Monday, July 13, 2009

Kwashiorkor


At about 3am on Saturday morning I was trying to get a history out of a non-compliant epileptic with whom I had no language in common, when I heard the unmistakable wailing of a woman who has just discovered her child to be lifeless. A few seconds later a staff nurse came running out of the gastro ward with the floppy body of Yoliswa, a two-year old kwash we'd had with us for a few days, in his arms.

Kwashiorkor occurs in abundance in The Crater and South Africa as a whole because the bulk of the population is dirt poor and people don't have enough money to provide their children with even the most basic nutrition, even though we live in a highly fertile country where the trees hang heavy with fruit and the land is full of livestock, and politicians do million-dollar arms deals even though we'll never go to war, and they grow fat in luxury while the people who voted them in die from starvation. Anyway, you'd think it would be really easy to treat, but unfortunately it has a poor prognosis. We lose many, many children despite aggressive treatment of their opportunistic infections and intense re-feeding.

So here was Yoliswa, small and swollen, with no hair and ulcers all around her mouth and neck and armpits, minus any respiratory effort or pulse. We commenced CPR and miraculously, after one cycle, she resumed her trademark high-pitched kwash-cry, grimacing in pain from our chest compressions. I called her mom into the room, and started preparing for a blood gas, when her crying stopped and the complexes on the monitor started disappearing. Out went the mom and back onto her chest we jumped, but this time thirty minutes of pushing and bagging and adrenalin-injecting produced no results, and at about 03:40 I called the resus off.

We tidied Yoliswa up: pulled out her ET tube, picked up the broken adrenalin vials, pulled the monitor stickers off her chest and put her jersey back on, cleaned her bum and put it in a clean nappy, and wrapped her in a sheet. We called her mom in who, like the non-compliant epileptic, understood no language that I or any of the nursing staff spoke. We tried to explain in English and Afrikaans and Sign Language, our hands open in the universal gesture for 'I'm sorry', but she still didn't get it. Eventually we called in a security guard to tell her that her baby was dead. The wails of almost an hour previously resumed.

After that, I had to get back to the epileptic. I stalled by washing my hands over-thoroughly, wondering what the best way to restart the frustrated conversation would be. I like my job, but sometimes it's just all too depressing for words.

Picture Credits
grind
Originally uploaded by
ebola bebop

5 comments:

As always,humbled by your humanity and by the professionalism of all those south africans still with the courage to stay and work in those compassion-destroying hospitals. Its always the kids we remember in our midnight-of-the-soul moments...

intellileg said...
July 13, 2009
 

Without you, who else?

i understand.

potatoe famine said...
July 14, 2009
 

its good that you blogg. i am reading this in a tiny island off Ireland. 130 years ago......babies died here too of famine. your little baby who died has not been forgotton..........because, no matter how painful it was to even remember the event: you were clever enough to suscintly put it down on the blogosphere. i hope you also keep a copy of it, so its little soul does not escape into the bloggosphere ether. A luta continua. I pray for you

Oh Karen, I'm sorry.