Cry Haiti

Marked as HIS

2012-02-12T14:03:00.000-08:00

This is Miss Susan,' the Haitian lady said, introducing me, for the second time, to a tall, Haitian toddler, whose eyes were bright with fever. 'She is your other Mummy', the lady continued, 'She and Mme John had an utterly miserable time with you when you were a baby!'

The small boy listened quietly, barely blinking as his mother talked, and I laughed, not because she was joking or exaggerating, but because she was telling the truth, and because of the truth she hadn't told.

Jonathon came to us in the spring of 2009. Born over 2 months before his due date, he was several days old and had not received any medical care. Jonathon was icy cold and desperately dehydrated. Had it not been for our director's exceptional nursing skills, he would have been dead within minutes.

Over the days that followed, Jonathon's condition became been more critical. He was resuscitated for over two hours one morning. Unable to revive him, we withdrew treatment so that I could hold Jonathon in his last minutes. Miraculously, he did not die!

I laughed as Jonathon's mother talked, because we did have a truly miserable time with Jonathon. Yet here he was, a big strong boy, ready to start pre-school in a few months. The misery made the rejoicing all the more intense when he survived those seemingly impossible challenges as a premature baby.

We learnt that after he was discharged from our NICU, Jonathon had suffered life threatening croup on a visit to a town in the North of Haiti. He had required surgical intervention and had 'died' on the operating table. Four times, we counted. Four times in less than 3 years, he had died and risen again. I was soaring now. My baby was back, and he was T.H.R.I.V.I.N.G. I knew God's hand was on him. I experienced a surge of anticipation. I might never know God's plan for this child's life, but I knew Jonathon was marked as his.

An Auspicious Sign

2012-02-05T15:04:00.000-08:00

Haitian society has a rich oral tradition that has given rise to hundreds of Kreyol proverbs and sayings containing a wisdom that is simple, without being simplistic. There is depth also, to Haiti's folktales. I will call them folk tales, and not old wives tales, as they are known in the part of the world I am from, because there are few old women in Haiti to propagate these beliefs.

One of the newest arrivals to the NICU is 2 month old Steevenson. When I checked him over, the day he arrived, it was immediately obvious that Steevenson had very special hands, with 6 fingers and not 5 on each hand.

This is a condition, known as polydactaly. It is my understanding that polydactaly can sometimes presents with other congenital problems - malformations that babies are born with. I examined Steevenson top to toe, and found nothing to be concerned about. He was perfectly proportioned, with symetrical features. Everything was just where is should be. I shared these findings with the Haitian staff. 'Of course'. The mirth in their 'of course,' told me that the Haitian understanding of Polydactaly was quite different to my own.

'Ate his twin?' I repeated. 'Really?' I was dressing Steevenson, in the back, upstairs hallway of the main house, in an area that has been set up for medical consultations.I was genuinely interested to hear the pediatrician's explanation: that many Haitian's do not believe that polydactaly is an anomoly, but rather an indication of a twin pregnancy, that the baby with polydactaly consumed his or her twin, giving rise to a few extra digits, as a sign to the parents of this momentous prenatal event.

So, rather than be alarmed or concerned at the presence of a 6th finger, many people in this country look upon Steevenson with pride, believing that he is a strong boy, and a victor. I think that if I really believed Steevenson ate his twin, (and I don't) I might be a little bit wary of him! I am glad Haitians are not. Some cultures hold very negative beliefs about the presence of polydactaly.

When the baby arrived, his 6th fingers, which were not fully formed and which were attached to the 5th fingers by a piece of skin, had been tied of with thread. The extra fingers, having lost their blood supply, have since shrivelled and fallen off. The are gone, but no-one here will forget the auspicious sign that accompanied the arrival of this baby. They expect big things from him.

Steevenson is shown above in a purple butterly-monographed sleeper: tough and tender :-)

Letting Go

2012-01-29T17:30:00.000-08:00

Wideline's father has dark, glowing skin and smiling eyes. Even in his deep grief, those eyes smiled on me, inviting me to talk with him, share with him. He was softly spoken and would not try to compete with the din of the generator close by. To hear him, I had to incline myself towards him. The exchange that followed was heartrendingly honest in its simplicity.

'The mother of my children, my first born children is seriously ill. She is so swollen her stomach is this big,' he told me, indicating on his own frame, the extent to which his partner's stomach had swollen. The lady has post-partum cardiomyopathy. It is a serious and life-threatening condition, and American missionaries that run the isolated clinic in Cazale are treating her.

'First my son died, and now my daughter. The lord gave them to me, and then he took them away, and I have to say, 'Thank you Lord,' but I have to know what happened to them.'

For a few moments, his open question hung in the air. As truthfully but as gently as possible, Mme bernard and I went on to explain: The babies were premature, growth retarded in utero, and very, very fragile. Their father nodded. Yes, he knew that. We didn't know why his son died, because we never met him, but by the time Wideline came to us, she was dehydrated and malnourished and her temperature was low, and her body was on the brink of shutting down.

She responded to treatment, and we hoped that she would do well. We did what we thought was right. Looking back, we think she had an intestinal infection that did not respond to the antibiotics. Her body began to swell and she began to bleed under the skin (we think because of malnutrition and infection.) We did everything we knew to do, including changing the antibiotics, giving blood to correct her anaemia, lots of medicines to get her kidneys working........ She stopped breathing and we resuscitated her, but she was not responding to treatment. Her skin was peeling off all over, her body becoming ever more swollen. When she stopped breathing the second time, we saw that treatment wasn't having an effect, and the baby was suffering, so we let her go.

As we talked, Wideline's Father continued to nod. He was unceasingly gracious. Someone came in with a photograph. I cringed inwardly. The photographs that they gave him were taken after the baby had died, when she was a bloated, bruised, bloody mess. There was nothing gentle about this!

The man's response surprised me. A light of understanding dawned on his face. 'Oh, yes. Oh, yes, I see. Thank you, ladies!'

It was a very sincere thank you, but for what?

I can see now, that she was suffering. Thank you for all the care you gave her. Thank you for letting her Go.

And that was a kind of closure for both of us. For the bereft father, and for the nurse who made tough decisions, in the absence of the baby's parents. We had acted according to what her father wished for her. The Father who had made the three and a half hour journey from Cazale to Thomassin and back three times in a week. No small feat for an impoverished Haitian family.
Life while she gripped on to it. And then a release. That is what he wanted for his precious daughter.

'I believe she is in heaven.'
'I do too.'

And this was no empty platitude - the bible teaches that the dead in Christ will rise first, and I handed Wideline over to God when she was critically ill.

We look forward to the glorious reunion, that is promised, knowing that Wideline precedes us in the assent heavenwards.

We still struggle with the injustice of her suffering, even as we accept that the secret things belong to God (Deuteronomy 29:29).

One day we will understand. One day.

Little Did I Know.......

