Sweet baby Lorel

Saturday night, April 25, 2009
Today our normal Saturday clinic hours turned into a fight for the life of a toddler named Lorel. It was obvious that she was very sick, but we were unsure why. Reda had seen her Thursday and had already treated her with antibiotics for a respiratory infection and covered her with quinine so as not to miss malaria. But today she was lying in her mother’s arms, pale, lethargic, dehydrated, hot with fever and trembling. It was the trembling that scared us the most. Though she had a fever, it was not high enough to give her seizure activity. We were looking at meningitis or cerebral malaria. Since we don’t have fancy diagnostic tests or a laboratory, we were forced to treat based on symptoms alone. Not that it is a problem; we still would have given quinine and amoxicillin.
If you have ever started an IV on a very ill child, you will have no problem understanding just how difficult it was to get a line in and just how disappointed we were when that line stopped flowing and we had to get another in.
So tonight I have several people sleeping on my front porch including a little girl hanging on, ever so loosely to life.
She has not been the only one. In the last week we have also had a 3 month old with very severe pneumonia and a young mother with high fever, headache and a painful mass in her belly. I am relieved to know that it is an unusually busy week, and that these kind of cases don’t usually come quite this often.
Lord, give Reda and me the wisdom and good judgment to make the right choices with this sweet little child and with all the other patients that come our way.

Monday morning, April 27, 2009
Our sweet little Lorel has survived her second night in our front porch PICU. Her mom has been with her the whole time, providing the best care she knows how to provide. She’s had a constant flow of visitors, and some family members have even taken up residence in a little mongulu (leaf hut) that we had made for demonstration and hadn’t been intended to actually house people. I am glad to see our little community here showing their love by bringing food to Lorel’s mom, doing some menial tasks like washing linens, and taking turns sitting with her.
On the clinical side of things, her status is still very critical. After her first night here, she showed a little more strength, but her breathing and heart rate were still far to fast and her hydration level was far below ideal. As we had lost all IV access, we had to figure out how to hydrate her and administer medication. IV’s were nearly impossible to start and almost as difficult to keep patent, and we were not to comfortable starting an IO, given the inability to keep the environment perfectly clean. We were encouraged that she seemed more alert, occasionally murmuring “mama” and reaching for her mother, but she was still not taking enough orally. So we settled for IM administration of antibiotics, rectal administration of quinine and fluid replacement by NG tube. After inserting the NG tube, it became clear that she had aspirated during the process. Our little semi-conscious patient has become a little more comatose again and is struggling for every breath. However, her hydration level has improved, and she has been free of fever and seizures for over 24 hours.
Last night was still very touch and go, as she was working so hard just to get oxygen, but I was happy to see her looking more relaxed this morning even though she doesn’t have much fight in her. Her mom is sitting up with her, offering breastmilk when she will take it and stating that she still has a strong suck. She only tolerates nursing for very short periods of time.
We’ve had 24 hours of rain and dreary weather, but this morning it is sunny and warm, lifting our spirits a little. We are praying for some improvement today.

Monday afternoon, April 27, 2009
With sadness in my heart, I report that baby Lorel lost her fight for life a couple of hours ago. She went peacefully. She stopped making urine and then slipped into a non-responsive state, and then she simply stopped breathing. The family expressed thier grief loudly and are in obvious pain, but her suffering is over.