(Doug)
Chantel just wrote about an hour's worth of blog and then lost it because of the Internet connection. I won't write too much about the day yet, because it is her story and she was doing a great job telling it, so I hope I can convince her to type it again. So briefly, we had a travelling clinic today to a town just on the other side of Port-au-Prince. It was a town with a school, so right away you know that the overall health will be better because the school kids get fed every day. I had a great day. I only saw about 40 kids, most of them not that sick. At the end of the day, I had a line of about 6 pre-teen to teenage school kids left, and I had a good time, talking and joking with them. They are as smart and sarcastic as any middle school or high school kids back home, so we had fun. Plus, any child who is lucky enough to go to school, they learn French, so along with Kreyol, I had French to fall back on if I couldn't think of the right words. When we got back, we briefly took care of a 2 year old boy named Meritsky who had been walking around with fever for 2 weeks, but over the prior 5 days he had stopped making urine.
The mosquitoes search through the air for their next blood meal. they can sense the heat of a body, they can smell carbon dioxide and a chemical that we all give off called Octenol. When they bite a person infected with malaria, a small number of the malaria parasites move into the mosquito's stomach. The mosquito now has malaria. The parasite develop within the mosquito, change form, and move to the saliva glands. The mosquito goes on the hunt, again. This time when it takes its meal, the parasites are injected with the mosquito's saliva into the person being bitten. The parasites find the liver, and may stay there for months, or weeks, changing form yet again, but then they move into the blood an start to multiply within red blood cells.
That's when the fever and headache start.
Classically, with malaria, there are cycles of sudden coldness followed by shaking chills and then fever and sweating lasting four to six hours the cycles occur every 2-3 days, but there may also be a less pronounced, almost continuous fever. Children with malaria frequently exhibit abnormal posturing, a sign indicating severe brain damage, probably due to increased pressure inside their head.
Severe malaria is almost always from Plasmodium falciparum infection, and usually arises 6–14 days after infection. Children are particularly vulnerable. Renal failure, sometimes called blackwater fever, can occur when the kidneys are overwhelmed with the hemoglobin released from broken red blood cells.
Meritsky comes to the clinic about 2 hours before when get back. He is posturing. He has periods of rapid breathing followed by long pauses. The team here does what they can. He gets IV's started, fluid is given to restore the circulating blood volume. Intravenous antibiotics are administered.
When we arrive back, we rush to see him. After looking somewhat better, he is largely unresponsive. We do what we can. Since his kidneys have shut down, the fluid that has been given accumulates in his lungs. He starts to lose his ability to keep his oxygen level up. The same looks that we traded a few nights ago with Jeff are passed around again. The truth is, he came in too late, and we don't have the tools in place to save his life. We provide supportive care, but he deteriorates quickly. The blood test result comes back. He has malaria. We wonder aloud why we didn't get him sooner, but that is the reality of Haiti. Although effective medicines exist to treat it, and the whole team is taking medicine to prevent it, the reality is that to the people who live here every day, such things are almost unimaginable luxuries. They are so used to working without a net, to having nowhere to go, that they don't go anywhere. Their children survive or they don't.
Meritsky is two. He is very small for his age, maybe 20 pounds, but his mother says he has always been lively and energetic. I think of the smiling, happy children I have seen today. One was seen in the hospital for anemia, told she had anemia and malaria, and sent home with vitamins. Two weeks later we see her and she is still having fever. We give her the medicine that will cure the infection.
We will not intubate Meritsky. There will be no mad dash through Port-au-Prince. We wrap him up and give him to his grandfather. His mother is in pieces, wailing "Wai!Wai!Waaaaiii!" which to us sounds like "Why?Why?Why?" which is what we want to ask. Everyone is in tears, again.
Why is such a good question to ask and such a hard one to answer. I guess my answer is my support of the Haitian Christina Mission and continuing to try to raise money and awareness through Missouri Haitian Relief Fund. The people have become aware that there is a continuing presence, so the sicker people and children are finding us. Next time, maybe, we will have a ventilator. maybe an ambulance. In a year or two, maybe an expanded hospital. The need is great. We do what we can. The rest is in God's hands.
Meritsky's grandfather and mother walk out into the night, taking him home.
Doug, Fond Parisiens
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