A Sobering Thought

We have an outbreak of Vomiting and Diarrhoea at GLA's main house - the first since our new water treatment system was installed. Symptoms are developing over a course of 2-3 days. The diarrhoea is severe and oral rehydration alone has only been sufficient treatment for a few cases. Today, I have several children on antibiotics (including 4 newborn infants) and two on IV fluids.

Sonia was so dehydrated that I was afraid I wouldn't be able to get a working IV line into her. Thankfully, IV fluids and antibiotics helped her recover rapidly. This baby had had a difficult two weeks. She had a respiratory infection and was on oxygen for 10 days. She came off of the oxygen on Thursday and went up on an IV the same day. She had her echocardiogram last week and we are waiting for the results, and hoping that they will reveal something that we can do to relieve Sonia's symptoms. Her breathing has been laboured ever since she came to GLA and she gets very tired when she sucks on her bottle. We suspect that these difficulties are related to a heart condition.

I was worried when Maudlin developed diarrhoea and vomiting. His mother received no antenatal care, and as a result, the pregnancy continued, unmonitored and he was born showing signs of significant, intra-uterine compromise. He weighs less than 4lb. He was unable to tolerate his milk feeds and he was jaundiced. In the developed world, we take few chances with sick newborns, and in countries like Haiti, where low birth weight babies, like Maudlin, are born very weak, and with immune systems compromised by malnutrition from the time they are in their Mothers' womb, we take even fewer chances. Maudlin was always going to be susceptible to infection during the neonatal period. I was concerned that this infection had the potential to overwhelm him.

Maudlin was started on IV antibiotics right away. Over the weekend, he has been able to tolerate continuous feeds of a milk formula that has been specifically developed for infants with gastroenteritis. This formula is easier to digest and has higher levels of specific nutrients that have been proven to shorten the course of diarrhoeal illnesses. Maudlin's milk feeds are being delivered through our new feeding pump. If we didn't have it, Maudlin would have needed an IV, and without the nutrition from his milk, he would have taken much longer to recover.

I received an anonymous message from someone who would like to try to obtain another feeding pump for GLA. You can click here to see the make and model of the pump that we currently have. I would certainly appreciate another pump - it is always useful to have back-up equipment in a country like Haiti, where there are no technicians on hand to fix faulty medical equipment.

Meanwhile, tiny Bobo is struggling with a bad cold. He is unable to drink from a bottle and is on oxygen and receiving tube feeds. I really hope that he doesn't catch gastroenteritis on top of this.

I was talking to Dixie Bickel, who is currently in the states, a few nights ago. I was worried. A few days before, we had received news that the Baptist Mission Hospital had received its first confirmed cholera case. The hospital is just 5 miles away. As I struggled to keep up with the sick kids I had, it was painfully obvious to me that if we received a single case of cholera, we would not be able to contain the spread of the disease. Lack of space would make that impossible. Dixie shared my anxieties. We are in the process of implementing a very strict cholera prevention protocol and we are trying to obtain a several dozen doses of DUKORAL, an oral vaccine against the strain of cholera bacteria that is causing the current outbreak in Haiti.

Pray with me that by God's grace, these measures will protect our staff and children from this life-threatening illness. These past 10 months have been filled with incredible trauma and grief for all of us at GLA. Through it all, God never left us. He has protected us. He has faithfully provided. He has blessed us beyond anything we could even think to ask of him. We take none of that for granted. We know we can't afford to.

Uncomplicated

Our new baby boy is an uncomplicated little man. Or at least, despite a high risk pregnancy, and an unassisted labour and delivery, his nursing care needs are relatively uncomplicated.

Born full-term, but very small, weighing just 3lb 14 oz, (5lb 8 ounces is the minimum birth weight that is considered normal in a baby born after 37 weeks), he arrived a matter of hours after his birth. He is the son of a severely disabled teenager, who lives at a large and poorly resourced orphanage, that is located less than a mile from God's Littlest Angel's main house.  His blood sugar was low and he was hypothermic. Like many low birth-weight babies, Maudlin did not have enough body fat to generate heat. I knew it was likely that he was using all of his energy in an attempt to create metabolic heat, and that he hadn't received enough milk to maintain normal blood sugar levels. There are other reasons though, that a high-risk newborn might have low blood sugars, and a low body temperature. I worried that he might have an infection. I worried that his blood supply might have been compromised during the birth process. If that had happened, he might certainly have low blood sugars and hypothermia, but seizures and organ failure were also a possibility. 