2012-01-26T18:22:00.000-08:00

Last night, my heart was aching for the baby girl I had lost. I was reflecting. Knowing that the signs of protein-energy malnutrition were so subtle in this infant that no-one, picked up on them, no-one, I still wished I'd listened to my gut. I remembered thinking Wideline's cheeks were full, the day I met her, although they didn't look puffy. As the days passed, she seemed to fill out. Looking back, I think her little body was slowly, very slowly filling up with fluid. We all thought she looked better. She seemed to be doing better too. There were other, subtle signs in her blood work, that might have alerted me to the fact that Wideline had an intestinal infection her immune system just wasn't responding to. This is hindsight, of course, because I didn't know the signs, or what they pointed to, but that doesn't hold back the wave of regret.

Regret is only productive, if it is felt by someone with a capacity to learn, and I am a learner. I think that is why my heart longed for another baby - not one to fill the hole Wideline had left. No, I was waiting for another baby, who might benefit from the things I wish I had known last week. Little did I know, that baby was already with me...........

Malouzi is a month and a half old. She arrived yesterday amidst the chaos that surrounded Wideline's final hours. I only had a chance to glance at her.

The NICU was quiet. this morning. My attention was on our new baby. 'She's a little bit pale,' I commented. 'Scrawny too.'
'Her Mother has mental health problems, Susan. And her father is deaf. She didn't get very good care. She has been spoon fed porridge.....She is awful demanding,' Mme Bernard, told me, raising her eyes just slightly. I don't think she has been mothered. I think that's what she needs, to be mothered.' As she said this, the head Haitian nurse took the baby's tiny hand in hers. It was a gesture of loving affection. I was able to appreciate it only for a moment.

'No!' I exclaimed.
Mme Bernard registered the problem, the instant I did.'She's a little puffy.'
'No! I can't to this again!' I knew the chances of a 6 week old baby beating protein-energy malnutrition were slim. Too slim.
Mme, Bernard nodded patiently. 'Susan, you don't have a choice.'

Malouzie's hands and arms look pudgy and her legs are shiny, as result of a fluid build-up under her skin. She is not a chubby healthy baby. She is suffering from Protein-energy malnutrition. This is a life-threatening condition and a nutritional emergency.

There are a few things I wish I had known to do for Wideline. Now I am doing them for Malouzi.. She is getting the right medications and the right vitamins and minerals. The right tests and investigations are being done. The right observations are being made.

On the grand scale of things, her chances of survival extremely poor. Based on our recent experience though, there is reason to be hopeful. Malouzi is the 4th very young infant (3 months old and younger) that we have admitted to GLA in the past year with protein-energy malnutrition. Two of the babies before her survived. One died. It is my prayer, that I will be able to count sweet Malouzi among the babies that lived.

This tiny girl is very uncomfortable today from the pressure of the fluid that has built up under her skin. I have spent lots of time holding her and rocking her. This is the only thing that soothes Malouzi. I was glad to be able to cradle her in my arms. As glad as I am to have her under my gaze and under my wing.

Malouzi is my reason to press on.

So Many Questions

2012-01-25T16:10:00.000-08:00

I have so many questions. There aren't answers for any of them.

This morning, Wideline's blood pressure dropped. She went on to bleed innternally. Blood pured from her mouth and nose, and stopped breathing. I had been up until past mid-night, doing everything I thought might help. So much of what I had done was painful for Wideline, but she still had a lot of fight in her body, and I felt I needed to respect that.

Now I believed enough was enough. I told the NICU staff I didn't believe that we could save this baby, and that I didn't want to prolong her suffering. They were not ready to let her go, so we resuscitated Wideline.

The morning passed in a bewildering flurry of activity. I remember pushing fluids and all kinds of drugs. I remember that I squeezed Wideline's heel, trying to get a blood sample for some tests I wanted to run. I remember wincing as Widelines skin skipped away under my grasp, leaving yet another fiery lesion, seeping straw coloured fluid. I remember sitting outside on the balcony, where Mme Bernard drew blood from me. I remember that we gave it to Wideline.I remember she looked better after she received that blood. The swelling in her face went down. I remember dressing her wounds with Lisa, a Canadian nurse-volunteer. I remember starting CPAP, then leaving briefly to do some research.

By the end of it, Wideline was stabilising, but still, her kidneys were not working.

Oh, I have so many gruesome memories of this afternoon. Some things are best not shared. And I have so many questions. Why was our best effort not enough? Why not? Why do I have to write yet again, and tell the people who have been praying, that in the end, all I could do was hold her? I watched a tiny baby put up an astonishing fight. Why God, could you not have taken Wideline gently, weeks ago? What was this all for?

And there are no answers. There is exhaustion, and there is grief. For some reason I can't explain, there is also a waring spirit; the will to press on, and a sense of urgent expectation.

I am waiting for my next baby.

Wideline: Seriously Ill

2012-01-24T18:25:00.000-08:00

Last night, Wideline's face and feet began to swell. In the early hours of the morning, her temperature dropped, and her body began to shut down.

Later in the morning, I wiped her face clean. Suddenly, her face was bloody. I examined her top to toe. The creases of her neck, behind her ears, her underarms, were raw and moist. It looked as though the baby had sustained second degree burns. I was horrified. Utterly horrified.

Our paediatrician diagnosed dermatitis of Kwashiorkor. Kwashiorkor is a particular kind of malnutrition, caused mainly by protein deficiency. It is usually fatal in babies under 6 months of age.

In the past 6 months, two very young infants have been nursed through Kwashiorkor at GLA, but nether of them were as sick as Wideline is now. She has just received her 5th mini transfusion of blood and two further doses of sodium bicarbonate to reduce the acid levels in her body.

I have done all I can. The rest is in the hands of my God. Of Wideine's God, and yours. Ours is a God who answers prayer.........

God Speaks

2012-01-22T13:50:00.000-08:00

On Thursday morning, I went on a cleaning spree. As I worked at a slightly feverish pace, wiping down and organising NICU supplies, I felt the eyes of the NICU staff on me. The behaviour they were observing looked an awful lot like 'nesting.'

'You do know Susan, that now you've done all of this, God will send you a baby?'
'Of course I do,' I replied, in an even, matter-of-fact-tone 'He will send a baby very soon, just one, though. Not twins this time, and I need to be ready.'

The next morning, our director came upstairs with news. A 3 lb baby had arrived at a clinic in Cazale. I nodded. The baby had a twin brother who had already died. Yes, oh my, so that was why I would not be receiving twins. The surviving infant was not doing well Did I want to go and collect her?

'Yes', I did.
A nurse shook her head and smiled. 'I've been told God doesn't speak to people.'
'He does.' After all, the day before, he had whispered to me about a baby, and now, I was going to find my baby.

Wideline was born 5 weeks ago, approximately 6 weeks early, to a mother with a previously undiagnosed heart condition. Unable to produce breast milk, the young mother had fed Wideline and her brother watered down porridges, along with other family foods. The babies lost weight and became sick. When Wideline arrived in Cazale, she had watery diarrhoea and was severely dehydrated and anaemic. A visiting paediatrician gave some fluid through a needle that she placed in the baby's bone, and then managed to start an IV in her scalp.

