Celia

 Little lady, we couldn't say no to you the day you arrived at our gate, and we still can't say no to you.


Celia was seen by our Pediatrician today. She was well hydrated. Most Haitian hospitals would discharge her home at this point. Since Celia wasn't out baby, I wondered if it might be best for her if we sent her back to the orphanage she came from with some instructions and supplies to enable the staff there to continue her care. I planned on giving the orphange workers the option to call for advice, or to bring Celia back if she wasn't doing well.

'But who will take care of her there?' the Doctor asked.
They have a nurse at Celia's orphanage. They also have nannies, and lots of older orphan-girls who help out with the little ones. I told the paediatrician this.

'I think she should stay here for another week or ten days.' Dr Nathalie clearly had a lot of confidence in our abilities and that was a great encouragement.

'Until the swelling has gone down, at least?' I asked. The doctor nodded. 'Ok, that sounds like a plan.'

So if her orphanage director is in agreement. Celia will stay with us at GLA, until our Paediatrician returns next week to review her. We have nurses on site 24 hours a day. People who can respond immediately if Celia develops complications during the stabilization phase of her treatment.

And anyway, she hasn't smiled yet. Until she does, and until she regains her appetite, and loses the fluid that has accumulated in her lower legs and feet, and begins gaining weight again after that, Celia is not out of the woods.

We Couldn't Say No

We were reluctant to admit a child with diarrhoea to the main house. We all ready had so many frail babies in our care, and we had to protect them from new infections. We had fought so hard for for their lives. We were loathe to jepordise all of our little ones, for the sake of another, who should really be treated in a hospital.

Yet, two charity hospitals had said, 'no' to her. It was 3pm on a Friday afternoon. The Brothers orphanage, which is less than a mile away had brought her to us. The toddler in front of me was was severely dehydrated, and her body temperature was low. I knew that if I said no to her too, she certainly would not survive.

She doesn't have a name, and we don't know how old she is, but we are calling her Celia and we think she might be 18-24 months old. 'Celia' was abandoned at the gate of a remote orphanage. Two weeks ago, she transferred to the Brothers  orphanage in Thomassin, for special care. Celia has Protein-energy malnutrition -her hands, feet and calves are very swollen and in this malnourished state, her body and immune system have been overwhelmed by an intestinal infection. Twenty-four hours after she became ill, she had lost so much fluid that her body had gone into shock.

She did not respond when I pricked her finger to test her blood sugar. When Mme Berrnard started her IV, mercifully able to find a vein, as tiny and flat as they were, Celia didn't even stir. She was on a warming bed and her body temperature was going up. Her glucose levels were in the normal range. These were good signs that she would respond well to treatment.

We gave her a bolus of fluid and Celia's eyes opened. She cried after I'd finished giving her medicine. She was thirsty and reaching for the syringe. I gave her two ounces of oral rehydration solution to drink. It was a mistake. Over the next 2 hours, her body dumped 16 ounces of fluid. Celia was in an extremely fragile state. Her shock had progressed. I counselled her orphanage director, over the phone, that I was working very hard to rehydrate this little girl, but that I wasn't sure she would survive.

By 10pm, I had given Celia a blood alkaliser, and several fluid boluses. Finally her breathing pattern was normal, her heart rate was regular,  her hands and feet were warm and she was awake, lethargic, but aware of what was happening around her. She started to moan. She took a hold of my scrub top. She would't let go.

I scooped Celia up out of her crib. At that point, she had two IV's running. She rested her head on my chest, and she fell asleep. As I sat with Celia, I experienced a feeling of warmth. God was very close. I hoped you would say, 'yes'. 

He was smiling and he was blessing me, I knew it.

A Debt Of Gratitude

For this child you prayed.......

Charilson came within inches of death. Born prematurely, tiny and frail, anemic and malnourished, he caught an infection that overwhelmed his weakenned immune system. He became desperately dehydrated and sick to the point that his body shut down. And he almost died. Almost.

