A Shot In The Darkness

"In the Lord I take refuge; how can you say to my soul, ‘flee as a bird to your mountain; for, behold, the wicked bend the bow, they make ready their arrow upon the string, to shoot in darkness at the upright in heart." (Psalm 11: 1-2)

In the midst of the political unrest that plagued Haiti this week, we were visited by two tiny sojourners. Jacob was the first to arrive on Monday, born three months prematurely and weighing 1lb 9oz. He had several birth defects, including a severe cleft lip, and deformations affecting his nose, eyes, ears and hands. I was touched by the love of his family, who, travelled from Petionville to Port-au-Prince, before doubling back and making their way up the mountain, to us, after being turned away by hospitals in both cities. How could we give Jacob anything but the best care we could offer?

Jacob was not breathing when he arrived, and his heart was barely beating. After a successful resuscitation, Dixie and I made several adaptions, that made it possible to run our nasal CPAP equipment with a facial mask. Little Jacob had no nasal passages, so nasal CPAP was not an option for him. He passed away in the early hours of Tuesday morning.

Stephie arrived late on Friday afternoon. She had been born six days earlier, around 4 weeks before her due date. Her twin brother died in-utero. Stephie's s family are heart-deep in voodoo, so instead of taking her to a hospital, they took her to a voodoo priest. The priest tied a fetish around the baby's arm, and sent her home. By the time Stephie made it down the mountain to GLA, she was only just clinging on to life. Her Aunt explained that they had given her only

water to drink.

This 2lb 13 oz infant was dying from malnutrition: so cold that we could not get a core temperature to register, she was swollen from electrolyte imbalances and a protein deficiency. Stephie had a metabolic acidosis from burning fat for energy. Being so tiny, she had used up her sparse reserves, and her blood sugar was dangerously low.

Stephie was warmed and given a bolus of dextrose. She deteriorated to the point that she needed compressed air to prevent apnoeas, then oxygen, and finally CPAP. We knew from the outset that Stephie was fragile. We gave her small volumes of milk and IV fluids, as part of a plan to slowly correct her electrolyte imbalances - rapid correction would have caused brain swelling.

Sophie's protein deficiency caused her blood clotting mechanisms to break down. She developed what we think was a stress ulcer - probably the result of cold stress - and although Dixie and I tried everything we could think of to stop the bleeding, and although we pleaded with God for her life, Stephie bled out, and died at mid-night.

I am tired of burying babies. I have buried five in the past month. Discouraging thoughts are the arrows shot in the dark. Today, they miss their target.

I am mindful that each tiny fragile infant, however short their time with us, teaches us something - a novel or unconventional way of treating problems with the medicines and equipment that we have. A reason to reflect....... What did we do well? What could we do differently next time? Is there anything we don't have, that we could get, that might help a baby in a similar situation?

As of the early hours of this morning, we are now on a mission to research the options and obtain a plasma volume expander, that we could use as a blood substitute in future emergencies. We are too remote for blood transfusion to be feasible in these situations but there are life-saving alternatives that we could store here at GLA.

So I persevere in the work that God has called me to, with a new hope in the battle against discouragement. We are fighting a good fight. I desperately want the next Stephie to live.