I’ve been lucky recently to go out on a few outreach activities. Our project currently supports 2 health centres in the region, at the villages of Kashuga and Kalembe. This Friday, I set out again, this time for the small village of Ihula where MSF runs a mobile clinic once a week. It was a beautiful day and the road wound higher and higher into the steep hills. In the back of my truck were a mother and baby we had brought back from Kalembe about 2 weeks before. The newborn had had meningitis and hadn’t been feeding for several days. It was amazing closure to see the mother smiling with her healthy baby just 2 weeks later. As we dropped her off and I watched her slip behind the mud and thatch buildings, I thought about their future. I thought how strange it was that we had entered each other’s lives for such a short period, and that we would likely never see each other again. I suppose it is the same for many of the patients I see in the ER back home, but here the future seems so much more uncertain.
When we arrived in Ihula, the team started to unpack and set-up the clinic. Waiting patients were filed into a registration room in a dark wood building. I heard the grunting and laboured breathing before I could locate its source. It was coming from a small child, several months old. We hurried the mother and her child to another room where I took a quick history and did a physical exam. It was brochiolitis, an asthma-like illness caused by a virus that is very common in infants. Unfortunately, large studies have shown that the usual treatments for asthma, salbutamol puffers and steroids, don’t work for bronchiolitis. The only useful supportive treatment, that the child desperately needed, was oxygen but that was a 2.5 hour drive away. But the thing about evidence-based medicine is that it doesn’t seem to apply when you are in the middle of nowhere in a resource poor context. So we dug through our emergency medical box and found IV fluids, antibiotics and salbutamol.
It was amazing to watch the national MSF nurses work on the side of the dirt road, searching for an IV. They gave the antibiotics and started IV fluids (the child was very dehydrated, in addition to gasping for air). While they searched, I tried to figure out how to give the salbutamol. Usually it is given via mask and aerochamber but we didn’t have those. I spotted an old aluminium fetoscope, a cone-shaped instrument that you hold to your ear and press to a pregnant mothers belly to listen to the fetal heart beat. I grabbed it and cut up a latex glove and fashioned what was actually a very effective system (thank you to all those years of watching MacGiver!).
I gave the child several puffs every 15-30 minutes and reassessed his breathing. Meanwhile, the mobile clinic team was seeing about 100 patients. There was a difficult decision to be made; do we shut down early and head back to the hospital? What if there was another patient waiting who was desperately ill and we left them behind in our haste. The life of one or the life of many?
I decided to hurry things along and try to leave early. The team still managed to see all the patients who had arrived that day! Amazing!!!
We loaded up and hit the road. Our national mobile clinic nurse supervisor sat in the back with the child listening to his breathing. He told our driver, just how critical the case was, and we were off. What was a 2.5 hour drive up, became a 1 hour drive back! We flew down the pot-holed dirt roads towards Mweso. Our driver was not only fast, but surprisingly careful (mind you, fast is only 40 km/h). I felt completely safe in his hands.
The sound of the child’s grunting became reassuring in a way. As long as I could hear it, he was still breathing. A million thoughts rushed through my head. Did I leave it too late? What if the child died in the car? Should I have cancelled the clinic first thing and headed back to Mweso? The weight of those thought pressed into my shoulders and my clenched jaw.
I had radioed ahead to Intensive Care, so when we entered the hospital, the supervisor of the ICU was waiting to take the child into his arms. We put him on oxygen and continued the treatments.
The last 2 days have been rocky for this child. I still don’t know if he’ll make it. What he really needs is a ventilator, but all we can offer is the incredible care and attention given by our national staff. They are my heroes.