Looking back over the past day and a half, I am thankful for many things. I am thankful that we were able to use extreme, life-saving measures to bring Charilson back from the brink of death, and thankful for the knowledge and skills I have gained. I am thankful that we were able to use that knowledge and those skills, to the glory of our God.  I am thankful that we had everything we needed, to provide intensive care to Charilson at this orphanage, when he needed it. I am thankful that at 'such a time as this', an O negative blood donor just happened to be here, able and willing to donate blood to support charilson's embattled body, at a very critical moment. I am thankful for your prayers. I am thankful for the leading and direction of Charilson's heavenly father: the great physician. I am thankful that Charilson is alive.

Tonight, Charilson continues to improve. He is off of CPAP, and no longer needs oxygen. He has lost weight, so he still needs to be in the incubator to stay warm. He is weak, and on an IV, but he is beginning to suck again. He is absorbing his feeds, and his diarrhoea is minimal. 

I don't doubt that he has received a divine touch, and I feel honored to be a participant in and a witness to Charilson's remarkable healing. 

The emotions are intenese. Gladness, interwoven with relief, and pain - many of the supplies that we have now, the things that saved charilson's life, are things we haven't always had.  Some of the  equipment and the medication that sustained Charilson were aquired after we lost other lives. It is  a victory tinged with pain, that brings me to my knees.

This thanksgiving will be especially poignant for me. This thanksgiving, I am not just thankful. This thansgiving, I owe a debt of gratitude. 

Because I Promised

Charilson is critically ill tonight.

Last night, his nurse documented that he was absorbing his feeds well. This morning, Mme Bernard, the head Haitian nurse found Charilson extremely dehydrated and profoundly hypothermic, with a very distended abdomen.

The drop in Charilson's body temperature was the first sign of a severe infection that made his gut stop working. Charilson deteriorated rapidly. The Haitian nurses were not able to start an IV. Charilson stopped breathing several times as they tired. There was one more thing left to try, but I was sure I couldn't do it.....

I sited a needle in the baby's thigh and began infusing fluid into his bone marrow. It was a radical measure, only used in neonates in dire emergencies, but Charilson was on the point of death. I had never inserted a needle into the bone and I have always felt physically ill whenever I have seen broken bones, or heard the broken ends grating. I didn't think I could overcome that physical reaction. I knew that I could not stand in front of his bereaved Daddy unless I was able to say that I had been true to my promise. I did it because 4 days earlier, I had told his grieving father that I would do everything I could, to restore his son, strong and healthy to him.

We have managed to rehydrate this precious boy. He is stabilizing, but he needs a nurse by his side constantly. Katie, an Australian nurse-volunteer is with him now. Our staff and volunteers are devastated by the sudden deterioration in Charilson. He captured our hearts fast - such a tiny elfin baby.

His father desperately wants him to live and we desperately want that too. I think if we can get him through the next 48 hours, he might survive this. Pray for him.

A Promise To His Daddy

I was on a military airfield in Scotland, about to board a flight to Haiti, when far, far away, I heard the distant ringing of my Haitian cellphone.

I woke just as the ringing stopped. Disorientated, I reached for the phone. It was pitch black outside. I glanced at the screen display. 3:48am, and I had a missed call from Cami, the night nurse in the NICU. I knew she wouldn't call unless there was an emergency.

I was on my feet when she rang for the second time. 'You need to come and see Louna, She's not doing well.'
'Louna?'

I had treated Bianca for heart failure 12 hours before. I had been afraid that the medicine I gave would make the potassium levels in her blood fall. I worried that this could affect her heart rhythm or cause seizures. Louna was sick?'Yes. Louna.'

Louna had developed a mild case of diarrhoea overnight. It was a very, very mild case, but her oxygen levels were low and she was breathing very fast. The night nurse had started oxygen. She didn't have a cold and her chest sounded normal. It didn't make sense. The night nurse said she could not get Louna to feed. The baby, had been unusually sleepy over the past week, and she looked pale now. We ran a blood test.


Louna was anemic. Her hemoglobin was 8. It had been 16 four weeks ago. The baby would not suck. She wasn't dehydrated, but at less than 4lb, we know that she soon would be. We put a feeding tube down and gave some fluid to replace what she had lost through the diarrhoea, then began drip feeding donor breast milk. Before I knew it, the sun was up. It was 6am.