A few hours after he was admitted, Maudlin was in an incubator, and had taken a small milk feed. His temperature and blood sugar were both within the normal ranges. I had fully assessed him and the results of my nursing assessment were encouraging. 

As we warm hypothermic babies, we monitor them for breathing problems, for heart rhythm irregularities, and for blood pressure and blood sugar instability. Maudlin was stable and appeared healthy. His lungs were clear and his heart beat was strong. His muscle tone was normal, his abdomen was soft and there were no signs of infection or congenital abnormalities. I counted 10 fingers and 10 toes. He was sleepy, and he had a weak suck, but he was drinking.

So Maudlin wouldn't need CPAP, or an IV, or antibiotics or even a feeding tube. You are very red, I thought, I hope you don't have polycythemia - a condition in which a high concentration of red blood cells can make newborns blood viscous. Occasionally, this can cause breathing problems and seizures. More commonly, it causes newborn jaundice. The bedside test I ran suggested that Maudlin did have a high concentration of red cells, but not high enough to cause symptoms. Maudlin was unlikely to need any special treatment, we would just have to keep him warm, monitor him and make sure that he stayed well hydrated, so that his blood did not become too thick.

Two days after he arrived, Maudlin still has to be wakened for feeds every three hours, but he is drinking well from a bottle. Recently, we have admitted three infants with chromosomal abnormalities and we have cared for some extremely sick children. This has made me hyper vigilant. I can't help looking for problems. I am glad that in Maudlin's case I didn't find any serious or complex issues.

Sorrow, and a Beautiful Experience

Erick died late on Thursday morning. His blood sugar dropped and there was a faint smell of decay emanating from him. Although I knew that he probably would not survive, I had hoped that he would. He was hungry, and eager to eat and he was very alert, right up to the moment that he stopped breathing. I am haunted by the memory of his startled eyes, fixed on me, and that look of alarm giving way to absolute trust and wonder, as I help him close, and spoon fed him. I am very glad to have been given the chance to hug Erick and rock him in those last hours and minutes. The suddenness of his death, though, has left me stunned and despairing.

Woodley and Geraldine, who came to us last week from a local orphanage, no longer have diarrhoea, but they continue to vomit. Geraldine became hypothermic on Thursday morning and wasn't able to tolerate even an ounce of milk, every hour. On Wednesday night, I gave medications to help with the vomiting, and the worker from Geraldine's orphanage, who has been staying with her, syringe fed Geraldine 20 ml of oral rehydration solution or formula every hour. By the morning, Geraldine was dehydreated and her caregiver was exhausted. Geraldine needed glucose, fat and protein to bring her body temperature up, as well as fluids. An IV was not going to be enough.

Previously, the only option that would have been open to us would have been to put Geraldine on a warming bed, start an IV and give her very small volumes of milk. Last week, though, I received a feeding pump from the latest shipment of relief supplies. This made it possible for us to rehydrate Geraldine rapidly, by giving oral rehydration solution through a feeding tube, at a consistent rate, controlled by the pump. Most children tolerate this method of rehydration, even if they vomit the fluids that they drink.

Once Geraldine was rehydrated, I was able to begin feeding her. I set the pump to deliver formula at a slow rate, round the clock. She quickly stabilized and was able to rest for the day, while receiving all of the liquids and the nutrients she needed to recover. Geraldine has gained a pound since Thursday

'Miss Susan, will you please give me something......a gift.' her nanny asked.'
'What kind of gift?' I asked, feeling slightly suspicious.

' A photograph, Miss Susan?' the nanny asked softly. A photograph of Geraldine, and that machine that is giving her milk.' The nanny shook her head and smiled. 'I have never seen anything like that before, and the nun who is in charge of our orphanage doesn't believe me when I tell her what is being done for Geraldine.'

I nodded, and we both smiled.

'Will you please give me a photograph, so that the nun can see for herself? This is a great thing! It is a beautiful experience!'

Sometimes, I look at children like Erick, Frandline, and Geraldine, and I experience a pang of guilt. I feel guilty that my babies and I are so blessed, while they are not. We can turn on a tap, and clean, pure water flows out: their families struggle to haul filthy water from contaminated rivers and streams. I can chose almost any type of formula for my babies and they can drink as much as they want, and often as they want: theirs will go to bed hungry tonight, hoping for something to eat tomorrow. When my babies are ill, I have medications, IV supplies and oxygen right here: there is no Doctor in their village and there are no medicines. A hurricane whips through Haiti. We are untouched, while they drown in flood waters, and die in houses, crushed by landslides.

