A paediatrician in Guinea-Bissau: Mango season

15 August 2017

Paediatrician Mårten has recently joined the team in Guinea-Bissau. He blogs about the unexpected dangers of the mango season...

Eight-year-old Mamadu looks up at me from where he is lying on the hospital bed. He looks a little scared and I can certainly understand him. This is the first time he has been able to see in two weeks, ever since he fell out of the mango tree and ended up here in a coma. When he is finally able to open his eyes he finds himself looking at me, a strange white man who holds him in his arms and tries to open his swollen eyes every day. I can understand why that would scare someone.
 

A large mango tree with a cluster of children gathered beneath it

A mango tree covered in ripe fruit. Photo: Mårten Larsson / MSF
 
We are at the end of the dry season, and the mangoes and cashews are ripe on the trees. In Bafatá the mango trees are everywhere, and in them you can see small boys trying to reach the much-coveted fruit in various daring ways. The best way to get at the mangoes is apparently to climb the trees and knock the branches with long sticks. Every other tree is full of boys. Of course, it’s a risky job, and it’s easy to fall.
 
When Mamadu entered the emergency room he was unconscious, with severe swelling and blistering over the forehead, and he was showing signs of head fractures. For three days he only moved in response to pain. By the fifth day he could drink some milk.
 
Today, two weeks after the fall, his eyes are less swollen and he has recovered movement so that he can open his right eye on his own. But he cannot open his left eye and I can see that the pupil is dilated and unresponsive. He can’t move his left arm either. Both of these things suggest brain damage. He takes some first steps, supported by his mother. He is in for a long rehabilitation, but it looks like he will be able to walk again.

He is in for a long rehabilitation, but it looks like he will be able to walk again

Mamadu is far from the only child in the department who is in this situation. Since I started my work here at the children's clinic in Bafatá one month ago we have had four boys and one girl, all aged between 9 and 12 years old, who fell from trees, hit their heads, and were knocked out. Local doctors and nurses tell us that it is always like this when the fruits are ripe.
 
There are no machines to establish the extent of internal damage, and no possibility of surgery if it is needed. What we can do, though, is to give intravenous fluids until the patient is well enough to drink on their own, and antibiotics as a precaution against infection. With good care and patience this is often enough. All the children can now stand on their own two feet and three have gone home without further problems.
 
Soon, the first raindrops will fall and the country will enter the rainy season. Then the fall injuries will decrease. However with the rain will come diarrhoea diseases and malaria, and these will fill the hospital beds in the children's department instead.