A few hours later, Charilson, a 3lb 11 oz baby boy arrived from Cazale. The baby was 3 weeks old. I had hesitated to say 'yes' to him the day before. We had an outbreak of diarrhoea and vomiting in the NICU, and herpes in some of our other rooms. I didn't want to expose a fragile baby to these infections unecessarily. The centre that referred the baby here still felt that it was in Charilson's best interests to GLA. His mother had died a few days before. We all knew, when we heard this, that his situation was urgent.
The baby was skinny and pale, but bright eyed when I met him in the waiting area. I expressed my condolences to his grieving father. This was his only child, he told me. Charilson was a precious son. He wanted him to live. I assured the baby's father that we would do what we could to get the infant strong and healthy. ' I am just so glad,' he told me, 'that there are people who can help us.'

I returned to the NICU to find Bianca having a seizure. I had all ready ran some blood tests on her. Her potassium levels were low, and I had increased the amount I was giving to her to correct this imbalance. Her Mother, had gone home the weekend before, suffering from a high fever. I tested Bianca for malaria. The test was negative.
It was a busy afternoon, with Bianca requiring constant monitoring, Alaine not feeding well, Louna on oxygen and tube feeds, and now, tiny Charlison in the mix.

4:30pm: Bianca was having several seizures and they were lasting longer and longer. I gave her some medication rectally to stop the seizures. She wasn't able to retain it. As I was giving her an injection, a nanny whispered to me that there was a baby downstairs with his aunt. The aunt wanted a nurse to see him because he wouldn't open his eyes. I smiled and said I would see him as soon as Bianca stopped seizing. Her colour was ghastly. Every time I've thought I was losing you baby, you have come back to me. Please come back now. Just then, her seizure stopped.

Downstairs in the waiting area, I unwrapped a tiny, premature infant. I couldn't believe it! We were really pressed in the NICU as it was. The baby had been born that day, in the 7Th month of his mothers pregnancy. A green, blood stained discharge was oozing from his swollen eyes. 'I can't make him open his eyes!' the Aunt exclaimed. The baby was icy cold and he was working hard to breathe. I told her I needed to take him up to the NICU, right away!

The baby was chubby, and he had a deep red colour. I knew that as he warmed, he would have even more trouble with his breathing.He needed IV fluids, antibiotics and CPAP. The Haitian nurses were going off shift. How was I going to get ever thing done myself?

I sent out an SOS, and Katie, a Paediatric Nurse from Australia, who is volunteering at GLA just now, answered the call, graciously foregoing a dinner out with the rest of the staff and volunteers, so that she could help me with GLA's newest admission.
Although we got him stabilized, his heart rate plummeted at 9pm. It was still dropping after 3 fluid boluses. I gave a dose of epinephrine to bring his blood pressure up. It took another 3 fluid boluses to improve his condition. He was dehydrated, cold and he had an infection. His body had been going into shock. I'm so glad, little man, that you wouldn't open your eyes. If you had, no-one would have brought you to us and you would be dead by now.
It was almost mid-night. Time to go to bed.

The next day, our premature boy was looking better. Bedside blood tests showed that he needed some minor changes to his IV fluids, but that CPAP was correcting his breathing problems. Bianca was hungry, still on a fluid restriction to keep her out of heart-failure, and not appreciating this in the slightest. Charilson was sucking well. Louna was drinking again too but she still needed her oxygen.

Over the afternoon, we had some trouble keeping our preemie boy's blood sugars up. He was well enough to start receiving small amounts of breast milk but his mother was extremely reluctant to express. The oxygen on his CPAP was being weaned down. At 8pm, I was exhausted but relieved to note that all of our fragile little ones were doing well.

They continued to improve overnight. This morning, I took, Louna off of her oxygen. Gave IV antibiotics, and made some CPAP adjustments. I went downstairs to do some chores.

Two hours later, a nurse came to find me. Charilson was very dehydrated, she told me. I could hardly believe that. He had looked so well earlier this morning.

Upstairs in the NICU though, I learned that Charilson had developed watery diarrhoea. He was pale and sunken-eyed. His skin was looser than usual and he had lost 8 ounces of weight. A few hours can change everything, I thought to myself, as we tried, unsuccessfully to start and IV.

