.fury

I don't think I'll ever understand it - I don't know if I'll ever really be able to put myself in their shoes

I'm too busy being completely infuriated

there is a baby in bed 22, except he is not a baby - he is a 2 year old. 

He has never walked. 
He can barely hold his head up.
His teeth are rotten, broken, black

Arms a little bigger than my thumb - loose skin hanging in folds from his armpits, buttocks, inner legs, you can see all his veins spiderwebbing across his scalp - he doesn't have any hair.

I had to switch him to oral quinine last night - I didn't want him to miss a dose - and she was completely out of money.

i exchanged the malaria exam for oral quinine - he really should have had a third IV quinine perfusion, but after scolding her, hassling her, repeating everything, i finally decided she had nothing. 

her clothes are torn, she doesn't have much.

And then I saw the father.

he came for the first time in three days.  He was large and burly, thickly built with a big belly - he had on a 3 piece suit. 

he drove away on a motorcycle. 

he drove away on his motorcycle. 

he didn't leave her with any money. 

did he not know that his son was supposed to have walked by now?
did he not worry when he saw that his teeth were rotted and black
did he not look at the skinny arms, the swollen feet, and think.....

maybe my child is sick?  maybe he doesn't look like other children??

it makes me abhor the men here all the more.  and that is biased of course.  I freely admit it.  and there are individuals i love and admire - like Teskrio, and Mary Charles, and some others I know..... but in general - i just want to glare at them all. 

Wendy Roberts brought in bouille tonight - peanut butter, sugar, salt, water - its thin enough to put down NGTs.  its rich enough to keep them alive.  She is opening her nutrition center soon - maybe next month - and i can't wait.  it will be such a pleasure and such a relief to be able to refer them there.  to know that when they leave the hospital they aren't just going home to a slow death.  it will be amazing to know they will have a chance at a full recovery.

because when the kids go home, it is almost a guarantee they won't be given the medication correctly

its almost a guarantee they won't cook them nutritious foods, or even add peanut butter

its as if there is a total disconnect - but really?? how can you NOT know your child is severely malnourished?  or do you know but the circumstances are far more desperate and complicated then i can understand....

i put an NGT in tonight - a little boy in not much better shape.  feet, legs, hands, puffy and swollen, arms tiny, bones sharp, skin crinkled in loose, irregular folds

has he eaten today?

he doesn't want to eat

has he drank anything today?

he doesn't want to drink.

I hear it all the time, almost every other patient.  so why have you not given any water and its 4 PM and the child has a fever of 104 and its 110 degrees outside?  why did you think he didn't need water?? because he doesn't want it. 

hmmmm.... imagine how well a pediatrics ward would run in the US if we had to get the toddlers permission first. 

so this baby - i sat down, and i tried to carefully explain

did you know your baby has malnutrition?? 

he said he didn't know

did you know that this isn't normal? 

he didn't know.

you need to add peanut butter to his bouille.  you need to feed him 5 or 6 times a day, little amounts.  2 times at least during the night.

He spoke French.  I explained carefully, repeated myself multiple times. 

sometimes i wonder why I bother - because I know he won't do it.  I know i'll come in tomorrow and see the full bottle sitting there - the one Wendy brought

and when i ask why it wasn't given - he'll say -

he didn't want it. 

most of the time i want to grab everyone by the neck and shake them. 

i want to scream at them - your child will die if you don't listen to me.

your child will DIE if you don't change


your child is dehydrated - GIVE THEM WATER.

your child has an infection - needs IV medication, is vomiting - DON'T GO HOME AMA!!!!

i gave out 5 bottles of water mixed with Oral Rehydration Salts tonight - I explained carefully - i made them give it front of me.  but i had 17 patients...... and when i did my last round - the bottles were full. 

i don't understand

i am literally totally and completely baffled

these kids man, their fontanels are sunken - you could pitch a circus tent on their stomach and it would retain its form - lips are dry and cracked - how man times do i have to explain, how many times do i have to mix up the salts in front of you, what am I doing wrong here??

and i'll come in tomorrow = and the bottles will be full.  and I will say, WHY WASN'T THIS GIVEN.  and they will act surprised.  I was supposed to give it???

