Life Down the Rutted Red Road

As I did my usual morning visual scan of the paediatric ward a tall woman draped in a purple gauzy shawl called out to me “Shukran. Shukran. Thank you. Thank you.”

I recognised her from the previous day. They must have graduated up from a mattress on the floor in the procedure-come-overflow room to the ward.

But, other than the change of location, at a quick glance I could not work out why she was thanking me. Her two year old son appeared to still be unconscious and he still had oxygen on at the highest level, a nasogastric tube and intravenous fluids. That is the extent of our interventions and if a child has all three of these it generally indicates that he should be in an ICU, if we had one. Here though he was one of 23 patients (and 30 other patient relatives) cared for by two nurses overnight.

I tried to explain to the mother that her son was still very sick. But she still thanked me. “He breathes. He is not hot. He is not seizing”.  True.

I had heard the wails in the early hours of the morning from my bed. As I had listened I thought that it was most likely him who had passed. He had presented 48 hours earlier with cerebral malaria. Despite having completed three doses of our strongest anti-malarial he had still seized the day before for over an hour, as his mother wailed on the floor. When the seizure finally finished he was choking and gasping for breath, because of the water they had been pouring into his mouth when I was not watching. Throughout the day his lungs sounded terrible and he still did not regain consciousness. His grandfather and then his grandmother spent the day holding him in their arms as they tried to balance on the mattress on the floor. I had spent quite a bit of time with him over the day trying to think if there was anything else we could do. And there was not.

So, I had thought the wails were for him. But, they were for another child, another child for whom the malaria had been too strong for their body. Why was he still alive this morning and not the other six children who had died from malaria during his admission?

And, I do not know. He had definitely been sick enough to die. We did not do anything different from our normal. This has been a very bad malaria season and having to wrap up yet another body has at times felt like the pervasive theme.

But his mother reminded me of the need for gratitude. In the midst of the wails at night, the daily struggle to find enough mattresses and beds for sick kids, the worry that we will run out of anti-malarials, the tired and stretched staff, the frustration with the things that we cannot do; will I choose to be grateful?

Yes, there is so much pain and brokenness. Yes, there is a long way to go in recovery. But, he breathes.