Charilson is being re-hydrated with IV fluids, delivered a drip at a time down a feeding tube. His fathers words, spoken to me two days ago, and my promise to him drifted back to me as I settled Charlison. I really wish we had been able to get an IV line into him.

A Setback For Bianca

Baby Bianca,our severely malnourished 2 month old girl, who, was admitted last week in a critical condition, has experienced a setback in her recovery.

She went into heart failure today. This was not entirely unexpected, since Bianca is in a very fragile state. She was given an extra feed last night, and that was all it took to overwhelm her body.

Bianca has been given a dose of medication to help her get rid of some of the extra fluid that is building-up in her circulation. This has taken the pressure of her heart and it has made her breathing less laboured.

We are going to have to limit the amount of fluid Bianca takes in, to prevent her heart failure from worsening.

Please, continue to pray for this angel.

Magical Moments

Day by day, there are real and tangible improvements in Bianca - on Saturday morning, I noticed that her cheeks had filled out, just a little bit. On Sunday, the necrotic skin on her arms and trunk had began to slough off, revealing new skin,soft and smooth and fresh. Today, Bianca is losing her wrinkled appearance. Her eyes remain puffy, but apart from that, the swelling from her malnutrition has gone down. She is gaining weight now. Laying down fat stores. Facially, with her round cheeks and plump lips, she is beginning to resemble her mother.

Bianca is following the NICU nurses with her eyes. She is sucking on her fingers, and even trying to drink from a bottle. Although this utterly exhausts Bianca, she gazes up at me when she has finished her bottle feeds, and smiles weakly.

It is magical to witness each phase of her transformation. In the pale light of her smile, I am warmed and soothed by the hope of the frail beauty that is emerging. I am drawn in, as if by an invisible magnet and pierced by the reality of her suffering, still so evident, and so far from being consigned to memory.

Daring to Hope

As the sun slipped behind a mountain last night, surrounding GLA's main house in darkness, I hung my head in defeat, convinced that my precious Bianca would not see another day.

It had been a tough shift. Twice, sudden drops in her blood sugar had brought Bianca to the threshold of death. I had watched her, and her monitors constantly. I quickly learned that the first sign of of a falling blood sugar level, was a slight drop in her body temperature, followed by a dip in her heart rate. I had tried so hard, but despite everything I was doing, Bianca was fading. Her tiny body, so ravaged by malnutrition was giving up. The baby had an unearthly pallor. Her blood was watery. Her kidneys were not producing urine. Her breathing was shallow. She was unconscious, barely responding to pain.

Her mother was not producing more than a few millilitres of breast milk at a time and I suspected the formula we were feeding to Bianca continuously, through a feeding tube, drip-by-drip, was too strong for her damaged organs. I had a small amount of pasteurized donor breast milk. I poured it into the bag that hung from an IV pole above her feeding pump. A few hours later, Bianca had a wet nappy! I instructed the night nurse to give Bianca regular boluses of sugar water, in addition to the donor milk, to keep her blood sugar up

Over night, she stabilized. I found her sucking on her fist this morning. Awake, alert, crying pitifully, hungry. Alive!

Her colour is much better tonight, the swelling in her feet has gone down and she is holding eye contact with me, and she even smiled. 'Imagine', I told the NICU staff, 'after everything she has suffered, she still wants to live, and she can even manage a smile.'

Bianca wants to live, and I dare to hope, that she might.

Don't stop praying. Her life is still an extremely fragile thing, even if her hold on it is firmer.

Bianca

There was a hint of desperation in the nurse's voice. She was calling from the Samaritan's purse clinic in Site Soleil. A 3lb baby had presented at the clinic in a critical condition. We had a crib for the baby, but she was breast-fed, and we didn't have a bed for the baby's mother. If you could only see this baby, you wouldn't say no. I deliberated with Dixie Bickel, and with Mme Bernard, our head Haitian nurse. We decided that we would make it work.

The baby arrived, wrapped in blankets, with her face covered. The moment I unwrapped her, I knew that this baby would certainly have died if we had said, 'no' to her: Bianca is 2 months old and she is desiccated, emaciated and puffy-faced with fluid collections in her hands, feet, and liver. She has now entered the swollen stage of protein-energy malnutrition. There is a faint odour of decay about her. Oh, lord, have mercy!

