A Week Ago Today.....

Around this time, a week ago today, Dixie Bickel and I had just finished stabilizing a very sick little girl.

Leissa is 23 months old and she does not live at GLA. She arrived with Dr Claude, who lives here and works at the Baptist Mission Hospital in Fermathe. He said that they did not have a Paediatrician on staff and that they did not have the equipment they needed to give breathing treatments to this child.

Leissa had a severe respiratory condition that affected her upper airway. There was swelling in her throat and all the way down to the air passages leading to her lungs. Leissa's oxygen levels were dangerously low. She was working hard to breathe, but just couldn't get any air in. She was drifting in and out of consciousness, and the people who were with her said that she had been that way all afternoon.

Leissa's Aunt, who is not her main care giver, was with her, and so it was impossible to get an accurate account of the child's illness, and how it developed. We established that she had been unwell for three days, that she had a cough that was worse at night time. She had had a fever and had not eaten or drank anything that day.

'No', her Aunt told me in reply to my question about whether Leissa was usually 'puffy' and jaundiced. That started yesterday.

With each breath, we heard the child's airway shut off. When she coughed, it was a barking cough. She was able to swallow her saliva, and there was no rash. Did she have croup? Malaria? Tuberculosis? An atypical infection? A cardiac condition? Maybe, a combination of things were leading to these symptoms?

Leissa received Nebulized Epinephrine, steroids and albuterol. There was an improvement, but not as much as we would have hoped to have seen. Without oxygen, her oxygen levels (measured across the skin surface) went down to 56%. These were extremely worrying signs that told us that Leissa's condition was life-threatening.

She was so swollen with fluid, that we could not see any veins, anywhere. Our only choice was to give her medications by Intramuscular injection. The risk: the pain of these injections would cause an airway spasm and Leissa would stop breathing all together!

I gave a steroid, some lasix to help with the fluid retention, and an antibiotic. Leissa regained consciousness and began to cry, but the thing I most feared would happen did not happen. Within 30 minutes, the fluid began to disappear from her face, arms and legs. She passed a lot of urine, and she was breathing much easier.

We continued with steroid injections and round the clock nebulizers. The next day, Leissa was alert, and able to eat and drink. That was a great relief, but it was not until Friday that Leissa finally came off of her oxygen completely.

She tested negative for malaria and Tuberculosis. Our Paediatrician diagnosed croup, a condition in which a viral infection causes inflammation and narrowing of the airways.

Initially, I was concerned about keeping Leissa at this house, where we have may fragile infants in our NICU. Iam glad that we decided to nurse her in an isolation room. I am sure that this is a decision that saved her life.

Leissa is under weight for her age and she shows other signs of malnutrition; she has orange hair, caused by micro-nutrient deficiency, and at almost two years of age, she is unable to walk. We sent her home with a fortified peanut butter paste to help her gain weight. We will see her again in two weeks time. If Leissa become unwell again before this review, her Aunt has been instructed to bring her back to God's Little Angels.