Chris blogs from Sierra Leone about a young patient who needs an urgent referral...
My phone flashes in rhythm to the ringtone, lighting up my room. I went to bed at 9pm. The time on my phone reads 9.30.
Eldon our night nurse tells me of an ill child in the clinic needing urgent referral to hospital. He asks if I can review the child and help organise the ambulance.
It takes less than five minutes to drive from our home to the health centre. I arrive to find the building in darkness. This tells me that the solar powered batteries have been drained.
Torch in hand, I enter and meet our two night shift nurses holding their mobile phones above the community health officer as he writes a referral letter.
On the bench at the entrance of the ward sits a teenage girl. At her feet is a large wooden bowl containing her belongings; a plastic plate, cup, and some clothes.
She holds a sleeping child in her arms, lightly wrapped in the local fabric so that it covers his whole body, including his face and head. I turn my head away from the mother and towards the staff.
“Is this the child?”
In answer, one of the nurses reaches across and lifts off the fabric.
My first thought is that the child has severe burns around his thighs and back as the top layer of skin is missing. I move the torchlight from the body towards the bald patches on his head. I look at his face and see a boy with eyes swollen shut. His hands and feet are so swollen you can barely distinguish his fingers and toes. I’m told he is three years old.
The child is suffering from a form of malnutrition that occurs when the body is starved of protein. As if reading my mind, the health officer says aloud “Kwashiorkor”. The name is derived from a language in Ghana, where it translates to “the sickness the baby gets when the new baby comes”.
This is her only child. We’re told how she has visited many different traditional healers who have been giving the child herbs but he remains sick. She eventually arrived at our clinic, drawn by the promise of free care.
Before I arrived, the staff explained to the mother that the child should be admitted to hospital to receive medicines and food to make him strong and healthy again. At first the mother did not want to go, her rationale being that she has no money. She changed her mind when told that the care is free, and that there will be other mothers to socialise with in the hospital.
We give antibiotics and sugar water before the child starts the journey. I make some phone calls to the hospital and ambulance driver to arrange the referral. The two nightshift nurses decide whose turn it is to go in the ambulance.
I walk with the family and nurse to the ambulance. I make a mental note to visit this child in when I’m back in the main project over the weekend. The mother freezes as we open the back doors. I recognize this situation and ask the driver to put the lights on. Some people here have little experience of cars, and climbing in to the pitch black rear end of a land cruiser is intimidating. She passes her son to me, who I hold whilst she climbs in. I take a one last look at his swollen face, before handing him back to his mother.
As the engine starts the nurse shouts at me from the passenger side.
“Have a good sleep!”
“I was having a good sleep until you phoned!”
Our laughs are drowned out by the crunching of tires on gravel as the ambulance rolls off.