Wideline's Mother, bloated, sick and exhausted had been counselled that further pregnancies would probably kill her. Wideline was alert, but her temperature was low, and that was a worrying sign. The mother was not well enough to stay at GLA, but her father asked to be allowed to ride in the back of our truck. He had to see where we were taking his daughter. She was his only child.
'Of course'.

I placed Wideline on my chest, under my scrub-top. She warmed up, began crying and sucking on her fists. She drank an ounce of formula milk. Although she settled after that, her breathing became very laboured during the last 30 minutes of the ride up the mountain to GLA.

Bedside tests at the orphanage showed that the baby had very high acid levels in her blood. This, together with her anaemia were life-threatening. The baby was showing early signs of heart failure.

As the first of three drug infusions was in progress, there was some good news: although the blood bank in Port-au-Prince was closed, Wideline had the same blood type that I did, and my blood had recently been screened for infections.

She received a mini transfusion within the hour. It got her through the night.

Using an IV pump that we received just a few weeks ago, we were able able to give Wideline two further transfusions of my blood the next day. It was wonderful to see the baby, who was at that point so pale that our Haitian staff said she was white, not Haitian, take on a lovely rosy glow. She was started on very small feeds, just two millilitres every three hours, but her gut was so fragile that she was not able to tolerate even these tiny volumes of formula milk.

Wideline receiving her second transfusion of Blood in GLA's NICU

At this point, Wideline benefited from another donation, this time a donation of breast milk that was given to us a year ago, by the mother of a three month old baby, named Fannie. Oh, how thankful we are! Wideline, as sick as she was, was able to digest the milk that Fannie's mother gave to us. We also gave Wideline some pre-digested fats intravenously while we gradually increased the volumes of her feeds.

Nutrition is absolutely critical to stabilising the tiniest victims of malnutrition. I stood by Wideline's incubator for hours, watching her breathing, observing her movements, and charting trends in her heart rate, temperature and blood sugar levels. I wanted to know how much urine she produced. How often her bowels moved........

Although her anaemia was severe, her malnutrition could not be classified as severe, since her weight was almost normal for her length. This poor baby though, had been undernourished both inside and then outside the womb, at a time when her tiny organs were underdeveloped. Now her body was embattled. I hoped Wideline had arrived in time. A very experienced nurse once told me that all the training that a well resourced NICU in the developing world might provide, could never prepare a medical professional to care for a baby like Wideline. It was true. Babies like Wideline did not exist in North America or in Europe. I had tried, several times, to tap into whatever expertise existed, in the care of very young babies, with life-threatening malnutrition. It seemed that if such expertise existed, no-on was sharing it.

Wideline did stabalize. Today she is hungry, That means that she is moving out of the stabilisation phase and into the recovery phase of her treatment.

Please pray for continued improvements in Wideline's health, and pray with confidence, knowing that God already has an interest in her survival. If he didn't, he wouldn't have spoken to me about her.

A Father's Prayer

2012-01-15T13:42:00.000-08:00

The witness, an Australian nurse, recently arrived in Haiti, was utterly overcome as she watched the young father, as strong as he was tender, cradling his only son, a tiny but growing infant in his large, powerful hands.

Photo Courtesy of Katie MacGregor

The Father's behaviour was like that of parents the world over. He undid the sleeper, counted ten fingers and ten toes, then unfastened the diaper, and apparently finding everything in order, nodded his head. With tears streaming down his face, he kissed Charilson over and over, Caressed his soft curls, and smiled.

'I prayed everyday for my son. Everyday, he said, wiping the tears from his face.'

The listeners where in little doubt, that this was a holy moment. A father, who loved his son so much, that he would hand him over to us. A father who, heeded my caution, that the infant boy was incredibly frail, and who prayed without ceasing, for 6 weeks.

In those 6 weeks, Charilson has been gravely ill, he has come back to us from the threshold of death and he has almost doubled his weight. The word miraculous is all too often used,and too lightly, yet excellent nursing care,good nutrition, and human love alone cannot explain Charilson's triumph over death.

Could it be that the constant prayers and the intercession of his earthly Daddy, and others who love this boy, paved the way for the divine to do an impossible work?

The miraculous may be nebulous and difficult to pin down, but a few things are not: I know that Charilson's Daddy is a wonderful father, and I that anxiously anticipate the day, when his son will be strong and healthy enough, to return to a centre closer to home. I know that I have leaned something about love from this man, about simple uncomplicated faith, and I know that there is something about unceasing prayer - about it's ability to get impossible things done.

Photo Courtesy of Katie MacGregor

An Amazing Thing

2011-12-19T18:04:00.000-08:00

In the past week, three children from the big nursery were admitted to the NICU for short-term care. The first was17 month old Frantina. She had a pneumonia that did not respond to oral antibiotics. On IV antibiotics, this little lady soon recovered.

The second child was Faland, a two-year-old girl, with chronic digestive problems. She developed severe, watery diarrhoea and wasn't able to tolerate Oral Rehydration Solution. She was on IV fluids for just a day. That was all it took to restore her to health.

Geraldson, also needed an IV to help him recover from gastroenteritis. His recovery was even faster than Faland's!

By Friday, all three children had returned to their nurseries. where they were cheered by their nannies and the 'brothers' and 'sisters' in their groups. 'I'm are so happy!' nanny, Chantalle exclaimed'. Her hand gestures were exaggerated but her facial expressions were very sincere. She told me that one year old Naika, had missed Frantina so much that she wouldn't eat. The other children in Frnatina's group were also out of sorts, Chantalle reported.

As we were caring for these children. an epidemic of cold symptoms, coughing and wheezing developed at the main house. Yesterday, two of the premature babies were struggling with this virus, and showing signs of bronchiolitis, a condition that causes the air sacs in the lungs to fill with fluid and collapse. At mid-day, Louna vomited and aspirated her feed. Her panicked mother responded by hiding Louna under her jacket. We don't know how long she was struggling for breath, but intuition told the day-nurse to check in on Louna. Ginette found the baby pale and gasping.

Although I suctioned her airway, sited an IV and gave preventative antibiotics and started her on oxygen, the damage had been done. She had breathed the milk she vomited into her lungs and Louna had several spells of apnoea over the afternoon, which means that she stopped breathing frequently. We were unable to keep her oxgen levels up, and by dinner time, Louna had to be started on CPAP. She went on to have seizures. It took two hours of intense effort to stabilise this baby, who became so irritable as a result of all the medications she was given that she pulled out two IV lines. Louna is doing much better today, and we hope to get her off of her CPAP in the next day or two.

Rivens, another premature baby boy also had to be started on oxygen yesterday, and today, he was too tired to feed. Bronchiolitis can be very serious for premature babies. He has a feeding tube down and we will be observing him carefully, constantly assessing him to make sure that he is not become exhausted. He will receive IV fluids or CPAP if he needs them.

It is an amazing thing, to be able to offer bubble CPAP to our babies who are struggling the most with bronchiolitis. Even in the developed world, some babies become so sick with this condition that they need to be ventilated. CPAP prevents our babies from getting to that stage. This is extremely important -to all intents and purposes, they are no Paediatric Intensive Care services in this country.

