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Pakistan: Caring for 'tiny' patients
Aisling Semple is working as a paediatrician in an MSF hospital, which looks after both newborn babies and malnourished children. Here she recounts her experience.
I arrived in Pakistan 6 weeks ago, and the past few weeks have been more overwhelming, challenging and heart-breaking than I ever could have imagined.
Malnutrition due to poverty and poor education
It’s in a city called Quetta, in the West of Pakistan, very near to the Afghan border. MSF has the only inpatient nutrition programme in this region, with a population of over 13 million. Due to poverty and poor education, malnutrition is a huge issue.
Downstairs we keep babies under 6 months, where the mums sleep curled up in the cots next to their tiny babies. Upstairs there are two big wards for children over 6 months – mostly toddlers. Unlike every other hospital in the area, all our care is completely free. Here, we have a well-researched refeeding programme, where we slowly rebuild these babies’ strength.
During my time here, I have met and cared for the sickest and most vulnerable patients I have ever encountered. I’d like to share the story of one little girl.
The story of one little girl
When she arrived, she was wrapped in what looked like an old duster. She was tiny, weighing 1.2kg (2 pounds, 10 ounces) – a third of the weight of the average newborn baby in Ireland, not much heavier than a small bag of sugar. And she was almost 2 months old.
I had never seen a baby this small outside of an incubator. And yet she had been living at home, with her parents- their first born. Her tiny body was thin and wasted, with her ribcage protruding through her thin skin. And she was weak, barely responding when I carefully undressed her to examine her. Her mum told us that she had been born at home a few weeks earlier than expected.
Like many mothers out here, she had been told that her breastmilk was not good for her baby. She did what she thought was best and started feeding her formula milk. Very young and inexperienced, with no support, she had been diluting the formula inappropriately and feeding her baby far too infrequently. She came into us seeking help when her baby refused to feed any more – she was too weak, too tired.
Our tiny patient was settled onto the ward and started on regular feeds through a feeding tube with specialised formula. We kept her warm and watched over her closely.
On the second day, her tummy became hard and swollen. She seemed even weaker than before. On our ward round we decided that we would have to stop feeding her and start her on a drip – letting her rest. We explained to her tearful mother that she was very weak and might not survive much longer.
We are very practised in such conversations – sadly, we have them every day. In these cases, the priority is keeping the baby comfortable and giving the family support and dignity through this devastating experience. We left her, fearing for the worst.
A few hours later, the night-doctor called me seeking advice. Our young patient was very restless and agitated. She was making a lot of noise, keeping the whole ward awake. When we examined her together everything seemed fine medically. Her tummy was soft again. She was more awake and active than I had ever seen her. Nurses, care assistants and doctors – we all stood around her cot, puzzled.
What was she trying to tell us?
Eventually, we figured it out: she was hungry. She was demanding to be fed. So we let her take a few drops of milk, which seemed to go down well. And then gave her a little more. She was instantly settled and satisfied, she slept soundly that night.
"Light came into her eyes"
After that, our little fighter grew stronger and stronger every day. She began looking around and interacting. Her weight increased and light came into her eyes. Her mum, who had been wracked with guilt on admission, became more and more confident.
We showed her how to keep her little baby warm by holding her in ‘kangaroo care’ next to her skin. She learned how to feed her with a cup and spoon and even managed to produce a bit of breast milk, with the support of our breast feeding expert. Soon the feeding tube was out, she was sucking well and she weighed an impressive 1.5kg (3 pounds, 5 ounces).
In less than 2 weeks, although still the tiniest patient on the ward, she was now the strongest. We let her go home, snuggled up in a fleece blanket in her beaming mother’s arms. She’ll come back to her outpatient feeding programme every week until we are happy that mum and baby are on the right track and no longer need our support.
Providing high quality and holistic care
This story is one of the hundreds that I could tell, based on my experiences here over the past few weeks. Not all have such happy outcomes, and every day brings us new challenges and new heartbreak.
But we will keep striving to provide high quality and holistic care, free of charge, to every baby and child who crosses our door.
Every day, mothers and grandmothers approach me on the wards. They hold my hands and kiss my cheeks. They pull me towards their babies, smiling proudly. They chatter away in Pashto and Baloch, Urdu, Sindhi, Brahvi and Farsi. They laugh at me when I gesture that I can’t understand them. But I know what they are saying- they are saying thank you. I try to gesture that it’s not me, it’s the dedicated team of national staff here, and the support and generosity of strangers in far-away countries.
It is your support that is allowing us to work out here- and with your support we are saving lives every day.