MALARIA AND MIRACLES

Lucas has had Malaria!!

I knew this could happen. Actually what worried me most was not recognizing the symptoms sufficiently quickly for early treatment. I had been told by all that rapid diagnosis and treatment was the key to success. As it happened I need not have worried. Lucas had a text book case, it was unmistakeable even for my untrained eye. Saturday morning we went off to football as usual. Lucas played well though I felt he was more distracted and came to the side line more often for a 'water break' After, we passed by a small shopping centre to pick up some groceries and met Tarek. It was his birthday so we stayed to have a milkshake with him. Without finishing his drink Lucas proceeded to fall asleep at the table. We made some comment about men and there sleeping habits but I knew something was wrong. Lucas NEVER slept during the day. By the time we reached home he had a slight fever 37.5C I wondered what he was sickening for? Over the next 2 hours his temperature rose to 40 C . He was sleepy and complained of headache. He was too tired to eat or drink and was too weak to even walk to the bathroom. I didn't hesitate. I carried him to the car and drove less than 10 minutes to a small clinic that had been recommended by a friend. We were seen immediately. Excluding any other signs or symptoms of infection a small finger prick sample of blood was taken which they examined straightaway under the microscope. It was confirmed in minutes. Affected red cells were seen but we had caught it in its early stages. Treatment in the form of tablets was prescribed and we went home. I was advised to use paracetamol to lower his fever and cold flannels or baths if necessary. Well everything prooved necessary! His temperature osscilated between 38.4 C and 40C for 36 hours. All weekend activities, including a birthday party and " sleep-over were cancelled. I stayed at his side constantly during that time either in bed or on the sofa. I was amazingly support by friends both by phone, messages and visits. Most had experience of the same with their young children, I found this most comforting. I think the worst moment was the first night at midnight when he was supposed to take his second dose of treatment. He immediatly vomited the lot! I phoned the clinic who helpfully told me to give an anti sickness tablet, wait 30 minutes and repeat the dose. This I did and much to my relief it stayed down. Then it was a waiting game. Sunday didn't see much change and I had my doubting moments but he was also not getting worse, which served to console me. Monday saw some improvement and he started to eat and drink a little. Its amazing how we feel so much better when children eat! Right from baby and infant time if they would only eat, breast feed, take the bottle, then they must be alright! By the evening I could see the difference and on Tuesday he wanted to go back to school! He stayed at home with his nanny and I felt confident enough to leave him. Wednesday he went back to school and is now active and happy once more and very proud to be the only one in his family who has had Malaria!
In conclusion I would say it has been a great learning experience for us both. That Africa is definitely the best place to be sick with Malaria! They really know what they are doing. The attention and treatment was fast and effective. The medical staff were knowledgeable, understanding and efficient...in short ,with all their short comings in other ares I could not fault them.
So now I'm not so scared of Malaria! It might still sound desperate and frightening to you all but this is Africa and we are learning to live with and in it.
Malaria is a killer disease here in Malawi. The people live too far away from health facilities. They have no money for transport. Although medicines should be available free many times charges are made and the 500 MKW is more than most can afford. ( I paid 3.500 MKW in total for Lukis treatment as we attended a private clinic, this is totally out of the reach of most Malawians who maybe only earn that much in a whole month)
There is so much malnutrition, HIV, Hepatitis, chronic anaemia and other ailments that Malaria kills. We are the lucky ones. Lucas is a fit healthy active child. He was diagnosed and treated fast and his body responded. Yes, the medication is available....but only for some. Yes, the medication works.... but only for some.

And what about the miracles then?

I arrived on Labour ward, as usual, at 7.30ish on Tuesday morning. What would I find today? A second twin waiting to be born! Quickly I looked in the notes to see the time of birth of the first....5.30am! more than 2 hours ago! I tried to find the fetal heart but without success..or maybe yes, maybe I could hear a faint heartbeat or not? I decided to actively get that baby born. It was her 4th child she should be able to push it out quickly, it would be quicker than a c/section if it was alive and I could not send her for a c/section if it was dead. So where was that baby and why hadn't it been born yet? I examined her, she was fully dilated, was it a head I felt? I broke her waters and found a hand and an arm! Oh no this was not a good sign. But wait, I was right, I could also feel a little head. I called for assistance and encouraged her to push. Chimani...Chimani...push..push, kwambiri....kwambiri...more..more. That mother was amazing. I dont know if she realized she was pushing to save the life of her baby or if she could hear the urgency in my voice, could sense the need to respond, but she just pushed with all her strength and out came that 2nd little girl with one hand up alongside her head. I thought she was dead. Quickly cutting the cord I felt for a heart beat. I couldn't believe it! It was slow, but it was there. At my side was Anne the Norwegian midwife, she took the baby from me straight to the resussitaire and started work...suctioning out the mucus that obstructed her airway and forcing oxygen into her little lungs. I heard a small infant cry! "She 's coming round" shouted Anne. And she was! An hour later her mother got up, showered and proudly took her 2 little babies to postnatal ward after breast feeding them both. It took a while for the adrenelin to subside but I'd never felt so alive!
Today I had a meeting with Lucas' teachers at 11.45 so I decided to go to labour ward for a few hours untill 11.30. Lucky I did, as we were just 3 midwives, 5 students and a full ward. Anne and I started to sort out who needed what and when and before 11am most of the babies had been born. I was walking past a bed where a doctor was examining a newly admitted referred patient. I could see the umbilical cord pretruding from her vagina. Oh no! cord prolapse! Is the baby dead? Is the cord pulsating? " Yes" When, at what time, how long had the referral and journey taken? There was no time for those questions they were not important now.. First baby or multigravida? "3rd" is she fully dilated? " yes" what is the presenting part? " a foot " Then we can get the feet down and pull, we can deliver this baby, it will be its best bet, its only hope.
The Norwegian obstetrician was at my side, Anne came quickly to help, we worked as a team and the little one was born. Just a faint heart beat was felt. We worked together to help that baby to survive. It took a while but slowly he started gasping, taking little breaths, getting pink ( yes African babies get PINK too!) I took him to nursery. Will he make it? I don't know yet but at least we have given him a chance.

I could tell of the ones that didn't make it but I think that this week I'd rather end on a positive note. The two Norwegians that I have talked of will be leaving next week. Two more have come in their place. Their government has promised to supply these medical staff for a period of 5 years. They each do a 6 month stint. I shall be sad to see them go. They have become well trained and experienced collegues during their time here, they will be greatly missed on labour ward. It takes time to learn and accustom oneself to Bwaila and now they are leaving. I wish them well. Who knows, maybe one day they will come back? Africa needs such as them, Bwaila needs such as them, the mums and babies need such as them, I need such as them.