The Winning Side

2011-12-11T11:57:00.001-08:00

I have three photographs for you that were taken a few minutes ago.

Do you recognise her?

This is Bianka, with a double chin, a beautiful, healthy baby. Bianka has had no further seizures and she is smiling. I am hoping to see continued progress in her development. Most babies who suffer severe, life-threatening malnutrition have developmental delays as babies and learning difficulties later in life. Whether Bianka heals with or without 'scars', her life has been salvaged. She is precious to us, and more than that, infinitely precious to her Father in Heaven.

Charilson became seriously ill, late on Sunday night with severe dehydration. He caught a bad cold on Tuesday. We have increased the strength of his formula, using guidelines that were provided to us by a dietitian. This baby needs to beat the cycle of sickness and malnutrition. The best way to do that is to re-nourish him as quickly as possible. So far, he is filling out nicely. Of all the fragile infants in the NICU just now, Charilson, the one who came in healthiest has been the most difficult to recover to health.

Remember Mario? He was admitted in October, suffering from Kwashiorkor. He was treated for suspected meningitis the week after he arrived at GLA. Thankfully, the tests that our Paediatrician ran showed that Mario did not have meningitis, but a severe intestinal infection. Once he beat that, the excess fluid quickly left his body, and was almost immediately replaced by fat stores (smile). Very few ladies, Haitian or foreign can resist Mario's charms - he is a terrible flirt!

Three faces: Three victories for GLA, for life, for hope and for love. I love being on the winning side!

A Job Well Done

2011-12-04T10:35:00.001-08:00

As I wrapped up the week yesterday, I took stock.

Alaine, was off of her nasal cannula. She'd had a sudden growth spurt, and was now stable without a constant flow of compressed air. We will continue to observe her carefully. The nannies will be pleased to do that. Alaine is ridiculously cute - her face is so round that I call her my cabbage patch doll. Her eyes cross badly whenever she tries to focus on us. That only makes the Haitian staff all the more fond of her. 'You have to send a photograph of Alaine for her mother, Susan. Maybe if she sees how fat the child is, her mother will have hope.' Alaine's Mother has lost 17 infants. We wonder if these babies had a genetic syndrome. Alaine has had airway problems and her ears are small and set very low on her head. God knows. We just enjoy this sweet girl and stay watchful for any health problems. Alaine's mother deserves to have one child, this side of heaven.

Bianka is going from strength to strength. She came to us severely malnourished, with swollen hands, feet and eyes. We almost lost her to renal failure, and she went on to develop heart failure and seizures as she stabilised. She was severely anaemic and her protein deficiency was so severe that she had very few immune cells. I was afraid that infection would claim her life. She had an ethereal, waxen pallor and her skin was coming off in sheets. The Haitian nurses were convinced that she had been burned. Her skin was so thin and raw that we had trouble keeping this baby warm and hydrated. I treated her like a very premature baby. Today, Bianka is recovering from her malnutrition, filling out, and tipping the scales at almost 6lb. Her survival is a work of God, and I am blessed to be a witness to her healing.

Want to see another miracle? Charilson is a premature baby who was transferred to our care by Real Hope for Haiti, a Christian mission run by our friends in Cazale. Charilson was very small for his gestational age when he was born last month.. He became malnourished when his mother fell ill and died. His grieving father dearly wanted this frail boy to live and in his sorrow, he gave thanks to God that there was someone who could nurture Charilson through the fragile newborn period, in which so many Haitian babies die. Touched by his gratitude, I promised his father that I would do all I could to ensure that Charilson grew strong and healthy. Charilson had mild diarrhoea and was very anaemic when he arrived. He contracted an intestinal infection and overnight, became severely dehydrated. When Mme Bernard reported for duty at 7am in the morning, Charilson's gut had shut down and dehydration and infection had sent his body into shock. He almost died.

Charilson was not doing well last night. The night nurse said that she couldn't get him to feed. He has mild diarrhoea and a swelling at the site his IV line was placed. He is now back on antibiotics and he has been started on Elecare, an expensive milk formula with pre-digested protein and fats and sugars that are easy to digest. He is sucking better today. Please pray that he and Bianka will receive a full healing.

Rivens, who was born 6 weeks early is off of CPAP and no longer needs a feeding tube. He is a beautiful baby, who is growing and thriving and very active in his incubator.

'Celia', came from an orphanage up the road, suffering from severe diarrhoea and protein-energy malnutrition. She is also on the mend today. Her admission weight was 14lb 7 ounces. We rehydrated Celia and then began treating her infection and renourishing her. We gave Celia medical peanut butter and a specific blend of minerals to help her absorb protein. Her weight dropped to 12lb 14 ounces at it's lowest point. Believe it or not, this was excellent progress - a sign that celia had metabolised the protein in her diet, and that the fluid in her tissues had been pulled into her bloodstream and left her body. Celia is regaining her appetite. We hope that she will lay down fat and build muscle as she recovers. She smiles and waves at the NICU staff now. If Celia continues to do well, she will return to her orphanage later in the week.

Anyone walking into the NICU now, seeing it so calm, without a CPAP system or an oxygen cannula or even a feeding tube in sight, would have trouble believing that just 2 weeks ago, we had five critically ill babies and that the room was full to bursting with medical equipment and monitors alarming all over the place.

That's a good thing: a sign, I think, of a job well done.

Celia

2011-11-29T17:42:00.001-08:00

Little lady, we couldn't say no to you the day you arrived at our gate, and we still can't say no to you.

Celia was seen by our Pediatrician today. She was well hydrated. Most Haitian hospitals would discharge her home at this point. Since Celia wasn't out baby, I wondered if it might be best for her if we sent her back to the orphanage she came from with some instructions and supplies to enable the staff there to continue her care. I planned on giving the orphange workers the option to call for advice, or to bring Celia back if she wasn't doing well.

'But who will take care of her there?' the Doctor asked.
They have a nurse at Celia's orphanage. They also have nannies, and lots of older orphan-girls who help out with the little ones. I told the paediatrician this.

'I think she should stay here for another week or ten days.' Dr Nathalie clearly had a lot of confidence in our abilities and that was a great encouragement.

'Until the swelling has gone down, at least?' I asked. The doctor nodded. 'Ok, that sounds like a plan.'

So if her orphanage director is in agreement. Celia will stay with us at GLA, until our Paediatrician returns next week to review her. We have nurses on site 24 hours a day. People who can respond immediately if Celia develops complications during the stabilization phase of her treatment.

And anyway, she hasn't smiled yet. Until she does, and until she regains her appetite, and loses the fluid that has accumulated in her lower legs and feet, and begins gaining weight again after that, Celia is not out of the woods.

We Couldn't Say No

2011-11-27T09:23:00.001-08:00

We were reluctant to admit a child with diarrhoea to the main house. We all ready had so many frail babies in our care, and we had to protect them from new infections. We had fought so hard for for their lives. We jepordize all of our little ones, for the sake of another, who should really be treated in a hospital.

