the Maasai baby

Shortly after arriving at Tenwek, the head of pediatrics showed up in the specialty clinic to see me. Seems he had an urgent case to run by me. In fact, so urgent that he didn’t page me, he just walked over to find me. The child had some swelling around the left eye that started the day before. The baby was brought to Tenwek, admitted and begun on treatment of IV antibiotics for infection. By the next morning the baby had severe swelling of the neck that was rising to just under the ears. 

Now, if Dr. Chuck Bemm walks from pediatrics to consult me, I’m certainly going to see the patient immediately.  I examined the child and found the worst swelling I’ve ever seen in an infant neck. I quickly passed a fiberoptic laryngoscope  to examine the baby’s airway. What I saw in the baby’s airway was shocking! The baby had a severe case of epiglottitis. That’s swelling and infection in the epiglottis - the flapper that keeps food out of your airway. Although rare, I’ve seen enough of these before. 

One of the advantages of doing mission work in the same place is that the locals get to know you. This paid off, as when I approached the OR charge nurse, my call for an immediate OR was taken seriously. They knew I wasn’t one to hit the panic button and quickly bumped a case to accommodate this baby. It was a struggle to get a breathing tube in, as the swelling was massive. In the OR I noted an odd, purple color of the epiglottis as well as some fibrous debris along the baby’s base of tongue. I collected it for culture and got the baby to the ICU. Later that day, I learned that the baby had anthrax! Yes, anthrax! I’ve never seen anthrax before, but I’ll know it now! Turns out, the baby had either played with or eaten part of a dead goat. Not he kind of history I usually get on my Louisville patients! 

Having a diagnosis, we started appropriate antibiotics but the baby began to decline. A day later, the swelling now consumed the baby’s whole head, but no other part of the body. After consultation with Dr. Bemm, we started the baby on high dose steroids. The next day, my exam showed that the baby’s neck was starting to improve. The antibiotics were working! Praise, God! But, this was not to be a happy ending. Three hours after rounds, during mid morning, the baby had an acute event in the ICU. The ventilator alarm either didn’t go off, or was not noticed. The baby didn’t have a cardiac monitor - something that would never take place in the U.S. The baby’s breathing tube plugged and then he had a cardiac arrest. He was not noticed for about 5 minutes. I was called stat to the bedside where we performed CPR for the next 30 minutes. During our attempted resuscitation, I removed and replace the breathing tube. The epiglottis and larynx had dramatically improved! But, the baby was dead. My resident, Phillip, informed the family while I tried to remain calm as I discussed the events with the ICU nurses. 

In the end, this baby didn’t die of anthrax, but of poor ICU care. In the US, this would never have happened. We have so far to go in training these people how to care for critically ill patients. They are good hearted people, but training to the degree of US standards comes very slowly. In the meantime, patients die, sometimes unnecessarily.  I’ve been grieving over this baby. More Kenyans have died since then and these people just move on. Death is so much a part of their culture - but not mine. A single death like this one lingers with me and I wonder why it had to happen. There are no simple answers. Some seem obvious, like train the nurses better! But once you learn the details of it, the simplicity goes away. Culture permeates everywhere, even the ICU and culture is slow to change. My prayer is for that sweet baby’s soul, the grieving parents, and those nurses who don’t even realize what they failed to do. I’m not bitter toward them, but just sad that they don’t realize what great things are possible and that fewer have to die. This hospital needs an ICU specialist to come here full time and change their work culture. Short term trips like mine, aren’t enough to change things. I pray that God will call someone here soon to fill this critical need.