18 July 2012

18 July 2012 Today is the first day of Ramadhan. The twilight sky starts to appear and there is nothing I want more than to go home and prepare food for the break of my fasting.  This year I spend the Ramadhan on my own, far away from home. My melancholic thoughts of home bursts into thin air, when a woman rushes entering my room. She puts a baby that is wrapped in a chitenje into bed and knees down on the floor. Malawians like to do this, a sign of respect -  but I hate it. I told her to sit on a chair. “She stops sucking and has shortness of breath since three days ago”  the woman tries to explain, with an  anxiety in her voice. I found myself not listening to her, my focus is to get myself across the table to closely examine a tiny body that is lying on the examination bed. I grab my stethoscope and walk towards  the baby. I unwrap the chitenje that covers its body and there I found a tiny baby. So tiny that I could grap both of her shoulders with one hand. “How old is she”, I ask without even turning my eyes away from the baby in front of me. “She is three weeks old”, the woman replies,  still sounds anxious, I could hear it behind my back. I watch the baby’s chest goes up and down, gently put my hand on it and count the breathings “83 times per minute – it is not a good sign, bullocks!” I’m muttering to myself. Soon the thermometer that I placed on her beeps, displaying 39 degree Celsius on the screen -  another bad sign!  I look at the baby’s face one more time, her mouth is dry and her eyes are closed. If I do not see her chest moving up and down, I would have thought that this baby is dead. Andy quickly sets an IV lines, hangs a bottle of infusion fluid without even wait for my instruction. His is so experienced and I am blessed to have him as my translator. I put the oxymeter on the baby’s hands and the machine starts beeping, showing the numbers that are also very low. I know I do not have much time, so I quickly tear a cover of 24G cannule – the smallest intravenous cannule we have here. I am trying to find a vein where I can insert the cannule but I keep failing again and again. The needle punctures her young flesh and blood comes out of her skin. I can feel my stress level increases, almost reaching its peak. I give up! I snap open the vial of antibiotic, pour it into a syringe and inject it on her thigh. I know it is painfull but this baby is not even responding nor crying. She is too weak to even realize there is needle entering her muscle. I call out for Gift, the medical assistance to come help me. In no time, both of us  already sit opposite to each other, with the baby in the middle, to insert the IV Cannule. Gift tries to insert the IV into a vein on her scalp when I still try to insert the IV  cannule on the legs. Just like searching for a needle in a haystack, this is almost an impossible job. But finally Gift is able to insert the IV canulle on the scalp. I pour the fluid, hoping that it will help the baby. I look at the mother who still knee down in the corner of the room. Malawians can do  that for a long time. I am angry and sad at the same time. I feel angry for her ignorance and I feel sad to know that she does not have a good education to realize the baby’s detoriating condition much earlier. And I know it is not her fault... The machine keeps on beeping, the number shown in the screen is not good. I am expecting a miracle...that her saturation will be back to normal but I know it will not happen.. “A mai, your baby needs an oxygen support..” I politely inform the mother. For malawians, an oxygen support means a death sentence. And  so getting an informed consent before putting someone on an oxygen support is a requirement. I’m preparing  myself for a rejection, but suprisingly, she agrees and nodds sluggishly... ... A sound of adzan rings out from my phone, telling me that it  is the time for me to break my fasting... Back home, at this time of the year, I would sit down with my family on our dining room full of my favourite seafood dishes and sweet cakes. I would enjoy the easy life, much less work tension, set a clear distance between my life and job. But here, I only have a glass of water to break my fasting with, the distance is only 10-minute walk and the tension never eases... I know from the very begining that it will not be an easy job, being the only doctor in this remote area of Africa. With all the limitation, I can not save all lives. But I took the chance to realize that at the very least my precense can help. But still sometimes, the fear of losing (lives) is too much for me to bear. “I think you can go home now doctor, I will inform you if there is any improvement” Gift gently tells me. I complete the baby’s medical record, and deliberately skip looking at her name. I just do not have a heart to live and remember one more baby that I cannot save... At 3:00am I wake up suddenly. The Ramadhan forces  me to start the day earlier. I pray and I can not go back to sleep. At 07:00am I am already at the ward, visiting the patients and giving them their medicines. And I think I will skip the observation room, assuming that the woman and the baby are no longer there anymore. Then I notice something different. The woman is still there, the baby is still on her laps, but now she is breastfeeding. I blink my eyes several times and it’s still the same... I’m asthonised in front of the door, the woman looks at me and smiles. The baby, fully concious now, is sucking at her mother’s breast. She still has some difficulties of breathing,  but yes, she is alive and improving! I walk towards them, my brain plays scenes of her helpless body last night: her weak pulse, a woman knelt down on the floor, all the punctures on her skin and my high tension. I touch the baby to make sure it is real. And suddenly, all the mixed feelings come together... ... “what is her name?”  my voice trembles when I ask her mother. “Olive, her name is Olive..” the mother replies. ... Olive, now I will never forget that name for the rest of my life... This article is first published in www.kompas.com in Bahasa Indonesia language.