As a pediatrician and a father of two young, healthy girls, sometimes it is difficult for me to separate my experience in the world of operational biosurveillance and the tremendous human suffering we are seeing in Haiti. It is hard not to lean back and cry every now and then...
The following account comes from Dr. Mark Pearlmutter (posted on Jan 26th), and I would encourage everyone to read his blog. I offer the below as a testimony to this poor little girl and the suffering she went through. It is so hard for us in a developed nation with our standard of care to imagine the agony this poor child went through prior to her death. She and her family are in our prayers:
Today, I awoke to the
news that our 4 year old who was diagnosed with tetanus decompensated
during the night. She was without family which perhaps explained her
sad penetrating eyes. On the day of her arrival, she presented to us
with a crush injury to both of her legs. She required extensive
surgical debridement, a procedure that extensively cleans a wound. The
following day she developed a fever and generalized spasm of her
muscles, especially her jaw. Her body would arch back in that typical
way I’ve seen only in text books. She was immediately given
antibiotics antispasmodics and returned to the OR to further clean her
wounds, hoping to reduce the bacterial tetanus load. The timing of
this event couldn't have been better as our new ventilator had just
arrived that day. However, the following night, her IV accidentally
fell out, and unfortunately wasn't noticed until the effect of the
medications wore off. By this time she was ins severe respiratory
distress. The best decision was to transfer the patient to a higher
level of care, the US Navy hospital US Comfort, Project Hope's ship
located in Port Au Prince harbor. At the bedside of such a sick
child, it's always hard to rationally think through the difficulty of
focusing on one child at the risk of not being available for multiple
other patient victims. As I ran the non breathing child across our
soccer field converted Helipad my singular thought was that this young
girl could survive and possibly lead an entirely normal life. Her limp
warm body on my lap contrasted with the cool hard steel floor that I
sat on. I was reminded of the frailty of life, and how dependent this
adorable girl’s life was on the proper cadence of my delivery of
ventilations with an antique ambu bag. As we swept across the country
side on the chopper I had the time to reflect on the past few days. Up
to this point there really hadn't been any time to think about
the intense and indescribable situation that both the Haitian people
and our medical team had experienced.
We
arrived on the US Comfort approximately 25 minutes later. There we
were directed down the elevator into the pediatric ICU where a team of
10 were awaiting us. We provided a brief report to the medical officer
in charge and were ushered back to a holding area waiting for the next
Navy chopper to take us back home. The return trip was much more
relaxing and provided a respite from the stark reality on the ground.
It
amazed me that although we had 250 patients in our hospital compound,
the entire team was emotionally connected to the fate of this child.
Part of this was because not one of us had diagnosed seen or treated a
case of tetanus. But I'm convinced it was more to do with the
dependent fragility of a sick child who was alone without her parents.
We all assumed a surrogate role that went beyond simply being medical
caregivers. Now all we could was hope and pray that the exceptional
care being provided on the US Comfort would make a difference.
The
next day we got word that the parents arrived by bus (a 36 hour ordeal)
from Port au Prince. Our hearts went out to the parents as we told
them about their child. We showed them pictures of their child,
initially intended for didactic purposes. Who would have known that
these pictures would be the last they would see of their child. Their
daughter, our surrogate child, had succumbed to the effects of
overwhelming tetanus infection. Although we all mourned the loss of
this child, we took solace and were even somewhat uplifted when the
parents thanked us for all that we had done.
As I watched them leave our compound, I couldn't help but feel that the entire country of Haiti had become our surrogate child.
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