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Saturday, April 30, 2011

What does it take to save the life of an infant? Ekam experience...

The infant struggling to breath was 3 days old and went by the cryptic hospital title of ‘son of lakshmi’, by the name of the women who happened to deliver it. I saw the son of Lakshmi for the first time in the neo-natal ICU of the Ramnathapuram Government General Hospital yesterday at around 3 p.m.  The staff nurse was manually pumping oxygen into its lungs, it was so tiny, that the infant could hardly be seen under all the machinery attached and the oversized diaper strapped around it.  Dr. Sailakshmi walked in and for a moment the young staff nurse turned around and gave a big smile along with the senior nurse who immediately recognized Sai from her reputation and offered all of us (along with Sai two of us had gone there) to show around the ICU. Sai immediately looked at the child, asked a few questions and said that pumping was inadequate and the nurse had to pump a bit more forcefully (‘you should be able to see the lung expand’) and more frequently. She showed it to the young nurse and explained why this was important. Then looking at what the child was being given through the chart, she enquired why a particular type of antibiotic was not given to the senior nurse. She noted down the number of the doctor on call and called him to enquire why the antibiotic was not given, suggested it be administered. The Doctor immediately calls the senior nurse in her phone and informs her to procure the antibiotic and administer the same.

Meanwhile, Sai has started to instruct the junior nurse about how the manual pumping operates, what it does to the child and how it is supposed to respond, also enquiring why there is no ventilator in the ICU. It turns out that there is a ventilator, a brand new one at that, it hasn’t been ‘set-up’ for reasons no one knows. The bio-medical engineer in-charge of the district hasn’t visited to do the installation. In Sai’s assessment, the child hasn’t responded to the medication and if it doesn’t , the nurses cannot go on with the manual pumping endlessly. The junior one bravely tells us that she will go on doing manual pumping as long as it required! But, all the same it looks improbable. So, with no ventilator, Sai starts to enquire as to the nearest hospital where she can refer the infant to. The nearest one is to Madurai and only private hospitals there have the facility to transport the baby with care and a ventilator from Ramnad to Madurai. Thankfully, Ekam has an MOU with one such hospital and as the junior nurse now starts pumping more vigorously, Sai is already asking Rajesh to get in touch with Madurai private hospital to ask if they will take the child. Meanwhile, she is on the phone to the doctor again to seek his opinion on the referral, getting his consent, she turns to the nurses and instructs them on the kind of medication required for the child to be transported; meanwhile Rajesh starts to locate the parents. 

Obviously ‘Lakshmi’ is in the labour ward, some uncle of the new born responds and later brings another man who says he is the grandfather of the infant. Rajesh and Sai explain the status of the child and how it is important for the infant to be shifted to Madurai where the ‘machine’ that is required for the child to be treated is available, the same is not available here. They don’t exactly say these words, but, that is what they translate it as…apparently, the family is that of agriculture labourers and Sai very fast explains to them that they don’t have to pay anything and the entire expense of the treatment will be borne by Ekam. They don’t know how to respond and are too shocked by the suddenness of the whole thing to respond, there is an expression of utter incomprehension in their faces. When Rajesh tries to find out more about the family, Sai stops him saying that, they are emotionally not fine and he should not ask any questions to them at this time. ‘they have come to the GH and didn’t go to any private clinic for delivery, they must be poor, good enough for us to support don’t bother’, she silences him.

 It’s 3.15 and the family gives its consent, Sai is holding phone with the Madurai  hospital contact all through her conversation and as soon as they say, ‘yes’, she confirms for the ambulance. There is one more call later from the ambulance people to get details of what they should come prepared for and also to get the phone no.s of the nurses and the parents, they call the nurse as well as the family waiting outside and have a confirmation even as they leave for Ramnad.

Meanwhile, we are leaving and our local host says it will take about an hour and half at least and he doesn’t expect the ambulance before 5 p.m. The ambulance beats him by 15 minutes and as we sit for a meeting with local community members in an old school for setting up of the community health care monitoring cell, we already have got the confirmation that the infant is in the ambulance. When we finish the meeting couple of hours later, the infant has already been admitted to the private hospital in Madurai. Ekam needs to send a letter as per the MOU recommending that the child be treated, but, the paper work can catch up later, they take the phone call as confirmation and start treatment. Sai instructs Rajesh to ensure that the letter is emailed that evening itself. She is now on the phone to someone in the Madurai hospital discussing the case of the child. We leave Ramnad after a few more meetings by 9.30 or so.

This afternoon, we visit the Madurai hospital. The NICU is in the ground floor and the smiling staff nurse informs us that only one person is permitted inside at a time and that too only with the mask on…the government hospital yesterday didn’t have any masks and the small dark nurses desk was in a crowded corner of the passage with all the relatives of the 5 infants (including ‘lakshmi’s child’) squatting in the narrow passage at one end. The Madurai hospital is amazingly clean and the nurse is insistent that only one person can go inside, so Sai dons the mask and is permitted inside, after she spends a few minutes, she comes out and says that that ‘lakshmi’s child is recovering  and the breathing has stabilized’, I am permitted a peak for whatever it is worth.

We walk out to see the grandfather and the same uncle we had met yesterday in the hospital, faces that we had only registered briefly, but, beaming now as they themselves see us as friendly faces in an alien place and situation. We meet  Lakshmi herself in a corner, sitting all by herself and sobbing, Sai consoles her and says that she should visit the child and talk and sing to the child, that children respond to the mother’s voice and recover faster. She informs the grandfather that the child is responding to the medication and that the next 24 hours will be important.   She enquires as to where they are sleeping and where they buy their food, suggesting that the food in the canteen may be cheaper than in the outside hotels.  The grandfather looks dumbstruck with nothing but gratitude all over his face, he doesn’t have words, just puts his hands together in the universal gesture of respect and gratitude.

As I leave with Sai, I realize it is another day of work for her She is responding to several such calls each week. I have just witnessed how a life can be saved through the Ekam experience, a life that would have otherwise stopped when a tired nurse stopped pumping oxygen or gave up on the lack of response to medication.  The life would have stopped for want of better facilities, the poor family would have accepted it as their fate, the nurses would have registered another case of death in their ‘death register’ (they had 6 for the previous week). I realized that  Sai doesn’t even know the name, village or any background of the child, it will be just ‘lakshmi’s child’!

Ekam helped save 65 such children in the past year, caring for them, getting them better equipment, facilities, support and better care, ensuring that all this is done within the government system so that the poorest of the people never see a child die for want of better facilities.  Now Ekam has initiated an ambitious programme to replicate the model in each district across Tamilnadu with local civil society support and participation. Now every neo-natal ICU ward in every government hospital will have a poster with a phone no. of the local Ekam coordinator, to call whenever they think they may give up,  but, don’t want to, to dial for hope. More about Ekam and donations details in the Ekam website,


Shanthi Krishnan said...

I have no words but only tears streaming down. Kudos to EKAM.

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