As Geraldine's nanny spoke, though, my guilt faded away.The love of God was poured into my heart. I understood, deep in my soul, that while poverty and misery broke the heart of our Lord, he wanted to bless his children with good things, and I was to rejoice in our blessings.

As I send up prayers of thanksgiving, to a God who has provided all of our needs, my heart aches for the children who are hungry and cold, those who are without shelter, for the sick and the dying, and for bereft mothers, grieving the loss of precious children they could not sustain.

We are under the shadow of his wing, but my little ones are no more precious in God's sight than the other children of Haiti. I am keenly aware that we are blessed, and I am glad for all that we have to share with children like Geraldine. I am glad that we are able to give them a beautiful experience.

An Update From The Issolation Room

'She needs someone to Mommy her,' Dixie said, first thing this morning 'She needs someone to hold her a lot.' She was talking about Geraldine, a baby that arrived at GLA last week, in a critical condition.

Geraldine is severely malnourished and weighs 9 lb, no more than some European and North American newborns. Geraldine, though is not a newborn. We were initially told that she was 9 months old, but when her birth Mother visited yesterday, we learned that she is actually 12 months old. Her dry, loose, yellow-tinged skin and bony frame tell a story of extreme starvation.

The IV is out and she no longer has diarrhoea, but Geraldine has been refusing to eat. The nanny who is with her says that she doesn't eat at home either. A combination of micro-nutrient deficiencies and chemical imbalances brought on by neglect and starvation can cause loss of appetite in malnourished children. There is a deep longing in the baby's eyes, stronger even than her apathy.

At Geraldine's orphanage, with just one care-giver for every 14 children, physical affection and coaxing are luxury commodities. Today, though. I indulged this sad little girl's desperate longing. This is a baby who will not recover without a lot of love and patience. I gave her medical peanut butter and Pediasure every three hours. Each feeding took around 40 minutes. I held Geraldine close and allowed her to suck the peanut butter paste from my little finger and sip at her pediasure. This is the only way I can get her to eat. At the end of feeding time, I held her up on my shoulder. She nestled her head against my neck, clinging to my scrub top. I hope and pray that we can get Geraldine past food refusal, before she returns home.

Next to Geraldine, baby Woodley has completely recovered from his illness. He drank 22 ounces of formula and had two bowls of corn meal porridge today, over a 9 hour period. He is sitting up in his crib, playing with toys and babbling in a sing-song voice.

At the back of the isolation room, 3 month old Erik is asleep in his bassinet. This emaciated, 5lb baby came to us from Cazale. The staff at the malnutrition centre there are inundated with cholera patients and asked GLA to admit this infant so that he can get the care he needs, in an area that is not currently impacted by the cholera epidemic. It is rare for babies to contract cholera, but as a precautionary measure, Erik is being kept apart from the orphanage children, for now.

Erik is in a very poor condition. he has some facial swelling and he is bleeding under his skin and from his intestine. His limbs are stiff and he is unable to suck. I fed him with a medicine dropper this afternoon and had to stimulate him to swallow. It is possible that Erik's malnutrition has caused some brain damage.

He is on a hypoalergenic formula, that is easier to digest than typical infant formulas. I hope that it will improve nutrient absorption and reduce the strain on his liver and kidneys. Sometimes, severley malnourished children die from organ failure when they begin to recieve nourishement - their damaged organs cannot process nutrients. I am also giving Erik an electrolyte supplement to help with the swelling, together with vitamins and minerals to improve his blood clotting and boost his immune system.

Erick and Geraldine both come from from extremely impoverished backgrounds, to which, they will have to return. If they survive and recover, it is highly likely that they will become sick and malnourished again once they leave GLA. This is the time for prayer. It is the time to hold tight to faith and to resist discouraging thoughts.

'Now hope does not disappoint, because the love of God has been poured out in our hearts by the Holy Spirit who was given to us.' (Romans 5:5)

Bobo

He is affectionately known as 'Bobo.' When he was admitted two weeks ago, he was 2 months old and severely malnourished, weighing just over 4 lb.

He has several birth defects: there are depigmented rings around the iris of both of his eyes. The bridge of his nose is flat and he has a tongue tie. His fingers overlap, his feet are clubbed and he had a urological abnormality.

We wonder if Bobo has a chromosomal disorder. We suspect that some of his internal organs might be affected. He has a high pitched cry and he can be very difficult to console, which, may be a sign of neurological problems.

