A don worry...

Last week Thursday my first patient was a 1 year old boy with a high fever and respiration of 97 per minute. Right away I was thinking admission. I assessed him and sent him to the lab, meanwhile giving paracetamol to reduce the fever in the hopes that his respiration would stabilize. A little while later I got his results; malaria and anemia. He had an Hb of 5.6 g/dL. Definitely low, however, for transfusing a cut off of 5 g/dL is generally used here. By 9 am he was already starting his antimalarials by mouth. After that we kept reviewing him every 1-2 hours. By 230 pm his temperature had stabilized and his respiratory rate had come down to 52, still a little high, but not bad. The NGO hospital had no empty beds so I was left with the option of sending to the government hospital or reviewing him at 8 am the next morning. His mother preferred the latter. So I sent them home with medication and instructions.

Friday morning started with torrential rains so I was already wondering how many of the 8 reviews I had scheduled, would actually show up. To my surprise, all of them came but one. And of course that happened to be the 1 year old boy. I was annoyed with myself for not going with my gut feeling the previous day! But it was too late for that. At 11am I secretly hoped he would still show up, seeing as the other 7 patients trickled in throughout the morning, having been delayed by the rain. No luck. At noon I thought it would be worth contacting the NGO hospital to see if a child with that name had shown up. Two hours later I received a text message, saying the child had been seen and admitted. Praise God! I was so happy to hear that; he was alive and admitted at the NGO hospital!

Today they decided to pay me a visit. It was good to see him again although he was a bit grumpy. He had been transfused and given iv meds and was now on the mend. I checked his Hb and it had come up to 8 g/dL. I told the mother “A DON WORRY” (=I was worried about the child), and that I was happy when I found out he was at the NGO hospital and not at home getting more sick, or even worse- dead. Apparently he had gotten worse (or mom had gotten more worried) Thursday night and she went to the NGO hospital, only to hear he needed admission but they didn’t have a bed. So she begged the security guards to sleep there and spent the night in the waiting room, and the child was then admitted Friday morning. I guess that’s how the system here works! This time it worked out well for my patient. I guess in theory I could tell more of my patients to try that tactic- but I don’t think my colleagues at the NGO hospital would be pleased. It is tempting though, rather than sending them home and reviewing them in the morning (with the chance they are much worse and that the NGO hospital is still full), to tell them to just show up there. But no, I can’t feed into the system like that. I will just have to send to the government hospital at times. Today for example, I referred 3 patients, 2 to the NGO hospital, but unfortunately the last one had to go to the government hospital because the NGO hospital was full. It's still better than taking chances at home...