The One Month Old Baby

       It is rare for a patient to come to the clinic at night. The walk up the mountain is difficult enough during the day, and even more foreboding at night. The same is true for the steep and treacherous mountain paths that connect to the clinic. That is why, when a patient does come to the clinic at night, it is because he is in dire need of medical care. This is particularly the case when the patient in question is a child. I tell you this as a backdrop to last night’s events.

     Last night at about 9:30 P.M., a mother arrived at the clinic with her one month old baby. The baby had developed a high fever three days ago. He had ceased eating. The day after he developed the fever, he started having seizures. During one of the seizures, the grandmother performed scarification over the baby’s lower chest. Scarification consists of making shallow incisions in the skin, generally with a razor or knife. The baby bled, but not profusely, and the bleeding was minor. However, the scarification was considered a success, because the baby did bleed. The seizures ultimately stopped.

The baby showed no improvement over the next 24 hours: the high fever persisted, and the baby took nothing by mouth. The mother then brought the baby to the local “Centre de Sante” (Health Center). These “Centres de Sante” are tiny offices which are found in almost any village in Burundi. They are staffed not by doctors, but by nurses who possess little medical expertise. The centers are ill-equipped, rarely possessing even the most rudimentary medical equipment, such as stethoscopes or thermometers. I refer to them as “Centre de Mort” (Death Center).

The mother of the one month old baby had no other choice but to take him to the Centre de Sante. She had no other access to medical care. The nurse at the center did not examine the baby. He merely asked the mother what was the problem, and then sent her home with Tylenol for the baby.

The baby was unchanged over the next 24 hours; he did not eat and continued to have high fever. The mother was then able to take the baby the next morning to the large provincial hospital in Rumonge. This is one of the major medical centers in Burundi. However, the baby was not even given a cursory exam at the hospital. Instead, the nurse, upon hearing the story, told the mother that they could nothing for her there at Rumonge, and that the mother’s only hope was to take the baby to our clinic in Kigutu.

I do not know the details, but I do know that, over the course of the day, the family was able to get access to a car. They made the one hour drive up the mountain to the clinic last night.

I was summoned along with the other weekend doctor, Dr. Remy, to see this one month old baby at about 9:15 P.M. One look told me that there was virtually no hope. The baby showed obvious signs of meningitis and sepsis. His anterior fontanel (“soft spot”) was bulging; his breathing was irregular, almost to the point of being agonal; his extremities were cold and clammy; he was profoundly anemic, as was evident by his extreme pallor. He was comatose, responding only to the most painful stimuli. His pupils were dilated, and responded sluggishly, if at all, to a bright light.

There were four of us in that room: myself, Dr. Remy, and two nurses. We did everything in our power to save that baby. He was so dehydrated that we could not find a vein, but we were still able to give him injections of three antibiotics: Ampicillin, Gentamicin, and Ceftriaxone. We gave him an injection of steroids to lessen the swelling in his brain. We put him on the limited supply of oxygen that the clinic possesses. We worked on him for over two hours, and stabilized him enough to get him to the ward. However, within 20 minutes of arriving on the ward, he died. I was with him when he died, and I watched while his breathing ceased. His heart slowed and very soon, there was no detectable heartbeat. He died in his mother’s arms at about 11:30 P.M.

Our cause was hopeless from the beginning. There was nothing that we could have done to reverse the cascade of events that led to his death. But was it too late two days ago when he went to the “Centre de Sante?” Was it even too late when he went earlier in the day to the hospital at Rumonge? Yes, it probably was, but we will never know for certain. But whether it was or wasn’t, it does not excuse the callous disregard for human life shown at the “Centre de Sante” and at the hospital at Rumonge. I know where I am. I know that I am in Burundi. I accept the medical limitations imposed by working here. I accept that I can only do so much for my patients. I accept what I have and what I do not have at my disposal. What I cannot accept and will never accept is indifference and irresponsibility from any person in the medical field. It is incumbent upon all of us who do this for a living, whether it is the lowliest nurse or the most sophisticated doctor, to do what we can for our patients. Shame on those who don’t; shame on the “Centre de Sante” and shame on the hospital in Rumonge for dereliction of their duty.