Elise and Boniface

Baby Elise presented to the hospital with severe anemia due to malaria with a hemoglobin of 3.5 requiring a blood transfusion (normal is 12). Following the transfusion she developed fever and began to have respiratory distress. She was grunting and hypoxic. Her liver and spleen were enlarged and a gallop rhythm alerted us to heart failure. Several doses of Furosemide (a diuretic) were given. She began urinating and her distress lessened. Still she was working hard. We gave her rectal Tylenol and sponge bathed her. I feared she might wear out. I prayed, nurse Olive prayed, her mother prayed. The family refused transfer to KCH hospital in Lilongwe which has ventilators. They did not have the money for transportation home. They would prefer to stay at Nhkoma even if Elise should perish. Was this transfusion related lung injury causing fever, hypoxemia, dyspnea and hypotension or fluid overload in a severely anemic child with heart failure? It is hard to sleep at night when you are caring for critically ill children with very few resources. I prayed Psalm 72 for Elise. “He will deliver the needy when he cries for help. The afflicted also. He will have compassion on the poor and needy and the lives of the needy he will save. He will rescue their life…and their blood will be precious in his sight.” The next morning Elise was sitting up playing on her mother’s lap. Her mother and I thanked God together.

I want all the children to survive and to be completely restored to health. The children who survive cerebral malaria are among the most severely neurologically damaged and the least likely to be restored to wholeness. They have often seized for hours and been hypoxic during that time prior to arriving at the hospital. Boniface was having decorticate posturing the first day that I examined him. At first I thought he was still seizing he was so rigid. His head was arched backwards, his leg muscles rigid with his legs held out straight and hands tightly fisted with arms inwardly turned. His eyes were deviated to the left. Could he have had an intracranial hemorrhage? Was this encephalopathy and hypoxia? For days he lay in his teenage mother’s arms unresponsive. I cannot imagine the future for this mother and child. If he does not suck how will he survive? How will she feed him? I encourage her to keep on pumping so her milk will not dry up as we feed the child by an NG. Can they place NG tubes in the village and feed him the way that we are? I pray every day for this child. Gradually his mother begins reporting that Boniface is making some effort at nursing. It seems unlikely as I watched them trying to spoon a little porridge in his mouth and wonder if I should stop them in case he aspirates. The Physical Therapy department comes by to teach the mother how to move his arms and legs to prevent contractures. We stop the anticonvulsants. Pong’ono pong’ono (little by little) he becomes more alert. He cries when uncomfortable. Then one day, his hands are no longer fisted and his tone is decreased. He appears to briefly fixate on an object moving in front of his face. He is nursing deliberately and strongly. I thank God and I keep on praying and hoping for little Boniface.