First of all, for the past two days, we’ve had no electricity or water throughout the day. We had borrowed a 20L container from our neighbour the day before and were lucky to have stored up some water in there. Meanwhile they were stifling hot days, with each hour passing in the pervasive heavy heat as we eagerly looked forward to the night when at least the sun will finally leave us.
Yesterday there was a ten month old child with severe malaria and severe anaemia. His conjunctiva and palms were white as snow. He needed blood but nurses had spent the whole day trying to get a peripheral cannula in with no success. Both sides of his head had been shaved during the attempts to find veins, giving him a fairly menacing looking mohawk. He would have looked comical if it weren’t for his being so dreadfully sick.
When I saw him after lunch, I found that they still had not succeeded in getting a line in, and he was having deep sighing breaths due to the worsening metabolic acidosis. He was also very lethargic, such that he was not even crying when I put needles into him. Failing to access the femoral veins, I succeeded in getting intraosseous access with a regular 21G needle (the only one I had). It was very difficult with the needle bending too readily, but eventually it went in with the satisfying crunch of the needle going through the bone cortex into the soft marrow.
Blood was quickly put up, but it ran really slowly (relying only on gravity overcoming the resistance of the marrow). I spent the next one and a half hours sitting there holding that needle still (the nurses were too afraid to touch it). However, even though some blood was getting through, the child was deteriorating too rapidly and the blood going in too slowly. We needed to get better access. After multiple further attempts of peripheral access, I tried once more at a femoral line. When the blood flowed easily into the attached syringe as the 21G cannula entered the left femoral vein, I could not resist a cry of delight. Success at last! We quickly changed the blood into that line and managed to get it in easily. He looked a lot better today, albeit still with some pallor and severe malaria, but I think he will continue to improve. I remembered thinking yesterday that this one success of saving that child’s life would make my trip here all worthwhile.
Lawrence and Edith, a doctor and accountant respectively, are volunteering with St Anthony’s Hospital in Tororo, Uganda. Palms Australia still requires significant funds to ensure this placement can continue. You can donate via their profile page.