Problem Children

Last week I was too busy with "Ti Fi" to be updating any blog. Ti Fi was delivered into our arms a week and a half ago. She is around 8 months old and has been in the care of her Grand-Father for the past 2 months. She weighed 8lb 4oz when she arrived.

She was all loose skin and jutting bones. Last Saturday, she began bruising spontaneously and was refusing to drink. She had been having a lot of diarrhoea and was dehydrated.

Malnourished children can bruise due to vitamin K deficiency, lack of clotting factors in their blood or because of severe infections. I examined her thoroughly but did not find any sign of infection. We started her on an antibiotic anyway, just as a precaution. We also started vitamin K supplementation. Thankfully, there has been no new bruising this week.

To be absolutely sure that Ti Fi receives the level of love and attention she needs to set her on the road to recovery, she has moved in with me. She has made good progress; she has gained over a pound, is smiling a lot and has found the strength to sit unsupported for short periods. Needless to say, I am smitten and you will be hearing much more about her!
So that is problem child number one, although I wouldn't call her a problem exactly. Problem child number two arrived yesterday, just as I was looking forward to a quiet weekend. She was born a month prematurely and is from the area in which the orphanage is located. Her Mum brought her to us because the baby was vomiting. She was born on Wednesday and it transpires that she has never passed a bowel motion. It looks as though she has some sort of obstruction in her gut. I placed a feeding tube down her nose and aspirated 70 cc of bile from her stomach. 70 cc far exceeds a new born's stomach capacity.

Sandia Laura is on IV fluids and antibiotics. We are aspirating her stomach contents every two hours to make sure that she doesn't aspirate them into her lungs. We will transfer her to a hospital in the city for surgical evaluation first thing tomorrow morning. Please pray for Sandia. She is stable but seriously ill.

Mike is problem child number 3. He is also from our area and he is an extremely low birth-weight boy, weighing 2lb 4oz and born approximately 10 weeks before he was supposed to make his debut appearance in this world. Mike was born early this morning and he arrived at GLA just after 9am. He was having some difficulties with his breathing at first. and he was very, very cold and had a low heart rate. When I left the NICU, he was warm, pink and crying. I want this baby to live so badly it hurts. God, mature his lungs and give him the strength to live through the next few weeks.

Problem child number 4 is a year old. D had a cellulitis (soft tissue infection) in her leg a few weeks ago. Today, she developed a slight fever and became very, very pale. She was breathing 8o times per minute and had a heart rate of over 200/minute. She is very unsettled and seems to be in pain, but a top-to-toe examination has failed to find a convincing source for the infection. I did a blood draw on her this afternoon and started her on an antibiotic and regular pain medicines. We will have to watch her very closely. We nurses do not like not knowing the cause of a fever in a child.

I laughed when the night nurse came in. She smiled nervously.I smiled back. 'You wont rest tonight,' I told her. 'I didn't rest all day! 'We went on to discuss the babies we (affectionately) refer to as our problem children. Hopefully, they will all be 'good', or, in other words, remain stable over night. This nurse desperately needs some beauty sleep and she wont be getting any if any of her little darlings misbehave.

The telephone in the main house rang, and rang and rang last night. It was 9pm and the office was closed, but the ringing was so insistent (read irritating) that I went to answer the call.

The Mother of one of my NICU babies wanted to visit. I told her that the house was closed to visitors over the weekend. She kept asking, 'If God willed,' could she come in the morning? I wanted to say yes, but told her instead that no-one worked in the office on Saturdays. She could come on Monday, though, 'God willing', to see her baby.

She paused for a moment. 'Is he sleeping', she asked? My heart ached for her then. Her tiny son is happy in our arms but her own saddness will not be quick to fade. She will always wonder what he is doing.

We admitted four new babies this week. Miss Magaly decided that we were going to do blood draws on them that very day. I met each of their Manmans. It is rare for me to have any contact with them at the point that they hand their babies over to us. Frankly, I would rather not be present for that. There was no great show of emotion from any one of the ladies, just a quiet resignation. Circumstance compels them to relinquish their babies.

Two of the babies were very malnourished. This tiny boy (below) is two months old and weighs 7.5lb. His face is swollen with fluid and his skin is depigmented and peeling: he has Kwashiorkor malnutrition. Young infants (statistically) do not have a good chance of surviving Kwashiorkor, but this one is smiling and feeding well. We couldn't ask for more hopeful signs than those. Still, we will manage Baby P conservatively. His immune system will be very compromised and so we are watching him closely for signs of infection. If we treat him too aggressively, and try to fatten him up too quickly at this stage, he could go into multi-organ falilure.

This baby's emaciated body tells an all too common story of starvation. At 12 months, he is old enough to pine for his Mother. Please pray for him. If he adjusts well to the orphanage, I am sure that he will thrive here. He is in good hands. Loving and experienced nannies, who know that he has lost everything, will do many little things to ease his transition. They will will hold him and rock him the way Haitian Mothers do. They will feed him foods that are likely to be familar this week, even supposing they are not the best foods to recover him from his malnutrition. Allready, this frail little boy is reaching for these ladies and allowing them to feed him strange new foods. I am in awe of them.

And we are seeing double, yet again. A gorgeous set of twin boys have joined us in the NICU. They are just 5 weeks old and are happiest when we place them so close that each can feel the warmth of the other. This is brotherly love!