Oxygen...

How does one decide which child to give oxygen to?
Fortunately this is not a decision I need to make everyday.
But this is something that I was faced with today.
Not making the actual decision but thinking about the choice.

We went to Children’s hospital to follow-up on 10 patients we referred.
One was a 3 month old my colleague had seen Tuesday with severe respiratory distress.
Now, 3 days later, she was still having difficulty breathing.
Yesterday the doctor that saw her had written up that she needs oxygen.

Great thinking, but did she get it?
No, said her mom, they have not given her oxygen.
So why was she not given oxygen?
The answer was simple: unavailable.

Only a few feet away lay another child.
A child that was on the verge of death.
Next to the child stood an oxygen concentrator.
This child was getting oxygen.

My colleague asked the nurse why our patient had not received oxygen.
The response was simple- it was only available for one child.
The second concentrator was broken.
And the split tubing so that 1 concentrator could serve 2 children was missing.

A dilemma.
And not only for our patient.
There were 3 or 4 more children on that same ward that needed oxygen.
So, how do you decide who to give oxygen to?

Do you give it to the sickest child who will likely die with OR without it?
Or the slightly less sick ones that desperately need it, in which it can be life saving.
Children who could likely die without it but have a good chance with it.
It’s a hard call to make and really a decision that should not need to be made.

Oh Salone.
Once again we are faced with dilemmas of healthcare in a resource poor setting.
This time I didn’t have to find a solution but a colleague at Children’s does.
I hope that for the patients on the ward that day, a solution was found.