As a doctor or a nurse, you feel responsible for everyone under your care.
Recently I was finding it difficult to deal with the number of children that were dying in the Kutupalong clinic; about one child under five dies in the facility every day. When I worked in the UK, I think I only ever saw two children die.
A woman tends to her child in the clinic. Photo: William Daniels / National Geographic Magazine
I was worried that I was not doing the right thing, getting the right diagnosis or giving the right treatment. I was feeling a bit demoralised on the way to work, so I decided to do a ward-round with the other international staff doctor to see if there was any room for improvement.
The first patient we saw was a three-year-old with severe acute malnutrition and a chest infection. Her respiratory rate was very fast and her oxygen saturations were low. We were dispensing antibiotics and offering the maximum oxygen we had available.
We managed to get the child to breathe again
As we turned away to see the next patient, the mother called us back. The child had stopped breathing. We started resuscitation. Somehow, with the emergency oxygen cylinder, three doctors and one nurse, we managed to get the child to breathe again. The question was, what to do next? We had no extra oxygen, nowhere to send the child and no additional treatment. So, we waited…
The child continued to breathe rapidly. One hour later the same thing happened again; the child stopped breathing, we resuscitated again and ‘succeeded’ again in getting the child to breathe. The mum held her child and we continued the ward-round knowing we couldn’t do anything else.
A young patient struggles to breathe. Photo: William Daniels / National Geographic Magazine
On the neonatal ward, we had three babies weighing less than 1.5kg (around 3 lbs) – not an uncommon scenario. One was born about two months prematurely. We were doing our best with a similar treatment combination to the three-year-old’s: antibiotics, oxygen, feeding and in this case, ‘kangaroo’ mother care. Kangaroo care means keeping the baby in skin to skin contact with a carer. Research shows that it has various benefits, including helping to regulate a baby’s temperature, so it’s particularly useful in environments where access to incubators is limited.
The baby was having apnoeas (periods where it stopped breathing). In the afternoon, the baby stopped breathing for too long. The mum and nurse were quick to react and we resuscitated the baby.
I left the clinic that afternoon not knowing if the day was a success or a failure
I left the clinic that afternoon not knowing if the day was a success or a failure. We performed three resuscitations and each time the child started breathing again. But we started their breathing again only to give them the same treatment. Was this a success? Or were we just prolonging the inevitable by performing resuscitation in these cases?
In the end, the three-year-old started to improve and her mother decided they would leave the clinic. I will never really know what happened. Meanwhile, the newborn continued to have apnoeas and died a day later.
Now that I have been in the clinic a bit longer I have a better understanding of the resources we have and the limitations of certain treatment. I have found areas to focus on like working towards employing feeding assistants to improve the programme for children with malnutrition. Plus, I must remember the majority of our patients do recover and go home, putting the work we do in perspective.