'He is going to be one of your babies,' the nannies and nurses declared.'

'I'll take him.'

The fragile babies are always gifted to me by the staff here. It is difficult for them to bond with children that may not survive.

'We have seen worse,' Nurse Claudia commented, to no-one in particular when she set eyes on Bobo. She is right - we have seen sicker, more malnourished babies than Bobo and we have nursed babies with far more severe deformities.

I believe that despite their reservations about him, Bobo is winning some of his nannies over. This afternoon, as nanny Ginette cooed and clucked over him, Bobo rewarded her with a smile. It was his very first!

We had assumed that Bobo's very obvious eye defects would impair his vision, but he is giving eye contact, watching our expressions intently, following our movements, and best of all, he is smiling at us!

We are surprised and delighted and we have decided to be hopeful about this baby.

I Grieve For The Living

On Monday morning, my Haitian colleagues expressed the belief that I was in shock. They said that I had invested too much into caring for Sophie, to be coping as well as I seemed to be in the days following her death. I told the ladies I was ok, because I knew we had done everything that we could for Sophie, and I told them that I was rejoicing for her, because I was absolutely convinced that she had gone to a place where there was no more pain, and no more suffering.

Today, I am in shock, but I greve for the living and not the dead. On Thursday evening, 3 critically ill babies were admitted to GLA from an Orphanage in a nearby town, located high in the mountains. The missionary who brought them told us that an outbreak of gastroenteritis at that orphanage, had all ready claimed the lives of two infants, earlier that day.

Frandline was the last to arrive, deathly pale, gasping for breath, and so cold that her temperature would not register on a thermometer. The medical team who has been with her had been unable to get an IV line in. Frandline had a large, distended abdomen and she was comatose. While Dixie worked for almost two hours to try to find a vein, I started Frandline on oxygen, and pushed large volumes of fluid through a needle that a Dr had placed into her thigh bone. After boluses of saline and dextrose to bring her blood pressure and blood sugar up, we were relieved to see Frandline regain consciousness.

Was she out of the woods, one of the missionaries who brought her asked? I was sorry to have to tell the lady that Frandline's condition was still critical. Her pulse oxygen levels were low despite receiving large volumes of supplemental oxygen, her blood pressure had not stabilised, and she was vomiting altered blood and faeces. We had to place an NG tube down, and aspirate Frandline's stomach contents to prevent her from aspirating. We suspected that the baby had a perforated intestine, or an intestinal obstruction. She needed a surgeon but there was rioting in Port-au-Prince and in Petion-ville, so it was not safe to travel. We poured ice water down the NG tube. It was the only thing that might stop the bleeding. I was struggling to replace the fluid she was losing. The baby was profoundly anaemic and needed a blood transfusion. She couldn't have one tonight.....

Dixie eventually got a working IV line into Frandline's scalp. It was close to midnight when I left the nursery. Frandline's  body was still in shock. Her temperature was in the normal range and she was awake, but glassy eyed. Her oxygen levels were fair, and her breathing was only slightly laboured.

At 7:30 the next morning, Frandline stopped breathing, and her heart stopped beating. We were unable to resuscitate her.

In the next room, 9 month old Geraldine, who had also been admitted the previous night, was lying listlessly in her crib. The emaciated baby was lethargic and her body temperature was dropping. She needed to eat but was unable to tolerate even small volumes of oral medications. I was very concerned about this little one. Hypothermia is a very worrying sign in a severely malnourished child. Hypothermia can be a sign of severe infection. and organ failure. It can also cause organs to shut down. I dressed Geraldine in extra layers of clothing. I drew blood, and changed her IV fluids, based on the results of the tests I ran, using our portable blood gas analyser. I gave her IV antibiotics, medications for vomiting and vitamins. I put ointment in her eyes, which, were swollen and oozing puss.

I held a bony hand in mine. The baby was so cold. I looked over at Woodly, a 9 month old boy, from the same orphanage. His body was swollen from malnutrition, and his eyes were gummy. He had profuse, watery diarrhoea but his condition was not critical, so we were rehydrating him orally. He had a searching gaze. He whimpered and extended his arms towards me. I couldn't help thinking, that maybe Frandline was the lucky one. Hers was a horrible death, but it was over.

When these children are well enough, they will go back to an underfunded, and under-resourced orphanage, where the water is contaminated, where there isn't enough food to go around, where there are few medicines, and even oral rehydration solution is in short supply. Their suffering is not over.

It is the living I grieve for, not the dead.

