I'm staring at the old bathroom tile. On its smooth surface sit four drops of blood in the form of a T. On each has been placed a drop of a different liquid: blue, yellow and two clear. In the dim, fluorescent light I search diligently for signs of agglutination. It is a matter of life or death.
It started with a call from the nurse...
"There's the doctor from Kélo who brought someone. He wants you to see them."
I walk quickly over from the house to the hospital. It is dusk and the shadows are gathering. I hear the roar as the generator begins its nightly two-hour vigil. The fluorescent lights fight flickeringly to overcome the resistance to their illumination. I round the corner of the OR and towards the yellow light of the one bed "ER".
The nurse on duty, Hortance, points me back outside where a father sits on a crude bench holding tightly to his 7 month old son while his wife sits at his side with fear, desperatation, and hopelessness in her eyes. Dr. Assane from Kélo is standing by in street clothes, a departure from his usual stylish sport coat and unbuttoned, tie-less dress shirt.
Assane quickly explains that he went to his home village to visit relatives and found this kid on death's door. Since our hospital is closer he brought them here.
Truly, the kid is not long for this world. His eyes are rolled back. His body is limp. His respirations come in gasps. I listen to his heart which is pounding furiously and desperately. I look at his eyelids...white as snow. Anemia. Severe malaria. Our bitter daily bread and butter.
In 2005 we saw 67 patients, over 90% of whom were kids 2 years and under, die of malaria. Of those 67, 25 died of severe anemia requiring blood transfusions (hemoglobins less than 5). As depressing as that is, in all we transfused 99 patients meaning despite the desperate condition of the patient which pushed us to transfuse (using whole blood donated from a family member), we were able to save 75% who would've surely died otherwise.
This baby has the look of not even making it long enough to test his blood much less transfuse. The father gazes at me, pleading in his eyes. I tell the night watchman to go get Anatole, our lab tech.
Meanwhile, I ask Hortance to try and find an IV on the child so we can be ready if and when the blood arrives. The father places the limp child on the exam table. His head flops to one side as he continues to stare up, uncomprehending. His arms and legs are like jelly.
Anatole is not at home and he hasn't left his key. I sit there helpless watching Hortance search in vain for a vein on this tiny baby who has lost probably at least 3/4 of his red blood cells to the Plasmodium parasites. I could probably do the blood typing, I've seen Anatole do it countless times. If only I had the key, as all the equipment is safely locked in the lab.
Adam, our newest student missionary, is standing by, so I ask him to go get the bag-valve-mask so we can at least help this tired baby breathe. He returns and I place the mask over the baby's nose and mouth and start pumping in air with every effort he makes. His mom starts crying behind me.
Hortance has used up two IVs already when Anatole's son arrives with the lab key. I pass the bag-valve-mask to Adam and hurry to the lab. I open the door, flip on the light, open the armoire, find the fridge key, and pull out four bottles with droppers: A, B, AB and D. I grab two bathroom tiles, two lancets, some cotton, some alcohol prep pads, and rush back to the baby.
I prick the baby's middle finger and squeeze out a drop of blood in four different spots on the tile. Three across for A, B, and AB and one underneath B for D. I drop one blue drop for A, one yellow drop for B and one clear drop for AB and a different clear drop for D. I use the bottom of the vials to mix the drops in with the blood (since I'd forgotten to bring mixers from the lab). I start rotating the tile so the liquid will move allowing me to see if small clots form (agglutination). After two minutes nothing has formed in A, B or AB but there are agglutinations in D. Baby's blood is O positive. I prick mom's finger and repeat the process. She is O positive as well. I hope I've done it right as a mistake could cause a life threatening reaction, but desperate times call for desperate measures.
We are also out of rapid HIV tests. The only test we have takes 45 minutes to an hour. I look over at the dad. He's holding the baby as Hortance has given up trying to find an IV. He is trying to close the eyes, saying that the baby is about to die. The mom is sobbing. I make a quick decision.
One of our government lab techs, Matthieu, has just showed up. He's on strike, but I ask him a favor. He agrees and takes the mom off to draw her blood for the blood transfusion. I take the child back to the exam table. I need an IV.
Sarah has arrived and she brings me a larger IV and a 2 mL syringe. I feel the baby's femoral pulse and stick the needle in to the inside of the pulse where I know the vein should be. I pull back on the syringe looking for that quick fill of dark blood indicating I'm in the vein. I search and search. Finally, on pulling out I hit a small flash. I try to advance and it goes in. I pull out the needle and see a little blood in the catheter.
Matthieu has just arrived with the blood. Adam continues to help the baby breathe. I attach the bag of blood and it drips slowly in. I breathe a sigh of relief.
After a couple minutes, Sarah points to the groin and asks if it isn't swelling. Sure enough, the IV isn't in the vein and the blood has been going in under the skin only. I ask for another IV and try the other vein. This time I find the vein easily and with the big flash I know I'm in. I attach the blood again and open it up to go in fast.
We watch a miracle take place before our eyes. First, the floppy baby's legs start to curl up. Then, he stretches his arms straight over his head as if he were Lance Armstrong celebrating yet another Tour de France win. Then he pees straight up in the air, a glorious clear fountain telling us his internal organs are waking up now too. Then, his blank stare transforms into an intelligent sparkle as he looks around at the world he thought he'd left.
Three days, one more transfusion, 8 IV infusions of quinine, and one unbelieving family later, the little boy goes home...
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