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"I’ve seen this only once before": On the paediatric ward in Pakistan

 

 

Aisling is a paediatrician working in Quetta, a city in one of the least developed regions of Pakistan.  Here she blogs about working to save a baby’s life, in an emergency that could have been prevented with a routine vitamin injection…

My phone rings one evening - the familiar old Nokia tune. It’s the doctor on call - she tells me a new baby has just come into the nursery. What’s the main problem, I ask. Bleeding, is the unexpected response. Where? Why? I ask.  From the mouth, from the nose, in her nappy. There is profuse bleeding, I am told. Can you come now?
 
I rush to the nursery and find our new patient just as she described. She is lying on the examination table, on blankets stained with bright red blood. I see her parents sitting, scared and helplessly nearby. She’s 3 days old, the nurse tells me. She was doing fine, then the bleeding started suddenly this morning. My chest tightens. I’ve seen this only once before.
 
A few months ago, the night doctors had called me early one morning, asking me to come to the nursery immediately. There I had found the staff resuscitating one of our previously very stable babies. She had started suddenly bleeding from her mouth and nose. The blood pooled in her throat, and she could not breathe. We tried our very best to save her, but we did not succeed. Breaking this news to her heartbroken mother is something I’ll never forget. It was a horrible morning.

Her desperate parents brought their baby to us - they heard our care was free.

This condition, which causes sudden and dramatic bleeding, is called 'haemorrhagic disease of the newborn'. It’s caused by a lack of vitamin K, which is essential for blood clotting. At home, all newborn babies get a vitamin k injection shortly after they are delivered. Most women here in Pakistan deliver at home, so their babies do not receive this protection.
 
I hear that this new baby had been born by C-section in a private hospital. They had stayed there for two days, but had to pay 40 euro per night for incubator care. They ran out of money. The baby had started bleeding that morning. The hospital gave some antibiotics and a transfusion and told them there was nothing more they could do. She was discharged. Still bleeding, her desperate parents brought their baby to us - they heard our care was free.
 
Listening to the story, I look down at the baby. She’s losing a lot of blood. I see a nappy full of blood next to her, and there’s a 10 ml syringe full of blood drawn from her nasogastric tube. It’s bright red; that means it’s fresh. She’s actively bleeding still. Despite her blood loss, she seems to be coping well. She hasn’t gone into shock, is still warm and active. Her colour is still quite good - she doesn’t look anaemic. I warn her parents that this is serious. We’ll do everything we can, but I don’t know if she’ll survive. They understand and thank us for taking her in.
 
We treat her with vitamin K - this should help the blood to clot. We hope that the bleeding will stop before she loses much more. 

 ‘She is very strong’, her father says proudly. 

The bleeding continues overnight but she stays strong. The next day she is pale and weak. We arrange a transfusion for her, and she perks up. I am relieved to see that the bleeding seems to have slowed down.  The main complaint from the nurses now is that she is hungry.  There’s still a lot of old and clotted blood in her tummy so we can’t let her feed yet. She makes it clear to us all that she is not happy about this.
 
I see her parents again on the third day, they are relaxed and smiling. I peak into her cot. She is pink and active, kicking her legs and trying to suck on anything that she can get near to. She looks great. I have grown very accustomed to sign language out here, and gesture to her parents that she is good, she is strong. To my surprise, her father answers in English - ‘yes, she very strong’, he says proudly. Thank you, he says. His wife nods, grinning in agreement.  
 
So on behalf of this one family whose lives we have touched, I thank you all. Thank you for supporting us. Thank you for donating. Thank you for allowing us to help these babies.