Yet, two charity hospitals had said, 'no' to her. It was 3pm on a Friday afternoon. The orphanage that had brought her here had no options left. The toddler in front of me was was severely dehydrated, and her body temperature was low.I knew that if we said no to her too, she certainly would not survive.

She doesn't have a name, and we don't know how old she is, but we are calling her Celia and we think she might be 18-24 months old. 'Celia' was abandoned at the gate of a remote orphanage. Two weeks ago, she transferred to another orphanage in Thomassin for special care. Celia has Protein-energy malnutrition -her hands, feet and calves are very swollen and in this malnourished state, her body and immune system have been overwhelmed by an intestinal infection. Twenty-four hours after she became ill, she had lost so much fluid that her body had gone into shock.

She did not respond when I pricked her finger to test her blood sugar. When Mme Berrnard started her IV, mercifully able to find a vein, as tiny and flat as they were, Celia didn't even stir. She was on a warming and her body temperature was going up. Her glucose levels were in the normal range. These were good signs that she would respond well to treatment.

We gave her a bolus of fluid and Celia's eyes opened. She cried after I'd finnished giving her medicine. She was thirsty and reaching for the syringe. I gave her two ounces to drink. It was a mistake. Over the next 2 hours, her body dumped 16 ounces of fluid. Celia was in such a fragile state. Her shock had progressed. I councelled her orphanage director, over the phone, that I was working very hard to rehydrate this little girl, but that I wasn't sure she would survive.

By 10pm, I had given Celia a blood alkaliser, and several fluid boluses. Finally her breathing pattern was normal, her heart rate was regular, her hands and feet were warm and she was awake, lethargic, but aware of what was happening around her. She started to moan. She took a hold of my scrub top. She would't let go.

I scooped Celia up out of her crib. At that point, she had two IV's running. She rested her head on my chest, and she fell asleep. As I sat with Celia, I experienced a feeling of warmth. God was very close. I hoped you would say, 'yes'.

He was smiling and he was blessing us, I knew it.

A Debt Of Gratitude

2011-11-23T18:51:00.001-08:00

For this child you prayed.......

Charilson came within inches of death. Born prematurely, tiny and frail, anemic and malnourished, he caught an infection that overwhelmed his weakenned immune system. He became desperately dehydrated and sick to the point that his body shut down. And he almost died. Almost.

Looking back over the past day and a half, I am thankful for many things. I am thankful that we were able to use extreme, life-saving measures to bring Charilson back from the brink of death, and thankful for the knowledge and skills we have at GLA. I am thankful that we were able to use that knowledge and those skills, to the glory of our God. I am thankful that we had everything we needed, to provide intensive care to Charilson at this orphanage, when he needed it. I am thankful that at 'such a time as this', an O negative blood donor just happened to be here, able and willing to donate blood to support charilson's embattled body, at a very critical moment. I am thankful for your prayers. I am thankful for the leading and direction of Charilson's heavenly father: the great physician. I am thankful that Charilson is alive.

Tonight, Charilson continues to improve. He is off of CPAP, and no longer needs oxygen. He has lost weight, so he still needs to be in the incubator to stay warm. He is weak, and on an IV, but he is beginning to suck again. He is absorbing his feeds, and his diarrhoea is minimal.

I don't doubt that he has received a divine touch, and I feel honored to be a participant in and a witness to Charilson's remarkable healing.

The emotions are intenese. Gladness, interwoven with relief, and pain - many of the supplies that we have now, the things that saved charilsons's life, are things we haven't always had. Some of the equipment and the medication that sustained Charilson were aquired after we lost other lives. It is a victory tinged with pain, that brings me to my knees.

This thanksgiving will be especially poignant for me. This thanksgiving, I am not just thankful. This thansgiving, I owe a debt of gratitude.

Because I Promised

2011-11-21T18:56:00.001-08:00

Charilson is critically ill tonight.

Last night, his nurse documented that he was absorbing his feeds well. This morning, Mme Bernard, the head Haitian nurse found Charilson extremely dehydrated and profoundly hypothermic, with a very distended abdomen.

The drop in Charilson's body temperature was the first sign of a severe infection that made his gut stop working. Charilson deteriorated rapidly. This Haitian nurses were not able to start an IV. Charilson stopped breathing several times as they tired. There was one more thing left to try, but I was sure I couldn't do it.....

I sited a needle in the baby's thigh and began infusing fluid into his bone marrow. It was a radical measure, only used in dire emergencies, but Charilson was on the point of death. I had never inserted a needle into the bone and I have always felt physically ill whenever I have seen broken bones, or heard the broken ends grating. I didn't think I could overcome that physical reaction. I knew that I could not stand in front of his bereaved Daddy unless I was able to say that I had been true to my promise. I did it because 4 days earlier, I had told his grieiving father that I would do everthing I could, to restore his son, strong and healthy to him.

We have managed to rehydrate this precious boy. He is stabilizing, but he needs a nurse by his side, constantly. Katie, an Australian nurse-volunteer is with him now. Our staff and volunteers are devastated but the sudden deterioration in Charilson. He captured our hearts fast - such a tiny elfin baby.

His father desperately wants him to live and we desperately want that too. I think if we can get him through the next 48 hours, he might survive this. Pray for him.

A Promise To His Daddy

2011-11-19T10:42:00.000-08:00

I was on a military airfield in Scotland, about to board a flight to Haiti, when far, far away, I heard the distant ringing of my Haitian cellphone.

I woke just as the ringing stopped. Disorientated, I reached for the phone. It was pitch black outside. I glanced at the screen display. 3:48am, and I had a missed call from Cami, the night nurse in the NICU. I knew she wouldn't call unless there was an emergency.

I was on my feet when she rang for the second time. 'You need to come and see Louna, She's not doing well.'
'Louna?'

I had treated Bianca for heart failure 12 hours before. I had been afraid that the medicine I gave would make the potassium levels in her blood fall. I worried that this could affect her heart rhythm or cause seizures. Louna was sick?'Yes. Louna.'

Louna had developed a mild case of diarrhoea overnight. It was a very, very mild case, but her oxygen levels were low and she was breathing very fast. The night nurse had started oxygen. She didn't have a cold and her chest sounded normal. It didn't make sense. The night nurse said she could not get Louna to feed. The baby, had been unusually sleepy over the past week, and she looked pale now. We ran a blood test.

Louna was anemic. Her hemoglobin was 8. It had been 16 four weeks ago. The baby would not suck. She wasn't dehydrated, but at less than 4lb, we know that she soon would be. We put a feeding tube down and gave some fluid to replace what she had lost through the diarrhoea, then began drip feeding donor breast milk. Before I knew it, the sun was up. It was 6am.

