I can't help!

When I was fourth year medstudent at Pitt, I had an opportunity to return to Malawi and spend a four week clinical rotation in the Lilongwe Central Hospital in the capital city of Malawi.  I was four months from graduating medical school and I was super excited to learn about medicine in the developing world and to head back to Malawi to see some of my friends that I had met during my time with World Service Corps.

Having been to Malawi before, I knew intellectually about the problems the country faced.  Malawi is one of the poorest countries in the world and at the time had the second highest maternal mortality rate in the world.   I also had learned through my previous visit that many of the problems are systemic and that long term, sustainable change aimed at working on systemic issues was much more helpful than having a few Americans come for a month or two to "help out."   Still, I figured that as an almost doctor, I would have something to offer.  

That perspective changed the first day I set foot on the pediatric ward.   I was immediately indundated with all of the sounds and smells that come with being in a large room with 300 sick children.   There were three to four children to a crib, with their mothers huddled over them.  Most were malnourished, many afflicted with AIDS, malaria or both.  As we were getting ready to start rounds, I heard the nurse say that there were supposed to be five nurses on the previous night, but two had just moved to the UK for better jobs and the other two were sick, so she was the only nurse that night to care for 300 children.   There had been 8 deaths overnight because of the short staffing. . .  

There really wasn't a chance for this to sink in before we were off to rounds.   We started on the new admissions and the first child I saw was 2 but looked the size of a 9 month old.   She was breathing fast and using every muscle in her chest to try to breath.  I felt her pulse and it was 190.   I listened to her lungs and they were full of wheezes.   I began talking to the medical assistant who was accompanying me.   I rattled off a dozen orders that this baby needed right now (or more like 2 days ago).   I asked about oxygen . . . about nebulized albuterol . . . about antibiotics . . . about IV fluids . . . and I asked about what this child really needed - a ventilator.   The medical assistant gave me a knowing look and showed me the orders written on this little girl's chart.  This medical assistant with only one year of training knew exactly what she needed and had ordered them all last night when she came in. . . but none of these things were available and with only one nurse for 300 children, only 3 oxygen stations that were already in use and only penicillin and chloramphenicol for antibiotics this child would not survive.  I stood dumbfounded as I watched him write a few notes and then we moved on to the next child in the same crib.   

Two minutes later, I heard a shriek and then sobbing.  I turned to look in the direction of the shriek and the mother of the child we just examined was huddled over her little girl.  I looked down and the little girl was no longer breathing.   I remember feeling a flood of emotion at that moment.   Tremendous sadness at the loss of life . . . tremendous helplessness that there was nothing I could do about it . . . tremendous anger at a system that allowed such horrible in justice.     Here i was equipped with a great education . . . and there was nothing I could do to save that child.   This was the first and only time I've examined a child that was deathly ill and was unable to do anything at all.   At that moment I felt powerless.

But that moment changed me.    I wanted to do my part to try to work on the problems that led to the death of this precious little girl.   

Unfortunately, the issues are daunting and overwhelming.    One way to get at this problem would be to try to train more doctors and nurses in countries like Malawi were there is such a deficit of these providers.   The problem is that these nurses and doctors often leave for better paying jobs in other countries.   One other challenge is that the resources are not always present to treat many of the medical conditions that patients face when they do get admitted to the hospital.   I was shocked to see that a major hospital in the capital city only had chloramphenicol and penicillin to treat the infections the patients were facing.   

Organizations like HealthEd Connect take a different approach.  By focusing on training and supporting community health workers (CHW) the emphasis is on prevention.   The CHW supported by HealthEd Connect have the knowledge to identify problems early and are focused on broader indicators of health in their community.  It is why the health workers in Zambia have suggested that providing quality education and grief support for the many AIDS orphans in their villages is vital to improving the health of their communities.   And HealthEd Connect is working to build classrooms and schools that can help improve the education and lives for these children who have already lost so much.   

If you want to learn more about HealthEd Connect please visit their website.    If you want to help me reach my goal of raising $2000.00 then either go to www.healthedconnect.org and click on the button pay now or follow this link.  You'll see Jeff's run for healthy kids in the purpose of gift drop down menu.  Thanks for your support.