A first sadness

 

On review on Tuesday morning, our unwell 6 month-old baby with the distended abdomen was not much better and we decided to perform a laparotomy (open his abdomen). A laparotomy is an operation that I am well used to performing in adults but have never done one in a child, never mind such a young infant. We found that his bowel had obstructed with a very impressive intussusception – small bowel had inverted an enormous distance down to the sigmoid colon. We were unable to fully reduce the small bowel back, so performed a limited right hemicolectomy and end ileostomy (removed a section of colon and brought the small bowel end to the skin).  He was on antimalarial treatment and multiple antibiotics – Dr McAdam describes the Chitokoloki treatment algorithm as the “AK-47” approach – treat all disease possibilities, as aggressively as possible!

 

On Wednesday, we arrived to find that our baby had been even more unwell overnight, and looked awful – exhausted and desperately sick.  The ward round was interrupted as his breathing and heart rate slowed, and he was picked up and rushed to theatre where the team spent most of the morning trying to resuscitate him, but by lunchtime it was apparent that our efforts had failed. The sound of inconsolable heartbreak filled the air when his mother was told that her child had died.  The team felt pretty flat for the rest of the day too.  This child had been diagnosed with malaria some 6 days before, and had waited a long time to encounter a surgeon and get the right diagnosis.  Even in a UK setting, with abundant healthcare resources, it would have been a challenge to achieve a good outcome.

According to the World Health Organization (WHO), the African, Eastern Mediterranean and South-East Asia WHO regions account for 47% of the global population, yet have only 17% of licensed surgeons. There is a long way to go before health care equity is achieved. The figure below shows the percentage of the population in various countries where safe, affordable surgery and anaesthesia is not available.

 We enjoyed spending some of Wednesday evening with JR (Julie-Rachel), a missionary nurse-midwife who has been capably fulfilling multiple roles at Chitokoloki for over 10 years.  JR’s cats were in the mood for cuddles and we felt soothed by their affection.