A few hours later, Charilson, a 3lb 11 oz baby boy arrived from Cazale. The baby was 3 weeks old. I had hesitated to say 'yes' to him the day before. We had an outbreak of diarrhoea and vomiting in the NICU, and herpes in some of our other rooms. I didn't want to expose a fragile baby to these infections unecessarily. The centre that referred the baby here still felt that it was in Charilson's best interests to GLA. His mother had died a few days before. We all knew, when we heard this, that his situation was urgent.
The baby was skinny and pale, but bright eyed when I met him in the waiting area. I expressed my condolences to his grieving father. This was his only child, he told me. Charilson was a precious son. He wanted him to live. I assured the baby's father that we would do what we could to get the infant strong and healthy. ' I am just so glad,' he told me, 'that there are people who can help us.'

I returned to the NICU to find Bianca having a seizure. I had all ready ran some blood tests on her. Her potassium levels were low, and I had increased the amount I was giving to her to correct this imbalance. Her Mother, had gone home the weekend before, suffering from a high fever. I tested Bianca for malaria. The test was negative.
It was a busy afternoon, with Bianca requiring constant monitoring, Alaine not feeding well, Louna on oxygen and tube feeds, and now, tiny Charlison in the mix.

4:30pm: Bianca was having several seizures and they were lasting longer and longer. I gave her some medication rectally to stop the seizures. She wasn't able to retain it. As I was giving her an injection, a nanny whispered to me that there was a baby downstairs with his aunt. The aunt wanted a nurse to see him because he wouldn't open his eyes. I smiled and said I would see him as soon as Bianca stopped seizing. Her colour was ghastly. Every time I've thought I was losing you baby, you have come back to me. Please come back now. Just then, her seizure stopped.

Downstairs in the waiting area, I unwrapped a tiny, premature infant. I couldn't believe it! We were really pressed in the NICU as it was. The baby had been born that day, in the 7Th month of his mothers pregnancy. A green, blood stained discharge was oozing from his swollen eyes. 'I can't make him open his eyes!' the Aunt exclaimed. The baby was icy cold and he was working hard to breathe. I told her I needed to take him up to the NICU, right away!

The baby was chubby, and he had a deep red colour. I knew that as he warmed, he would have even more trouble with his breathing.He needed IV fluids, antibiotics and CPAP. The Haitian nurses were going off shift. How was I going to get ever thing done myself?

I sent out an SOS, and Katie, a Paediatric Nurse from Australia, who is volunteering at GLA just now, answered the call, graciously foregoing a dinner out with the rest of the staff and volunteers, so that she could help me with GLA's newest admission.
Although we got him stabilized, his heart rate plummeted at 9pm. It was still dropping after 3 fluid boluses. I gave a dose of epinephrine to bring his blood pressure up. It took another 3 fluid boluses to improve his condition. He was dehydrated, cold and he had an infection. His body had been going into shock. I'm so glad, little man, that you wouldn't open your eyes. If you had, no-one would have brought you to us and you would be dead by now.
It was almost mid-night. Time to go to bed.

The next day, our premature boy was looking better. Bedside blood tests showed that he needed some minor changes to his IV fluids, but that CPAP was correcting his breathing problems. Bianca was hungry, still on a fluid restriction to keep her out of heart-failure, and not appreciating this in the slightest. Charilson was sucking well. Louna was drinking again too but she still needed her oxygen.

Over the afternoon, we had some trouble keeping our preemie boy's blood sugars up. He was well enough to start receiving small amounts of breast milk but his mother was extremely reluctant to express. The oxygen on his CPAP was being weaned down. At 8pm, I was exhausted but relieved to note that all of our fragile little ones were doing well.

They continued to improve overnight. This morning, I took, Louna off of her oxygen. Gave IV antibiotics, and made some CPAP adjustments. I went downstairs to do some chores.

Two hours later, a nurse came to find me. Charilson was very dehydrated, she told me. I could hardly believe that. He had looked so well earlier this morning.

Upstairs in the NICU though, I learned that Charilson had developed watery diarrhoea. He was pale and sunken-eyed. His skin was looser than usual and he had lost 8 ounces of weight. A few hours can change everything, I thought to myself, as we tried, unsuccessfully to start and IV.

Charilson is being re-hydrated with IV fluids, delivered a drip at a time down a feeding tube. His fathers words, spoken to me two days ago, and my promise to him drifted back to me as I settled Charlison. I really wish we had been able to get an IV line into him.

A Setback For Bianca

2011-11-16T17:28:00.000-08:00

Baby Bianca,our severely malnourished 2 month old girl, who was admitted last week in a critical condition has experienced a setback in her recovery.

She went into heart failure today. This was not entirely unexpected, since Bianca is in a very fragile state. She was given an extra feed last night, and that was all it took to overwhelm her body,

Bianca has been given a dose of medication to help her get rid of some of the extra fluid that is building-up in her circulation. This has taken the pressure of her heart and it has helped her to breath better.

We are going to have to limit the amount of fluid Bianca takes in to prevent her heart failure from worsening.

Please, continue praying for this angel.

Magical Moments

2011-11-14T17:50:00.000-08:00

Day by day, there are real and tangible improvements in Bianca. On Saturday morning, I noticed that her cheeks had filled out, just a little bit. On Sunday, the necrotic skin on her arms and trunk had began to slough off, revealing new skin,soft and smooth and fresh. Today, Bianca is losing her wrinkled appearance. Her eyes remain puffy, but apart from that, the swelling from her malnutrition has gone down. She is gaining wright now. Laying down fat stores. Facially, with her round cheeks and plump lips, she is beginning to resemble her mother.

Bianca is following the NICU nurses with her eyes. She is sucking on her fingers, and even trying to drink from a bottle. Although this utterly exhausts Bianca, she gazes up at me when she has finished her bottle feeds, and smiles weakly.

It is magical to witness each phase of her transformation. In the pale, light of her smile, I am warmed and soothed by the hope of the frail beauty that is emerging. I am drawn in, as if my an invisible magnet. And I am pierced by the reality of her suffering, still so evident, and so far from being consigned to memory.

Daring to Hope

2011-11-11T14:52:00.000-08:00

As the sun slipped behind a mountain last night, surrounding GLA's main house in darkness, I hang my head in defeat, convinced that my precious Bianca would not see another day.

It had been a tough shift. Twice, sudden drops in her blood sugar had brought Bianca to the threshold of death. I had watched her, and her monitors constantly. I quickly learned that the first sign of of a falling blood sugar level, was a slight drop in her body temperature, followed by a dip in her heart rate. I had tried so hard, but despite everything I was doing, Bianca was fading. Her tiny body, so ravaged by malnutrition was giving up. The baby had an unearthly pallor. Her blood was watery. Her kidneys were not producing urine. Her breathing was shallow. She was unconscious, barely responding to pain.

Her mother was not producing more than a few millilitres of breast milk at a time and I suspected the formula we were feeding to Bianca continuously, through an feeding tube, drip-by-drip, was too Strong for her damaged organs. I had a small amount of pasteurized donor milk. I poured it into the bag that hung from an IV pole above her feeding pump. A few hours later, Bianca had a wet nappy! I instructed the night nurse to give Bianca regular boluses of sugar water to keep her blood sugar up

Over night, she stabilized. I found her sucking on her fist this morning. Awake, alert, crying pitifully, hungry. Alive!

