Aisling Semple is a paediatrician working in Quetta in Pakistan.
I receive a call from one of the midwives in our community centre. She wants to send a baby in to our nursery. He was born today, at home. The grandmother reports that he was breech and the delivery was difficult - the body came out first, but the head got stuck. When they finally got him out, he did not cry. He did not move. So they wrapped him up and brought him into our mother and child centre. He doesn’t look good, the midwife tells me. And he will not take feed. I tell her I’ll prepare a cot for him, and ask her to try to keep him warm on the transfer over.
When he arrives, he is as I expected. He’s pale and floppy. He’s not moving. His primate reflexes are barely present. This is a case of hypoxic ischaemic encephalopathy - brain damage due to oxygen deprivation at delivery. I’ve seen a lot of it here in Balochistan, where home deliveries are the norm and mothers rarely receive antenatal care. There is no way to cure the damage done. We can only provide supportive treatment. Improvements are unpredictable and happen slowly, over time.
Babies on the paediatric ward. Photo: Amandine Colin / MSF
The admitting doctor and I sit with his mother and explain what has happened. She nods her head, but understandably doesn’t seem to be processing anything. We organise something for her to eat and drink and advise her to rest in our mothers' room, next to the nursery.
I am checking in on the nursery babies later that evening. I see an older lady standing over our new patient’s cot, mumbling prayers under her breath. When I approach, she grabs my arm and starts speaking to me. I gesture that I can’t understand - wait, wait . . . A paramedic comes to our assistance. This is a precious baby, he tells me. They have been waiting four years for him. She wants to know if he’s going to be OK. I look down at his still body and my heart sinks. I gently explain what has happened, and what the outcome might be. I try to manage her expectations, but still give her some hope. Her eyes well up as my words are translated. I wish there was something I could do or say to make this better. But there isn’t. So I squeeze her shoulder and find her a chair, so that she can sit next to her grandson, and hold his hand.
I squeeze her shoulder and find her a chair, so that she can sit next to her grandson, and hold his hand
As expected, the baby begins to have seizures the next day. We control these with medication. We feed him with a tube and give him some oxygen.
On the daily round, I remind the doctors that they must examine this one very carefully every day - looking at the way he is holding himself, his movements, his reflexes. This way we can pick up on small improvements. He does gradually improve. He begins to move his arms and legs. His eyes open and he reacts more. And although he can’t suck as well as most babies, he does make heroic efforts. We teach his mum how to express her breast milk, and feed it to him with a cup and spoon. His family rejoices with each small step, and are grateful to every little bit of support we give them.
When we are satisfied that the baby is getting enough milk with spoon feeds, and gaining weight, we start planning for discharge home. His family has been well counselled and understand that their precious boy might not walk and talk as well as other children. We’ve also discussed with them the importance of delivering future babies in hospitals, and being followed up closely during the pregnancy period.
On the day of his discharge, I see that I have no need to worry. It is clear that this boy is loved
As he his discharge day gets closer, I worry about what the future will hold for this little one. It upsets me to think that he won’t have the same support and services as a similar baby born at home. But on the day of his discharge, I see that I have no need to worry. It is clear that this boy is loved, and will always be well looked after. A congregation of immediate and extended family members come in to escort him home. They fill the corridor outside the nursery, waiting for the little boy to emerge in his mother’s arms. They crowd around when the pair come out, protectively encircling mother and child as they walk downstairs towards the exit, to the colourful tuk-tuks waiting for them outside the hospital gate.