Malaria. Off course. His favorit victims.

Yulita was well nourished, no other problems. Her mother was very caring and sweet.  When she came, the first thing I did was to take blood sample for grouping so we could get her a blood transfusion as soon as possible. She was awake, breathing and crying, but I knew that with that Hb, she could just faint and die any minute.

Sending the samples to the lab, I discovered that the Lab staff was not at work. Ther had not started their day yet. tried to call the one on call, but the hospital phones where not working by some reason. Frustration started to get to me, the morning had been horrible concering that kind of problems. The room was not well equipped as it should have been on a monday morning; we had no gloves, no dextrose. No nothing. And the most important thing we have in that room is dextrose. But we had none. Because someone didn't bother to order it.  Anyhow, when Yulita came, I sent people in every direction to collect everythign that we missed. And after a while, we had most things.

I gave Yulita quinine for the malaria, and extra dextrose. Her blood sugar was very low. And I put her on oxygen.

She seemed stable, and the other nurses went to do soem other work. We discussed wither we shuld take her to the ward or keeo her in the room, but I wanted to keep her under good surveilance until she had had the blood transfusion. Before that, I did not want to consider her stable.

I sat by her side just observing her for maybe 30 minutes, she was breathing and looked ok. No blood yet. At this point, we had waited for almost an hour for the blood. And in an emergency like this, you are supposed to get in within 15 minutes. She was totally depending on oxygen, and as long as she was on oxygen, she was fine.

BUT... off course... this ins Malawi. Nothing works. And the oxygen concentrator suddenly stopped working. I turned it on and off, banged it, yelled at it, but it didn't want to produce oxygen. I called the electritian, and tried to wake up the child who quickly fell in to unconsciousness when she no longer got oxygen. I shook her, tapped her body, pinched her and gently slapped her, all to keep her awake. But she just fell faster and faster into the grim reapers arms... I called for help, and started CPR.  a clinician and a nurse came to assist, and we attached the heart starter. It couldn't sense any heart activity, and did not advise shock. So we continued normal CPR, and for 65 minutes I and the other nurse massaged her heart and gave her breaths. That is a very long time to do CPR. We intubated her, gave her adrenaline and dextrose.. the blood came in the middle of everything, and I ordered the pther nurse to start just pushing it into her little body. If she was to come back to us, heart heart needed blood to move around, otherwise the compressions would be almost useless...


I did everything I could think of. But after more than an hour I had to face it... I had lost to the reaper.. again. I dont know how many times he has been pulling children out my arms since I came to Malawi... I stopped counting. I didn't win this time either... But at least I gave him a fight..

Would she have lived if she got the blood earlier...? would she have been alive long enough to get the transfusion if the oxygen concertrator hadn't stopped working? I don't know... But what I do know, is that it is a very difficult feeling... It is even difficult to describe. Can you imagine how it would be to witness a beautiful little girl like that, die because the equippment is badly maintained, and because people are not where they are supposed to be? And you being the only one deciding what to do, thinking out the next step when the first time didn't take you where you wanted... Usually doctors decide to stop CPR after maybe 30 minutes. I continued for an hour. Becasue of many things... I didn't want to give up. I didnæt want to make the decission. I wanted someone to come and put a hand on my shoulder and say, no, stop it.. It is not working. I wanted someone else to take the decission. But I had to do it. I had to decide that she was not gonna wake up. 

All the time we tried to resucitate her, her grandmother stood by her side. Even when things got very un pleasant, she didn't leave, och move. She understood at the same time we stopped CPR that her girl was dead, noone had to tell her. She just looked at me, and looked at the other nurse, and started pressing Yulitas lips together, and then she looked at her, holding her mouth, and the she took her hand and closed the girls eyes. Then she closed her own, and started singing, high, and loud. The mother of the girl came in, together with the father. The fell in to the singing, and the mother gave up a wail you can't even imagine how it sounded. Like a wounded animal. Her child was dead. The sorrow and the pain she felt, must be beyond anything words can ever express. Then, the grandmother took Yulita on her back, tied her with a cloth, and walked home. followed by the crying mother and father. All the way home, they would sing and wail and cry.

No one should have to see thier child die... No one.