MBABANE, Swaziland – On a Thursday morning in January, the hospital admitted a 13-month-old boy with a two-week history of diarrhea, according to his mom. It did not take long for us to realize that he was more than just a little dehydrated. In fact, this little one’s organs had started shutting down, and his newly placed IV was not working.
One of the doctors attempted to insert an IV on the opposite arm and then tried to place one along the wrist. Because of the volume of fluids this child was going to need, the doctor decided the external jugular (in the boy’s neck) would be a better selection. Three attempts were made on the left and then two on the right. Another pediatrician made four attempts to place the IV. A surgeon was enlisted to help, but his two attempts at placing the IV also were unsuccessful.
The medical needs of precious children in Swaziland – and the utter lack of basic medical supplies to care for them – was a real eye-opener for Hunter Johnson, a fourth-year medical student from North Carolina.
Next, we wanted to try placing the IV in the child’s leg bone or in a vein near his groin, but none of the physicians had done that before. The job was about to be entrusted to me, a fourth-year medical student who had just stepped off the plane. Fortunately, an ICU doctor agreed to insert the IV into a vein the boy’s groin. But, that area of the hospital wasn’t prepared for the procedure – or any procedure, for that matter. There was no line placement kit, no Lidocaine, no sutures, no scalpel, no gauze, no sterile water, no scissors, no tape, no Betadine and no needles or syringes.
The equipment was gathered from all over the hospital and, after treating him the best we could, we left the boy in his mother’s arms and moved on to other patients.
In the United States, doctors would have put this little one on a breathing tube because he was exhausted from breathing too quickly. The work would have been done and appropriate changes to fluids and electrolytes would have been made reflexively. He likely would have had more than one IV providing fluids. Most importantly, he might have lived until the morning.
But we were not in the States, and the morning brought heart-breaking news.
I am still not sure why his death caught me so off guard. It could be because I had not experienced the death of a pediatric patient until then. It may be because when we left, he looked better and more alert so I was not expecting anything but improvement. However, I think the most likely reason is that I have never seen a child die from something as simple as diarrhea.
Diarrhea killed this baby, and it happens every single day across the world. I was so naïve. Never again will I leave the hospital simply assuming my patients will all be alive when I return in the morning. Never again will I assume that people know things that seem so obvious to me – like the fact that two weeks of diarrhea every day is a cause for concern.
(EDITOR’S NOTE – Hunter Johnson is a fourth-year medical student who volunteered with Baylor College of Medicine’s HIV pediatric clinic in Mbabane, Swaziland, in early 2015.)