Bianca is hypothermic, and her heart-rate is dropping. Very few infants under the age of 3 months survive protein-energy malnutrition, and the signs we are seeing point towards Bianca's imminent, and almost certain death. Deep within me, though, I sense that this is not the time to surrender.

Please pray for this tiny, extremely fragile infant. Over the next few days, I will attempt to stabilize her. She doesn't need to make drastic improvements during this stabilization phase, she just needs to survive it.

40 Diapers. 40 Days: A Novel NICU Fundraiser

Late last week, I heard about a novel fundraiser that is in progress. Dubbed The Painted Diaper, this initiative is the brainchild of an artist, and mother to a preterm infant. The aim of the project is to raise $6,750 (USD) to purchase a new radiant warmer for the Intensive Care room at God's Littlest Angels.

When a preterm or sick infant is first admitted to the Special Care Nursery at GLA, the nursing staff often place them under a radiant warmer. The warmer is an open cart on wheels, with an overhead arm that provides heat and light. These beds are perfect for resuscitating babies and toddlers, starting CPAP, inserting IV's, warming hypothermic infants, and observing critically ill infants until they have stabilized. GLA's only radiant warmer is 28 years old!

Every day, for 40 days, Asha will display a tiny diaper on her website, each with a different design painted onto it. During those 40 days, people will have the opportunity to make a paypall donation. At the end of the 40 days, the diapers will be sold to the highest bidder in a silent, online auction.

Asha explains the origins of this unique fundraiser, which lie in her experiences of parenting her own premature baby, in a well-resourced NICU in the USA:

'When Alana was in the hospital, she wore the smallest little diapers that you ever saw. She was so tiny that we had to fold them in half so they would fit around her little body. I want to paint on diapers because I love the idea of the ordinary being used for something extraordinary. Diapers are an everyday item in many households, but when you think about these little diapers and the tiny babies who are fighting for their lives wearing them, it makes the everyday more personal.

November is Prematurity Awareness month, and I can’t think of a better time for this dream to become a reality! The cost of one warming bed is: $6,750.00, but when I think of how many tiny lives could be saved, I am reminded of what a priceless gift this would be. My hope and prayer is that this project would grow beyond my wildest dreams and support babies who truly need our help.'

To follow the progress of The Painted Diaper or to make a donation, please visit the project website.

Asha holds the first painted diaper in her hands. (Photo credit: The Painted Diaper.)

Pray For Mario

In the first few days after he arrived at GLA, 6 month old Mario, who was swollen with malnutrition, responded well to treatment. He tolerated his feeds and became hungry. We increased the levels of protein in his diet. The swelling began to go down. These were good signs.

Then, Mario became more irritable. Children with Kwashiorkor are often irritable, so we didn't think too much of this when he first came in. We just kept a close eye on Mario. The irritability was soon accompanied by vomiting. At that point, we became even more watchful. The protein deficiency Mario was suffering from would affect his immune system, we knew, and we wondered if in his malnourished state, Mario was developing an infection. We had to monitor him very carefully - Children with compromised immune systems often do not develop symptoms of infection until their infections are very advanced. Their bodies are just too weak to put up a fight.

Our Paediatrician was very concerned: Mario was not having true fever spikes, but the front of his head protruded, and his fontanel was bulging, These were possible signs of hydrocephalus (an abnormal build-up of fluid on the brain). The Paediatrician was worried that Mario might be developing Meningitis.

We hoped that wasn't true. We wanted the protruding forehead to just be a symptom of rickets. Many of our malnourished children come with bowed legs and protruding foreheads. We hope this wasn't Meningitis, but we had to treat it as though it was.

The day after we began treating Mario with high doses of antibiotics, he began spiking fevers, that would not come down.

Tonight marks the first 24 hour period he has been without a fever. The swelling on his body has gone down, and Mario is much more settled, and no longer vomiting. These are signs that the infection that has been making him sick is under control and that his body is healing.

Please, say a prayer for Mario tonight. There is sunshine in his smile and I believe that the world needs his
light.