Sunday, March 1, 2009


A couple of weeks ago I was on call with Elaine Wynne, a Canadian physician volunteering here for a couple of months. At the start of our evening rounds we found the clinical officer absent (delayed) and a queue of children waiting to be evaluated for admission. When I was calling the next child back, a man waiting with a child wrapped onto his back (as mothers typically do) said, "No doctor, take this one. This baby is very sick." We walked back to the waiting room and the child he laid on the table frightened me - sunken eyes, emaciated face. Its body was warm, but it was not breathing and there was no heart beat or pulse; it was too late.

During the rainy season there are often shortages of food. They have outlived the previous harvest. The number of children we see here at the hospital with severe protein energy malnutrition (PEM) is disheartening. It's even worse if you hear that the fathers are well fed, or that the mother believes maize porridge is enough for children (never mind that the family has beans, groundnuts or even chicken). Money and years have been spent on rural nutrition education, and yet marasmic children are still brought to the hospital. But what good is nutrition education if there truly just isn't enough?

Today, on Sunday morning rounds, I saw a patient admitted two days ago for PEM and gastroenteritis (namely, bloody diarrhea). When I saw it this morning at 9:00 the child seemed no worse than at Dr. Thuma's evaluation yesterday. It was now getting fluids (ReSoMal) via a naso-gastric (NG) tube instead of the initial IV fluids and had been started on the hospital's severe PEM protocol. I didn't think there was much else to do at the moment. However, upon returning less than two hours later to evaluate a different patient, the nurse asked me to review this child. She said, "It seems to be collapsing." The child was not breathing. There was no pulse. I felt helpless.

The child may have died because of some electrolyte abnormalities caused by the infusion of IV fluids. You could also blame the pathogen causing the bloody gastroenteritis. But the bottom line is, this child died hungry.

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