It’s two in the morning when the phone rings again. I stand at our front door for a while looking at the cascading rain pouring over the edge of the tin roof and wonder how I will make it to the hospital.
It’s the rainy season here in Niger. The rain has been patchy this year and people are worrying about their crops. But tonight the rain could rival any good monsoon downpour in the Northern Territory. It doesn’t show any signs of easing, so I jump onto the borrowed bike and ride into the downpour. It is about the eighth trip to the hospital so far tonight and each time I’ve left a deep set of tracks in the muddy path. The bike slides around like a crazy derailed train each time I go through the deep puddles. At least the lightning helps me to see where I’m going.
By the time I get to the medical ward I am completely saturated. The nurses stop and laugh at me when I walk in, although the drips I’m making on the floor of the ward are outdone by the small waterfall from the hole in the roof. Time to get to work.
I’ve been called tonight about a tiny three year old boy. I had admitted him earlier in the evening. When he arrived the staff were concerned, trying hard to get IV access. I got some basic facts – severe malnutrition, diarrhoea for 3 days. He was unconscious and shocked – cold hands and feet, slow deep breathing, slow heart rate. There had been lots of attempts to put in an IV with no luck. I called one of the experienced long term doctors to find out if there was equipment to place an intraosseous line directly into the bone. He told me it was not done often here, but we have a drill….
The boy’s mother sobbed as I drilled the needle into the tiny tibia.
At least now we could give fluid. I marked off on a scrap of paper each of the 14 syringefuls – each has to be pushed in manually. OK, 140ml of saline given. What was the blood sugar? Unrecordable. OK, give some 50% dextrose.
He seemed a bit more responsive and started making some movement.
Time to continue rehydration using a nasogastric tube – it is effective and safer for the child. Broad spectrum antibiotics. The usual range of vitamins that a severely malnourised child needs.
Now at 2 am I have ridden in through the rain to review him. On the phone I can’t understand the nurse due to my lack of French. When I arrive I get it – the antibiotics are due again and there is no IV line. The intraosseous needle has fallen out. Perhaps with the rehydration a vein can be found? In my soggy state I try once or twice with no success. I confer with the nurse – we will give the antibiotic intramuscularly.
The rain has eased as I ride home, making yet another set of tracks in the soft ground. I fall asleep wondering what will happen. Perhaps there is hope?
The next day I walk through the medical ward after I’ve finished seeing the maternity patients. The bed is empty. The nurse confirms for me – the boy died at around three this morning.
Over the last few days the sun has dried the tracks I made that night into hard ruts in the ground. Each time I go along the path I’m reminded of that night and that boy. What must it be like for the doctors and nurses who are here all the time, who deal with such stories every day? What kind of tracks are left on their hearts and minds?
Each time I ask one of the long term doctors how he is going, he smiles and says: “Lately there’s been more victories than defeats”.
Please pray for the people of Niger, and for those who care for them.