Sweetness and light

I am about two weeks behind. The Garbey-Kourou post, and indeed the details of last weekend, are still brewing.

However, I sort of reached my ghastliness limit today, so this will be rather less an amusing things which have happened to me in Niamey which may or may not have involved my nearly blowing myself up type missive. So skip it if you've just got engaged or something, hey?

The ward round this morning started badly. The first patient was a girl at the upper end of our limits - nearly two, and had been admitted overnight with rampant cerebral malaria: she just lay there with her eyes half-open and rolled up slightly into her head. She didn't respond to being spoken to, shaken gently, or to pain (you can press over the eyebrows or the sternum). Her pupils were dilated and slow to constrict when I shone a torch in them. She had bloody diarrhoea. She was dehydrated (but then they all are). Even Dr. Abdou, who normally takes things in his white-capped, funny-pointy-bearded stride, muttered darkly, "c'est grave, ça" several times. The rest of the new patients all have a decent chance - there was one boy with malaria who'd had a brother who'd died at roughly his age from "a febrile illness" who didn't look very well and weighed 6.5kgs at age 2, but no one else in extremis. I left as Dr. Abdou and the final-year student were finishing some paperwork in the admissions ward and went on to the neonates.

The first baby there was a five-day old boy who'd been born prematurely (they *never* know exactly how early here, but I'd guess not too bad - 32 weeks or so?) whose mother was lying on the bed by him. He looked a little grey. He was not obviously breathing.

I checked. He wasn't breathing, and nor did he have a pulse.

The team took it pretty much in their stride. I was expecting at least some attempt to revive him - but no. I guess the resources just aren't there to resuscitate them, and here it is a big deal, of course, but people are used to death. Mum didn't cry; she and the family all had black headscarves on (they cover only the head, not the face, here) within ten minutes, but they were efficient and dignified, even, in the way they dealt with it.

The notes showed that the nursing staff had noted that he was breathing 12 times a minute and had a pulse of 60 since 2130 monday night. This is normal in an adult - but desperately, immediately life-threateningly low in any child under a year, and particularly in a neonate, where a normal respiratory rate is 30-60 and heartrate 120-160. They had conscientously recorded two more readings through the night, both basically the same, with the last about half an hour before we'd got there. The nurse got an absolute bollocking from the Dr. Roubanatou (the big boss) later, not that it helped the kid much.

Then the next child had spina bifida with a lump almost as big as his head on his back and no ability to move his legs, and in the next room there was a baby who wasn't that ill but whose mother looked like something out a horror movie - she shambled in covered in these circular lesions, coughing blood, and with her lips basically wrecked coughing blood onto her scarf sporadically. Apparently she's HIV positive and had got Stevens-Johnson syndrome in response to some of the drugs; I have no idea of the kid's status, but thankfully she isn't breastfeeding and wouldn't be able to even if she wanted to in the state she's in.

The only positive thing was that the little boy with tetanus looks like he's pulling through.

And I'm sick of being asked for money, although on the walk here tonight two boys carrying water got talking to me and taught me some Djerma, then left without asking for anything, so I bought them pains au chocolat from the patisserie. If the biblical storm last night was a harbinger of today, I am taking this as a sign that tomorrow will be better.