Her colour is much better tonight, the swelling in her feet has gone down and she is holding eye contact with me, and she even smiled. 'Imagine', told the NICU staff, 'after everything she has suffered, she still wants to live, and she can manage a smile.'

Bianca wants to live, and I dare to hope, that she might.

Don't stop praying. Her life is still extremely fragile.

Bianca

2011-11-09T17:34:00.000-08:00

There was a hint of desperation in the nurse's voice. She was calling from Samaritan purses clinic in Site Soleil. A 3lb baby had presented at the clinic in a critical condition. We had a crib for the baby, but she was breast-fed, and we didn't have a bed for the baby's mother. If you could only see this baby,you wouldn't say no. I deliberated with Dixie Bickel, and with Mme Bernard, our head Haitian nurse. We decided that we would make it work.

The baby arrived, wrapped in blankets, with her face covered. The moment I unwrapped her, I knew that this baby would certainly have died if we had said, 'no' to her: Bianca is 2 months old and she is desiccated, emaciated, and her face, feet and hands are puffy. She has no entered the swollen stage of protein-energy malnutrition. There is a faint odour of decay about her. Oh, lord, have mercy!
Bianca is hypothermic, and her heart-rate is dropping. Very few infants under the age of 3 months survive protein-energy malnutrition, and signs we are seeing are not good.

Please pray for this tiny, extremely fragile infant. Over the next few days, I will attempt to stabilize her. She doesn't need to make drastic improvements during this stabilization phase, she just needs to survive it.

40 Diapers. 40 Days: A Novel NICU Fundraiser

2011-11-06T13:23:00.000-08:00

Late last week, I heard about a novel fundraiser that is in progress. Dubbed The Painted Diaper, this initiative is the brainchild of an artist, and mother to a preterm infant. The aim of the project is to raise $6,750 (USD) to purchase a new radiant warmer for the Intensive Care room at God's Littlest Angels.

When a preterm or sick infant is first admitted to the Special Care Nursery at GLA, the nursing staff often place them under a radiant warmer. The warmer is an open cart on wheels, with an overhead arm that provides heat and light. These beds are perfect for resuscitating babies and toddlers, starting CPAP, inserting IV's, warming hypothermic infants, and observing critically ill infants until they have stabilized. GLA's only radiant warmer is 28 years old!

Every day, for 40 days, Asha will display a tiny diaper on her website, each with a different design painted onto it. During those 40 days, people will have the opportunity to make a paypall donation. At the end of the 40 days, the diapers will be sold to the highest bidder in a silent, online auction.

Asha explains the origins of this unique fundraiser, which lie in her experiences of parenting her own premature baby, in a well-resourced NICU in the USA:

'When Alana was in the hospital, she wore the smallest little diapers that you ever saw. She was so tiny that we had to fold them in half so they would fit around her little body. I want to paint on diapers because I love the idea of the ordinary being used for something extraordinary. Diapers are an everyday item in many households, but when you think about these little diapers and the tiny babies who are fighting for their lives wearing them, it makes the everyday more personal.

November is Prematurity Awareness month, and I can’t think of a better time for this dream to become a reality! The cost of one warming bed is: $6,750.00, but when I think of how many tiny lives could be saved, I am reminded of what a priceless gift this would be. My hope and prayer is that this project would grow beyond my wildest dreams and support babies who truly need our help.'

To follow the progress of The Painted Diaper or to make a donation, please visit the project website.

Asha holds the first painted diaper in her hands. (Photo credit: The Painted Diaper.)

Pray For Mario

2011-11-01T18:34:00.000-07:00

In the first few days after he arrived at GLA, 6 month old Mario, who was swollen with malnutrition, responded well to treatment. He tolerated his feeds and became hungry. We increased the levels of protein in his diet. The swelling began to go down. These were good signs.

Then, Mario became more irritable. Children with Kwashiorkor are often irritable, so we didn't think too much of this when he first came in. We just kept a close eye on Mario. The irritability was soon accompanied by vomiting. At that point, we became even more watchful. The protein deficiency Mario was suffering from would affect his immune system, we knew, and we wondered if in his malnourished state, Mario was developing an infection. We had to monitor him very carefully - Children with compromised immune systems often do not develop symptoms of infection until their infections are very advanced. Their bodies are just too weak to put up a fight.

Our Paediatrician was very concerned: Mario was not having true fever spikes, but the front of his head protruded, and his fontanel was bulging, These were possible signs of hydrocephalus (an abnormal build-up of fluid on the brain). The Paediatrician was worried that Mario might be developing Meningitis.

We hoped that wasn't true. We wanted the protruding forehead to just be a symptom of rickets. Many of our malnourished children come with bowed legs and protruding foreheads. We hope this wasn't Meningitis, but we had to treat it as though it was.

The day after we began treating Mario with high doses of antibiotics, he began spiking fevers, that would not come down.

Tonight marks the first 24 hour period he has been without a fever. The swelling on his body has gone down, and Mario is much more settled, and no longer vomiting. These are signs that the infection that has been making him sick is under control and that his body is healing.

Please, say a prayer for Mario tonight. There is sunshine in his smile and I believe that the world needs his
light.

Names, Faces, Stories

2011-10-30T14:34:00.000-07:00

All of our children come with a story - a past, a history, life experiences that shape how how they think, feel and respond. We know and are aware of some elements of their personal histories. Other elements, we can only guess at or surmise. Sometimes, we are entirely in the dark.

Three children were admitted to the main house this week. The first to
arrive was Kimberlie. She is chubby, healthy baby girl. Although she weighs in at over 12 lb her mother insists that she is just 4 weeks old. We are not so sure. Kimberlie isn't holding her head up yet -babies usually do this at around 6 weeks of age - yet she moves her little arms and legs like a 3 month old. Maybe it was four weeks ago that the birth certificate was made? She is so big! We do sometimes see big babies - babies that are big not just by compared to their Haitian counterparts, but that are also big by North American Standards. Kimberlie is a very demanding infant. Haitians dote on chubby children, and we suspect that this one has been held a lot. She is perfectly happy when she is eating or sleeping. Otherwise, she wants to be held and entertained. Ssh! Don't wake her!

Our second admission, on Thursday, was 8 month old Emanuella. Her mother told us that Emanuella was a healthy baby. It was obvious looking at her, that this was not the case. Emmanuella has lots of loose skin folds, and seems to have lost some weight recently. She has a cough and an ear infection, swollen glands, a yeast infection in her mouth and fungal infections on her arms and legs. Her stomach is swollen and she has diarrhoea.

Emmanuella was clearly very attached to her Mother. She was the youngest child in a large family and she is grieving just now. As she adjusts to the losses and changes in her life, she needs a lot of attention from the nursery staff.

On Friday, a blessing returned to us. We first met Beni at the beginning of 2010, when he came to us for medical assistance. He was a tiny 5lb baby then, whose mother had died after a long and difficult labour. He didn't have a name, and so GLA supporters suggested names for this baby. Our director chose 'Beni' a name that in Haitian Kreyol means 'Blessing.'