Engraved On The Palms of My Hands

We suspect that Sophie had Trisomy 18, also know as Edward's syndrome. It is a 'lethal' chromosomal disorder, one that is 'incompatible with life'.

Certainly, most children with Edward's syndrome are miscarried, or still born. Only 5% survive labour and delivery and only 1% live beyond their first birthdays. Yet.......yet there is something unfair, and unjust and cold about the term 'incompatible with life' It infers that there was no hope in Sophie's life, and no point to it.

She was with me for two weeks, that was all, but in that time, through caring for her, I learned many things:

I learned to diagnose problems I couldn't see - subtle signs of poor gas exchange in her lungs, or a decrease in her cardiac output.

I learned to think outside of the box and to make use of what I had to treat particular problems Sophie was experiencing, like giving epinephrine to bring her blood pressure up and increase the volume of blood her heart was pumping with each beat, when I saw the signs that she needed this. I would never have thought to use epinephrine, except in a resuscitation, but it was a temporary fix that might buy us time, and stabilize another child in the future......

We didn't have an IV line, and so I researched alternative ways of giving particular medications that Sophie needed, with surprising results. This knowledge didn't save Sophie, but it made her more comfortable, and it might save another child..........

I came up with modifications to the CPAP that allowed me to do things that I would not have thought were possible. Although these modifications did not affect the final outcome in Sophie's case, I am fore-armed with a strategy that might save the life of a critically ill baby at some point in the future.

In Sophie's last hours, sick though she was, she was drawing in air with tremendous force, leaving deep depressions in between her ribs. Her blood oxygen levels were 'incompatible with life', yet her heart was beating at a steady rate of 150 times per minute, which is normal for a newborn baby. This was the instinct to survive, and it more than that. It was strength despite fragility, it was the will to to live, it was Sophie's remarkable spirit, fighting against the odds. What a privilege, to care for such a phenomenal little girl!

I am in no doubt that much of what I do here, from this day forward, will be influenced by Sophie. So you see, if her life was short, it was not without purpose, and she has left her mark, just as God intended.

'I will not forget you! See, I have engraved you on the palms of my hands.' (Isaiah 49:15-16)

Sophie Got Her Miracle

At 2:30 am this morning, Sophie Dora passed away.

Looking at her now, there can be absolutely no doubt in my mind that Sophie got her miracle. Her face has filled out, and she is radiant. As tangible as a rainbow after a storm, this is my sign, not just of God's promise but of the fulfillment of that promise.

Rest in peace baby girl x

Believing and Miracles

Sophie's Condition has continued to deteriorate. Last night, I spent 3 hours in the NICU with Dixie, trying to stabilize her. Sophie's oxygen levels were dangerously low and she was having severe breathing problems.

Had it not been for my nursing notes, the events of today would have been a complete blur to me. The details are not important: the bottom line is that Sophie is seriously ill. She is receiving 15 litres of oxygen through her CPAP, along with medications to keep her blood pressure up and to treat seizures. We suspect that Sophie has a life-threatening chromosomal disorder. Sending her down to her cardiology appointment tomorrow, with only 3 litres of oxygen would almost certainly prove to be fatal.

Medically, we are doing everything that we possibly can, but Sophie has suffered today, and seeing that, I have began to pray, 'Not my will, but thine, oh Lord.'

I believe that in the next 24 hours, Sophie will receive a healing, a wonderful miracle, that in all likelihood, will be performed in heaven.

This photograph was taken a few days ago by Susie Schulke, our updates co-ordinator. I cannot photograph Sophie today, at a time when she is so sick. I just can't.

Holding My Breath

A Knock at my door at 6:30am brought worrying news. By the time I reached the NICU to see why Sophie's oxygen saturation monitor was alarming, her oxygen levels had dipped to 45%. The oxygen had become disconnected from her CPAP. The colour had drained from her body, her mouth was open, her eyes were staring and she was gasping.

The night nurse documented in Sophie's chart that she had cried a lot during the night. She seemed to be in pain, the nurse thought. Her heart rate was high and her breathing was laboured. As of mid-day today, Sophie was still working hard to breath. Her heart rate continued to race. She had not cried. When I did a heel prick to check the levels of oxygen and carbon dioxide in her blood, she barely even grimaced.

As the days pass, Sophie's heart rate climbs, and her blood gasses deteriorate. As I continue to pray for a miracle, I prepare my heart for the ever more likely possibility, that Sophie will not survive. This morning's episode is a stark reminder of just how fragile this baby is. Please continue to pray.