Sunday, February 6, 2011

A few cc's of public health are worth a liter of fluids

Another child with seizures, this time without a happy ending. This little girl was 40 days old, and had been sick for several days. Her parents first noticed something was wrong when she stopped breastfeeding. Soon she began to vomit.

The family visited a traditional healer. After that they took her to the local government clinic, which advised them to go to the city hospital (hours away). They decided not to go. The baby then suffered five continuous hours of seizures, after which she remained unresponsive. The following day, when she hadn't gotten any better, they brought her to our clinic, a few minutes' motorbike ride from their home.

We examined the baby. Her breathing came in slow gasps. She made no response to painful stimuli. Her pupils were dilated and didn't react to light, and when we stroked her corneas with a wisp of cotton, there was no blink reflex. Her soft spot bulged upward, indicating dangerously high pressure in the brain, and her belly was much too firm. She died a few minutes later.

We visited the family the next morning, a couple of hours after they had buried their daughter. Her mother asked us several times how this could have happened when the child had been so healthy before. Our doctors explained to her that the child may have caught a bad germ that was "very strong." (There were other possibilities, but we couldn't be sure of any diagnosis given how short a time we had with her.)

The mother berated herself for not having come to us sooner. We told her it wasn't her fault.

And it wasn't, I don't think. It's hard to know exactly whose fault it is that this woman happens to have grown up on a remote, malarial island with only occasional visits from a midwife; that she received no schooling past age 11 and her fisherman husband little more; that they just moved here a few months ago; that they didn't know how to judge the severity of this illness. Could this death have been prevented if the baby had received treatment earlier? Yes, possibly.

What can I say? When it's too late, medicine isn't enough. Strong public-health programs and education must underlie any efforts to deliver medical care.

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