Northeastern Nigeria has been affected by a conflict between the military and armed groups for more than a decade. Thousands of people have died as a result of violence, malnutrition and diseases which are easily curable when treated in time. In this region, reaching healthcare can be difficult and many children don’t arrive until it’s too late. From MSF's children's hospital in Gwange, nurse Martina Jurigová shares this powerful story...
Another morning report. Several tired nurses and doctors hand over to us at the end of their shift.
Overnight there were about 40 consultations, 20 admissions and a number of referrals; we have enough blood-pack units; the number of malaria cases is increasing.
The number of patients with malaria is growing slowly right now, but it’s clear that, with the rainy season on its way, we’re going to be very busy. We hope that the cases of cholera we sometimes treat won’t turn into an outbreak, and we’re relieved that a measles outbreak is slowly fizzling out.
There are more problems knocking on the door. However, we’re ready for them… we hope.
The boy from bed three
Nobody died yesterday. That’s the only unusual thing in this morning report.
For many people it isn’t easy to get to our children’s hospital in the Nigerian town of Maiduguri. That´s why so many parents bring their children in late; often we can’t do anything for them.
Suddenly the door swings open and our paediatrician, Valentina, rushes in, a child in her arms, followed by a team of nurses
Suddenly the door swings open and our paediatrician, Valentina, rushes in, a child in her arms, followed by a team of nurses.
She has brought him from the Intensive Care Unit – or ICU – and she lies him down on a resuscitation bed. The boy isn’t breathing and his pulse is slow. They start doing chest compressions and bag-mask ventilation – using a mask attached to a balloon which pushes air into the child’s lungs.
At that moment I recognise him as the boy from bed three. Yesterday afternoon I’d been worried about him, afraid he wouldn´t survive the night. It was the same for the two children in the neighbouring beds.
We’ve done everything we can for the boy, so unfortunately now we can only hope.
A careful “hurrah”
I´m listening to the rest of the morning report and at the same time I´m watching Valentina and the rest of the team resuscitating the child.
They are doing well and they have enough people so I won’t intervene. More people in a critical situation sometimes just means more chaos.
The morning report ends. The boy on the resuscitation bed starts to breathe again and his pulse is normal. Hurrah! Well, a careful and diffident hurrah. God knows how long he will hold up. He has severe meningitis so his case is critical.
We’ll keep him in the resuscitation bed for a while to watch him carefully in case the situation repeats. For how long? Non-stop monitoring would be ideal, but due to limited equipment, it will only be possible to keep him here until a child in a more serious condition is brought into the emergency unit.
The boy will be taken good care of by the emergency staff.
It´s time to check on the ICU, which is right next door.
What? A third child?
As soon as I open the door to the ICU, I hear the foreboding sound of the suction unit. It doesn´t mean anything good.
I draw the curtain and see another child on a resuscitation bed being resuscitated right now.
I’d been wondering why the first boy was brought to the resuscitation bed in the emergency unit when they have one here, but the possibility hadn’t occurred to me that we could have two resuscitations going on at the same time.
Well, it’s only eight o´clock in the morning and it’s difficult for me to think clearly.
Valentina puts a stethoscope to his chest. She looks at me and shakes her head: his heart isn’t beating
Before I can pull myself together, I see that Valentina’s team are bringing another child into the ICU. What? A third one?
I recognise a boy with a serious form of malaria – the last of the group of three children I’d been worrying about last night.
They lie him on the resuscitation bed, next to the second boy, and Valentina puts a stethoscope to his chest. She looks at me and shakes her head: his heart isn’t beating.
Shit. We need to do another bag-mask ventilation.
We only have one bag-mask ventilator in the emergency unit, which is currently being used by the first team. There are no more bag-mask ventilators in the ICU – I need to go back and get the one from emergency unit.
I desperately hope they are not still resuscitating the boy there – if they are, we’re in deep trouble.
I push open the door and feel relief.
He´s wearing an oxygen mask, breathing on his own and has good saturation levels.
I take the bag-mask ventilator from his bed, rush back to the ICU, quickly connect it to the oxygen and give it to Valentina. We massage the chest of the third boy and follow the usual procedure: somebody announcing the time, somebody preparing the adrenaline.
I look back across the ICU - there are two mothers sitting motionless and staring at us, petrified
The next moment I think about the possibility that the first boy could stop breathing. But I block the thought immediately.
The answer is clear: if he stops breathing now, he’ll die. I’d better not think about it – I just hope it won´t happen.
I´m pressing this boy’s chest and counting aloud. Valentina is breathing into the child with the bag-mask ventilator, almost synchronised with the team on the other side of the bed.
I look back across the ICU. There are two mothers sitting motionless and staring at us, petrified.
I instantly look down – it´s unbearable, especially when we’ve been resuscitating for more than 20 minutes and are starting to feel that it’s unsuccessful.
The team next to us has just stopped.
It was taking too long, his heart still isn’t beating, his pupils are wide. There’s nothing more they can do.
We continue resuscitating.
I’m looking at the lifeless little body next to me and I still refuse to admit that soon there may be a second little body on the same bed.
I feel like I´m going to cry. I’m actually crying already.
It’s been almost 30 minutes and we’ll have to stop soon. His brain is already damaged from the lack of oxygen.
“All right”, Valentina sighs.
We finish the last series of chest compressions. She takes her stethoscope and puts it on his chest, tears running down her cheeks.
She is listening carefully for the heartbeat. She shakes her head. Nothing.
She raises her head, looks at the nurse standing next to her and says:
“Call the mothers.”
MSF in Gwange
MSF’s children’s hospital in Gwange, in the northeast Nigerian city of Maiduguri, serves some 1.8 million people. It is one of the few medical facilities in the area providing free healthcare.
Here, our teams treat children for diseases including malaria, respiratory infections, diarrhoea, measles and meningitis.
From January to June 2019, MSF admitted more than 8,000 children to the emergency unit – 65 percent of them in a critical condition and requiring inpatient care.