5 to Children's Hospital...

I referred a record amount of patients to the Children’s Hospital today; 5 children in one day. (Plus Anna referred 1) It was an unusual amount of referrals for one day anyway but especially to the government-run hospital. I prefer to refer to the NGO run hospital closer to our center (because it is free, they have better facilities, use protocols etc), but all of their beds were full today, so it left me with no choice; except not to refer.

I could either treat the children as outpatients and see them back the following morning hoping/praying they didn’t deteriorate overnight, or send them in to the government-run hospital, with less facilities. Less facilities meaning they often do not have electricity which means the oxygen concentrator won’t work, they often don’t have running water, lab facilites are limited, etc. And of course the never-ending dilemma of COST; Le 15,000 ($3) to see the doctor, Le 30,000 ($10) for blood transfusion, money for medication etc. Note a day’s wage is Le 15,000 and most of the mom’s that come to the clinic don’t have more than about Le 5,000 with them, so getting the money together for Children’s Hospital is always a bit of a dilemma, involving them begging, us trying to figure out how much money they do have, trying to call family members, etc. - more on that another time!

I decided to refer. A 2 month old with a severe pneumonia. A 3 year old with malaria and severe anemia. (Hb 3.7) Two siblings – both with malaria, one vomited the oral medication we gave and the other was very irritable (I’ve never seen her like this before and I know her well). Another little girl with malaria and severe anemia. (Hb 4.7)

Often it’s a struggle to convince the parents that the child needs to be admitted because of the financial burden. And most times they are afraid of the hospital because many children die there, mainly because they come in such a late stage of disease. All valid reasons I suppose. But the other option is to take the chance that the child gets worse at home overnight and dies. Today the mother’s were more sensible and willing to go. They managed to call the father or aunt who would meet them at the hospital. Good.

To be honest, maybe the siblings would have done ok with oral treatment at home- but why take the chance when they look unwell. And the little girl with an Hb of 4.7 might have been fine till tomorrow morning, but her Hb was bound to drop anyway and I would have had to refer tomorrow. So why risk her getting worse overnight at home? I hope they all went and were put on the proper treatment…