Baby Boy No Name

“Baby Boy No Name” has been my patient for the last month and I sent him home, probably to die.  I have mentioned that things are tough.  This is a perfect example.  From beginning to end, the frustration never ended.

No Name’s mom was admitted to the hospital because her bag of water broke and the baby’s leg was hanging out.  She had no idea how far along she was, but guessed around 7-8 months.  Without doing an ultrasound, it was decided to just induce her and “get it over with”.  I was checking on patients and happened to come across her.  I immediately stopped the induction, started her on antibiotics, and gave steroids.  The one person with the only key to the ultrasound room was nowhere to be found.  My hope was to keep the patient pregnant at least long enough for the baby to benefit from the steroids (lung development) and to keep her from getting an infection.  She stayed pregnant for another 5 days and then went into labor.  On day 5, I finally had access to the ultrasound.  No Name was about 30 weeks–or 2 months early.  Here babies do not live before 28 weeks, so this baby had a chance.

Since No Name was trying to come out foot first I felt that the best option was to do a c-section.  So we went to surgery.  Mom and No Name did great. After birth, I placed a tube in No Name’s nose to feed him.  I instructed mom to express milk.  She complained of hurting too badly from surgery and was not motivated to do so. So we started No Name on formula. The family literally spent their entire life savings ($9) on one small can of formula.

About two days after surgery, I went into the room to find mom burning with a fever and baby freezing cold.  Vital signs are never taken on babies.  When I had them take No Name’s temp he was hypothermic.  Both mother and No Name were started on antibiotics… or so I thought.  The mother was febrile for two days before I found out that the family was not buying antibiotics for the mother because of the cost (90 cents a day).  So, I started paying for the antibiotics.  No Name has developed some sort of skin rash, but was now able to stay warm.

The nurses help each other out and as a group take care of all the patients. No one is assigned to patients.  No Name was supposed to be getting fed every 2-3 hours.  It isn’t expected to write things in the chart, so I would get nervous never knowing if he was fed or not. When I would ask about expressing milk they would just ask the mom is she was doing it.  She would say yes.  I would then ask, “How many times a day?”    Mom would say once or twice….

Now let me tell you about the breast pumps here.  They take a 20 cc syringe and cut off the end of it.  It is a one size fits most nipples pump.  They then put the rough, cut edges of the syringe on the nipple and pull on the plunger.  Talk about uncomfortable!!!  Melodie Stocks, an Obstetrician from the states had sent a breast pump, so I brought it to the mother.  Most of the midwives were not convinced it was “strong” enough.  I can understand why they would think that, compared to their “breast pump”.

The next day, mom’s incision opened up and was pouring out pus.  The hospital was out of gauze (there is a shortage in the entire country), so I went on a hunt to see if any of the nurses had some stashed away.  I was able to find a few in the operating room.  We don’t have the proper soaps to clean out the incisions, so we used bleach water and then put the few gauze I could find in the wound.  With her being sick, her motivation to express milk was greatly decreased.  I wanted mom to express milk and then supplement with formula.  No Name just got formula.

It was a constant battle every day.  Many days, I would go between surgeries or at the end of my day to help the mom pump for an hour to make sure it was at least happening once a day.

When No Name was about two weeks old we had a big scare.  I was just popping my head into rooms to ask how everyone was.  Mom and dad were asleep and No Name was blue and not breathing.  I stimulated him and did mouth to mouth.  It was just an episode of apnea, but another medication was added to his list.

With time, both mom and No Name were improving.  No Name had gone from 1.5 kilograms at birth to 1.7 kilos about two and a half weeks after birth.   Mom reported No Name was sucking really well and she demonstrated it to me.  I was reluctant to do so, but I pulled the nasogastric tube and told her to breast feed.  The next day No Name was a little dehydrated.  Mom didn’t have much milk in and they weren’t supplementing with formula, so I told them to combine the two. The next day, No Name was even more dehydrated.

Both mom and dad were crying and begging to go home. Dad was literally on the ground begging me to let them go home. They are farmers and have 4 kids at home. No one has been caring for them. They were afraid that if they do not go home the whole family will starve to death. And if they can’t farm the fields it will affect them not just for a short time, but for the entire year. They had no money, so they couldn’t pay their bill and leave. Patients are just kept in the hospital until they pay up. There was no way to keep No Name in the hospital without a parent. I volunteered to take No Name home for a week or two, but was told I couldn’t because of the possible consequences if something went wrong. I paid their hospital bill, gave them another can of formula and money to get home and buy some food. In the reality of this world they had to go home. They chose survival for the ones that had the best chance. I don’t think No Name will ever get a name, but I hope that the No Name’s brothers and sisters will be able to survive.