Almost, by Dr. James Appel from Chad

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“Sometimes, you’re right where you’re supposed to be and you can’t explain it by simple coincidence.

I’m rounding in the women’s hospital ward which has turned mostly into a pediatric ward with kids struggling against malaria and anemia. I go from patient to patient continuing Quinine, adding Ceftriaxone, asking for a hemoglobin and on and on. I finish one half of the room and turn to the other wall to make my way back up to the exit. There is a small girl lying on the bed. I instantly recognize her as one I’d seen and hospitalized yesterday with edema, malaria, chronic diarrhea, malnutrition and a swollen belly.

Her mom is sitting at her feet staring blankly as she tries to close her daughters eyes with one hand. I’ve seen that motion before many times. The Africans do that immediately after a person dies. The girl does certainly seem to have passed on. Is that a flutter in her chest? I pull off my stethoscope and hear a slow heartbeat and some weak, shallow breaths. 

‘Patrice, go get Anatole immediately for a hemoglobin and blood sugar.’  The girl looks pale and is floppy and unconscious.  But that heartbeat and the occasional breath keeps happening.  I give her some chest compressions if I hear it slow down too much.  Anatole arrives quickly and pricks her finger, taking a small sample in a plastic piece that fits in a tiny machine.  There is an unused bottle of 5% Dextrose under the bed so I have Patrice hang it up and open the IV wide open.

‘Patrice, tell the mom to go get some sugar from outside.’  She runs out after Patrice translates from French into Ngambaye.  The heartbeat is barely there so I start serious chest compressions as the very dilute glucose trickles in.  Anatole confirms hypoglycemia and that the hemoglobin is ok.  The mom comes back with a tiny bag of sugar cubes.  I’m still doing CPR and listening often with my stethoscope.  Finally, the heartbeat gets stronger.  The baby starts to moan with each pressure on her chest.  Her eyes start to open.

I stop CPR and melt a sugar cube in a spoon with some water.  I force it into the girl’s mouth who tries weakly to resist but manages to eventually get a couple of sugar cubes down.

‘Does the mom have any porridge?  When was the last time she ate?’  Patrice translates and I find out she hasn’t eaten since yesterday.  I drip some millet and peanut butter gruel down the girls throat.  She shakes her head and cries and clenches her teeth until we force it in and then she calmly closes her mouth and swallows.

I move on to the next patient as the mom stoically continues to feed the child as if nothing has happened.”


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