Beni returned home to his father several months ago, strong, healthy and developing well. His Mothers sisters were anxious to care for him and we were confident that Beni would thrive well at home.

Sadly, Beni is back in our care, and this time, his father has relinquished his parental rights. Beni's family tried, they really did, but they are unable to nourish Beni. He is in the beginning stages of Kwashiorkor, with some mild swelling in his hands and feet. He is weak and pale and he has terrible diarrhoea, scarring from bacterial sores on his hands and feet and herpes in his mouth. He needs to heal, to regain his strength and to grow. The nursery staff were very pleased to see him. Beni smiled bashfully at all the ladies who came to welcome him back. Last night, I was told that he was beating the two year olds! I think he is going to do well here!

We pray that these three beautiful children will settle in their temporary home, that they will blossom at God's Littlest Angels, and that they will be matched with adoptive families very soon. There are parts of their histories that we will never know, but it is a privilege to enter into their life stories now.

Princesses

2011-10-23T13:29:00.000-07:00

I had a moment on Friday. I spotted one of those Anne Geddes shots - a beautiful, perfectly proportioned premature baby, cradled in her father's hands. My mind drifted upstairs to baby Louna, scrawny and rat-bitten in her incubator and tears sprang to my eyes. She wasn't exactly Anne Geddes material. I was jealous for Louna. I wanted for her, what that baby in the posed shot had. A well nourished mother, excellent health care, a safe, nurturing environment. It wasn't a lot to ask for, but she has lost out on all of these things.

Louna is a very stressed infant. Her premature birth in Site Soleil and the struggle to survive in that noisy and chaotic environment have overwhelmed her. Now, even nappy changes are stressful for her. Researchers have found that pain and stress can affect premature babies brain development well into childhood. Thankfully, we have found that Louna is quickly soothed by swaddling.

Baby Sarafina, I am told, has quite a fan club outside of GLA, but she wasn't really Anne Geddes material when she was born either. A few days after she arrived, this low birth weight baby, who was vomiting and who appeared to have lost weight in the days since her birth, was unable to keep any of her feeds down.

On a hunch, I decided to try a continuous feed, through a feeding tube. I am glad that I did that because Sarafina developed swelling in her feet, that soon spread to other areas of her body. We learned that this fragile newborn had developed a mild case of protein-energy malnutrition. I was full of dread. We have previously lost three tiny infants to this particularly debilitating form of malnutrition. Babies under three months do not tend to survive kwashiorkor, since their organ systems are not developed enough to withstand the damage that protein deficiency causes.

Sarafina was able to tolerate continous feeds. She beat the odds, making her my youngest survivor of Kwashiorkor. She is happy, contented and very alert now and I am so grateful that her mother brought her to us in time. For Sarafina, being admitted to GLA at just that point in the course of her illness, and being carefully re-nourished at that critical time, was life-saving.

Alaine was pretty, when she arrived, compared to most of the premature infants that we see at GLA but she was no Anne Geddes baby. Alaine came from the mountains above Cazale almost 3 weeks ago. She was a late-preterm infant, born in the 8th month of her mothers pregnancy. She was very small and skinny for a baby born at that gestation and we were concerned to hear that she was her mothers 18th child, and that all of her brthers and sisters had died as young infants.

Initially, Alaine was treated for apnoea and she was weak, very sleepy and difficult to feed. It became apparent around a week after she arrived that Alaine had problems with her airway. She needs a constant flow of compressed air through a nasal cannula to keep her airway open so that she can breathe easily, sleep well and suck from a bottle. It seems that a little bit of reflux was making her breathing symptoms worse; milk was refluxing up her oesophagus during and after feeds.

Thankfully, we are able to treat her reflux and Alaine is filling out nicely and really thriving. We hope that she will grow out of her airway problems but it is likely that she will need nursing care for a very long time.

Anne Geddes may not chose these girls as her models, yet, but I think they are beautiful. I have to stay mindful that whatever their earthly fortunes have been, or will be, they are daughters of the most high king, true Princesses who will recieve a rich inheritance.

.....And Two Become Four

2011-10-18T18:34:00.000-07:00

'You have a real NICU again all of a suuden', a friend exclaimed last week, when Baby Boy arrived. Suddenly, I had three medically fragile neonates in my care.

Well, Baby Boy lived less than a day and a half, and then, regretfully, three were two again. Applying the 'rule of three's' my friend and I surmised that no more premature babies were likely to be admitted for a while.

Last night brought news. In Cite Soleil, an 800g baby, almost three weeks old, was clinging on to life at home. She had been discharged from St Catherine's Hospital with an NG tube that her mother was struggling to manage. My heart sank. The baby weighed less than 2lb. Since she had survived this long, I assumed that she wasn't extremely premature, but she had to be severely malnourished and severely malnourished newborns tend not to survive.

As I finnished preparing the NICU for Louna, we admitted a 6 month old baby boy. Mario's Mother died 2 months ago. It was immediately obvious to us, looking at his puffy cheeks and peeling skin, that he had been in the care of a father without any real social support network, since his mother had passed away. Mario's father didn't have the knowledge or the means to nourish this fast growing baby, with high energy and protein requirements.

Mario is swollen due to Protein-Energy-Malnutrition, also know as Kwashiorkor. Low levels of protein in Mario's blood have caused fluid to leak out under his skin. 'No, he is not puffy,' the father insisted, 'that's just his shape, he's got a big round face!'

Hearing this I gave thanks inwardly, that his Father had decided to bring Mario here when he did. Like many people, Mario's fahter does not understand that his son is malnourished and in a critical condition. Over the next two weeks, we will attempt to re-nourish this child. We pray that Mario will stabalize. We need to see his weight go down as fluid moves out of his tissues and leaves his body. This will be a very fragile period. We pray that the electrolyte shifts will not be too dramatic and that Mario's organs will be able to process nutrients. Unfortunately, his protein deficiency has compromised his immune system and he will be very vulnerable to infection.

Louna arrived with her Mother early this afternoon. We learned that her mother had spent the last three and a half weeks going from hospital to hospital, seeking care for her tiny daughter. Louna was one of a twin, her brother did not survive, and Louna's mother doesn't have any other children. She has been very devoted to her tiny daughter, and has managed to keep her warm all this time. Last night though, the baby was bitten by a rat, and her mother knows that rat bites could make her fragile infant extremely ill.

I soon learned that Louna had been overhydrated. She has fluid on her lungs, which, is making it difficult for her to breath, so I am giving her compressed air through a nasal cannula to make this easier for her. She is also reciving antibitics, because she spiked a fever this morning.

I have estimated her gestational age at 34 weeks, but I am not sure how accurate these assessment will be in a baby who is almost a month old. Usually they are performed soon after birth. A visiting Neonatal Nurse Practitioner is going to do some more in-depth assessments tomorrow. If Louna really was born at 30 weeks, it is trully a miracle that she survived.

So now, two have become four.............