The thing about Malaria...

A couple of days ago, when I went in the evening to do the dressing changes of the two patients who are on twice a day dressings (one who is improving, one who is not), I saw two little babies in our "ICU" brought in with Malaria. 

Again, one had a hemoglobin of 2g/dl and the other 5g/dl (at that age, normal values are 11g/dl - 14g/dl).

The malaria parasites (mostly P. Falciparum in these parts) invade and destroy erythrocytes (red blood cells) causing anemia. 

The hemoglobin in the red blood cells is what carries oxygen in our blood. Without it, you can have all the oxygen in the world available, you're still going to slowly suffocate because there's not enough hemoglobin in your blood to carry oxygen to your cells. 

Hence why we immediately check hb levels and give blood transfusions, along with drugs to kill the parasites in the blood, and the hypnozoites which are maturing in the liver cells waiting to be released into the blood stream. 

Malaria, if diagnosed and treated early enough, is curable and you should feel well again in about 3 days. 

Here, these kids come in when they're already so sick, they're barely alive. The percentage of parasites in their blood is so high, it takes a while for the drugs to help. The transfusions improve oxygen transport, but don't fix the underlining cause. 

The drugs and the parasites damage the liver, and once they get jaundiced (sign of liver failure), there's little we can do. We have to stop the drugs, and then the parasites in the blood can once again roam free, worsening the anemia until the child is dead. 

That's what happened to one of the babies who came in Wednesday night. He was still alive last night, and I actually thought he was going to make it (when they come in that sick, they usually die in the first 24hrs)... but he was no longer there this morning. 

I broke my rule and asked what happened, and the night nurse said he got jaundiced, they stopped the quinine and the family took him home to die. 

In comparison, this is Chrystelle: 

She's the little girl I mentioned in this blog post: http://livinglifewithoutfear.blogspot.com/2014/08/the-day-i-did-everything-i-shouldn.html?m=1

For a few days after that, she would hide from me, because she knew I was the cause of her getting pocked full of holes so we could finally get her meds, fluids and blood. But it doesn't matter. She's back to her smiling, adorable self, went home with her mama, and even accepted a kiss on the cheek from me. Her parents always have a big smile on their faces when they see me. 

I might not be able to control the infection that is rampant in some of my fracture patients. 

I might not be able to save all the little babies that come in already half dead and unconscious from advanced malaria. 

But I will take heart in the story of Chrystelle. She might have been one of those who came in too late to be saved, if I hadn't stepped in. 

She'll probably not remember me after I leave. I, on the other hand, will never forget her...