I'm not exaggerating either. 

I am fighting a losing battle every single day.

also, with the NGT - maybe the kid will get lucky and the dad will give some buille and rehydration drink - maybe

but I can tell you with complete certainty that the other nurses will not. 

I can spend all this time fixing everything - i can writing out the exact number of mililiters of bouille on the dossier as if it were a medicine - i can detail it on our poor exscuse for patient notes column - and i can leave assured that THEY WILL NOT GIVE IT. 

I prescribed IVF tonight - but i couldn't give it.  there were too many holes punched in the bottle of quinine - if i unspiked it, no matter how i taped it, they would lose all their valuable medicine.  so its in the box.  I gave Dextrose, the kids eyes were rolled back in his head - did it last night and he perked right up.  But will anyone look in the box - see a Ringers, look at the kid - see dehydration??  no.  it will be there when i come in tomorrow night. 

i don't understand.

i come in tonight - quinine perfusions e hung at SIX AM were still completely full at 3 pm.  Granted, quinine is hard work, even with the utmost vigilance its impossible - to manage 15 drips - the parents touching it, the kids kicking and screaming, the IVs positional, they almost always go in to fast, or stop constantly - i get it.  but REALLY??  full since 6 am??? 

and many of the dosages were wrong.  even of quinine.  and when i pointed it out ( i need to stop being confrontational - not good in this culture - but somehow speaking in French completely removes my filter) and they blame it on the ER  - it wasn't me who wrote that - YES, BUT YOU GAVE THE MEDICINE!!!

and then i want to grab them by the neck and shake them

i make mistakes too - ones with no excuse  - but i am still infuriated

there are 5 people on days - 3 students who pretty much give all the meds - the chief, and another nurse.  do you think any of them take a vital sign?? no.

i have, however, won one battle - now we are labeling all the quinine perfusions in increments of 8 hours - much easier to rapidly control - really great actually - and now they are all doing it

also - just have to interject this bragging point - i gave a lecture on Typhoid to the nurses in French without a translator.....they said they understood!

and then

another kid

looks horrible - impossible to get an IV on, switched him to IM artomether - his mouth is eaten up with candidiasis - lips, gums, tongue - he won't drink, he won't eat.

well, they bought Nystatin Sirop.  and the mom gave all of it in 2 doses - should have lasted a week.

Olen wrote for more today.  did they buy it?

no

why not??

because they already bought it, and it didn't work.

the father refused.  he said, "we already tried that.  it doesn't work for him." 

he says he has no money.  i don't believe him. 

his eyes were rolling back too - mixed up sugar in a glass and gave it to him - i want him inside so if he gets worse the next nurse MIGHT know.....but she takes him outside to sleep anyway

i want to shake her too. 

and then the woman, she had mastitis and her breasts were completely engorged

Marci and I and Wendy started working with her, she has excellent milk production - we thought we were making progress - she looked better, the baby looked better

he would feed for hours, violently sucking - so hungry

she had been giving him water.

we said at least 34 times, DON'T GIVE HIM WATER.

well, several days ago,

"he didn't want milk"

and so she gave water.

now he is throwing up, exhausted, has bloody diarrhea, looks 2 weeks old but is 2 months -

why did you give water??  he didn't want milk

and they give well water here - its not potable - they don't boil or bleach it - and they splash it in every babies mouth

but if its a kid of 3 years  burning up with fever?? forget it - you can see the shock on their faces when I explain how much a kid needs.

maybe if an alien came to my hospital and told me that i needed to eat toenail clippings and dye my babies hair purple or he would surely die - maybe i wouldn't do it either

i don't know

i am just completely exhausted

completely frustrated

completely infuriated

completely exasperated

and completely baffled

and tomorrow - I'll do it all over again