Opening the door to the premature-sick infant nursery during the first day of rounding, I saw that only one crib was occupied with a comfortably sleeping infant. Enjoy the peace I told myself, life in this nursery can changes quickly. Within days mothers gave birth to one premature infant after another each weighing from 2 1/2 up to 4 pounds. Here, at St. Francis Mutolere Hospital in the Kisoro district of southwestern Uganda, if a child has the strength to breathe they have a chance at survival.
One of the 2 1/2 pound newborns , hours old, struggled with fast breathing,an in-drawing chest, and low oxygen levels despite supplemental oxygen. This was Jenna‘s daughter.
The baby was weakening by the hour. The maximum support for breathing available was a trial of CPAP, an oxygen delivery through the nose given under pressure. Rarely used tubes, bubble chambers, nose prongs, and a half functioning CPAP machine were assembled, fitted to the baby, and turned on. The oxygen level slowly began to rise, although labored breathing persisted. Intravenous fluids, antibiotics, glucose monitoring, and temperature regulation were started. Then we waited to see if this fragile infant had the strength to recover.
By the following day the child’s breathing struggles had eased slightly, the first hurdle had been jumped. A gauntlet lay head for infant and mother before reaching the capability of survival at home. Maintaining body temperature using hot water bottles rather than an incubator which depended on consistent electricity, keeping intravenous access, providing proper intravenous fluids both in composition and flow rates, delivering adequate breathing and oxygen support while avoiding damaging excess support . And finally having Mother every 2 hours provide expressed breast milk for nose to stomach tube feedings. Complicating all of these difficulties was having staff available to perform these tasks. During the night there were times when only two staff members were available to cover not only the nursery but also pre-and post natal healthy mother-infant care, and attend, at times nonstop, deliveries and emergency cesarean sections.
One step at a time, one day at a time, day after day, night after night. For this child death was near on three or four occasions as a result of airway obstruction‘s, prolonged periods of apnea (no breathing) due to prematurity, and recurrent aspirations from complications with feedings. Through all this Jenna was at the bedside. One day weary and exhausted Jenna asked for discharge despite the child weighing 3 pounds and not yet breast-feeding. As we talked tears filled her eyes she explained that she had no money and minimal family support to pay the expected hospital bill of about $100 and provide for Jenna‘s food and personal needs. Quietly she was told that we also wanted her baby to live and she would be supported by caring people unknown to her. On her knees now, smiling through tears she sincerely thanked us. Weeks past and the infant slowly and steadily gained weight. At 4 pounds the child continue to grow on breast-feeding alone letting us know she was ready for discharge home.
When that day arrived accounts were settled, instructions given, and family came to escort baby and mother home. At about 4 PM a nurse tracked me down saying Jenna wished to see me. They came to our house with a 50 pound sack of potatoes thanking us for all we had done for her and her daughter. Jenna would not leave before giving proper thanks even though it cost her and her family a late departure, followed by a four-hour walk going into a cold rainy night before reaching their home. This humble woman with her quiet, gentle, selfless, enduring love for her daughter humbled me to the core.
Infants are not named until mothers know they will live. I asked the nurse what name the infant was given… Miracle .
Dr. Lou Coda
Dr. and Mrs. Lou Coda shared this story from their time in Uganda at the beginning of the year. This is just one of the thousands of lives saved and touched by the healing hands of Mission Doctors in Africa and Latin America. They have been serving at St. Francis Hospital for several years caring for young patients and walking in solidarity with the people of Kisoro.