One of the two doctors at the hospital is away to attend a workshop. After rounds in the morning, the other doctor also leaves for Mansa. I am left on my own for the rest of the day. By now, I am familiar enough with the hospital and the staff that being on my own is not so stressful as long as there are no major emergencies.
In the afternoon, I run the doctor’s clinic with assistance from the theater nurse, who acts as my interpreter. No drama there – just seeing all the patients, renewing medication orders, and setting up follow-up appointments, etc. Afterwards, I head to the female ward to admit a patient.
Just as I finish writing up the admission, the ward nurse comes to me and tells me that there has been a delivery in labor ward earlier. The midwife resuscitated the baby before leaving but the baby is not breathing very well. A chill runs down my spine – neonatal cases are way out of my league at this point. I follow the nurse to the labor ward. The mother of the baby is resting in bed, the baby lying under the heat lamp with an oxygen tube in his mouth and a nasogastric tube in situ. I take the baby’s covers off. He is struggling to breathe – each short and noisy breath is following by a pause. His eyelids, hands, and feet are swollen with edema. He is still pink all over. His heart beat is quite strong, but only about eighty beats per minute. I turn on the suction and try to clear his airways but there is nothing. The oxygen tube is just resting in his mouth; it’s too big to fit inside his nose and there are no pediatric nasal prongs available. The nurse informs me that the hospital does not stock surfactant, but atropine has been given. I make eye contact with the nurse, looking for help. “He’s in God’s hands now,” he replies. I cover up the baby; the nurse tells the mother to get us if anything goes wrong and we go back to the ward.
Five minutes later, the grandmother comes in to the ward. The baby is not breathing. We run back in to labor ward. The baby is lying motionless under the heat lamp, with his edematous eyelids tightly shut. I listen to the heart – still beating strong. Intubation would be ideal, but I have never even seen an adult laryngoscope or endotracheal tube in this hospital, let alone a pediatric set. I pick up the bag-valve-mask and start to bag the baby. The first squeeze reveals a big crack in the bag – it’s useless. Another one is hanging next to the cart but is only partially working. I put a finger over the leaking hole and give it another go. The baby’s abdomen starts to inflate as I squeeze on the bag. His lungs are still so incompliant that all the air is forced into his stomach. I look up and ask the nurse to call the midwife in as I continue with my effort to revive the baby. All of a sudden, the heat lamp goes dark and the oxygen concentrator grinds to a halt – power is cut. If his life really is in God’s hands, then God must have the most cruel sense of humor.
With a last desperate attempt, I give him another injection of atropine. Pulling out his nasogastric tube, I stand there alone, with one hand holding the mask tightly against the baby’s face, one finger over the leaky hole, and the other hand gently squeezing on the bag. I watch helplessly as his abdomen inflates with each squeeze of my hand. I know he is not going to make it and my efforts are futile, but my hands seem to have a mind of their own and refuse to stop. I can feel his heart beat grow slower and weaker; I can see him slowly turning blue, first his fingers, then his hands, and his whole body; I can feel his temperature drop. Eventually, the rational side of me finally takes over and I stop the resuscitation effort.
The nurse tells me that he is going to tell the family. Relieved that the language barrier has shielded me from having to be the bearer of such awful news, I walk out of the hospital, which is now shrouded in complete darkness.
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