Doing rounds on the pediatric ward today gives a bit of a look into what is ailing kids around the developing world. What are the big killers of kids under 5 years of age? Pediatric cancer? Congenital heart defects? Not in countries like Kenya. In places like this, the big 5 are pneumonia, diarrhea, malaria, measles, and HIV. When was the last time a doctor in the US saw a child die from a bout of diarrhea, or even saw a case of measles? Things are very different here.
On our ward now we have a few kids with malaria. One little girl came in yesterday afternoon, weak looking and barely awake. A drop of blood was taken from her finger, spread out on a glass slide, and examined under the microscope. Staring back up at the laboratory technician were hundreds of malaria parasites growing and reproducing in her red blood cells, bursting them open when they were too many to be contained in a single cell. Probably due to the infection's effect on her bone marrow and spleen, her platelets are also quite low, potentially leading to the inability to form blood clots. She is sitting up in a little princess dress today, and smiling shyly at us. She's not out of the woods yet, but we're still happy and continually amazed to see children like her bounce back so quickly.
A boy sitting next to her with HIV and resolving malaria has been giving us high-fives for a few days. He's ready to go home, but we haven't seen either of his parents during rounds for the last few days. I'm amazed how parents can leave small children at the hospital without a care-giver. In the States, this would be considered child neglect. Here, it's often a reality of having to be at home to care for other children and chores.
The young boy next to him did not look quite as well. When he came in to the hospital yesterday morning, it was clear to us from across the room that he was having a hard time breathing. As he lay on his bed, weak and quiet, we could see his chest heaving rapidly. The average child his age breathes in about 20 times per minute. We counted his respirations, and he was breathing-in 88 times in a minute. With each breath in, his nostrils flared, and the soft tissues between his ribs sucked in slightly, showing us that he was using additional muscles to get the oxygen his body required. He was started on a powerful IV antibiotic and monitored for the possible need of adding oxygen (in the US he would have
definitely been given supplemental O2; here, where oxygen is expensive and precious, children with pneumonia are started on O2 when their blood saturation of oxygen falls below 90%). Today he's sitting up and looking much better. He would have almost certainly died if he had stayed at home much longer. Now, with even just a few doses of antibiotics, he is on his way to recovery.
There are a lot of patients admitted to the hospital that we cannot save, based on limitations of diagnostics and treatment. But these cases of sick kids that turn around quickly make our day.