This afternoon an expatriate internal medicine doctor started an ultrasound workshop with the doctors. I thought it would be useful for me to go, so I did. The ultrasound room is adjacent to the emergency room so while we were waiting for doctors to arrive the internist and I were reviewing a few patients. There were many really sick children. One infant had been brought in due to rat bites, although I think the child must have been sick prior to the bites because the child was really unwell. Another child was very pale and in urgent need of blood. Another child had a very high fever and was convulsing. It was hectic.
After waiting for thirty minutes, the internist decided to begin the workshop, so off we went to talk about the ultrasound machine, the use of ultrasound as a diagnostic tool, etc. Meanwhile, the emergency department was bustling. After the workshop was over, we left the ultrasound room by way of the emergency room. I noticed two doctors resuscitating a child. Minutes later they stopped, realizing it was ineffective. As I stood there and watched I could not help but realize that everyone else in the room just carried on with whatever it was they were doing. The other caregivers did not seem to be paying much attention, other staff was preoccupied with various activities and even the mother could not be found in the emergency room. In silence, the child passed away.
After the doctors covered the child with a cloth, they slowly moved away, disheartened by what had just taken place. Meanwhile the now lifeless child remained on the bed and to her left and her right, two other children were struggling to stay alive.
Chills ran through my body as I realized again how much death has become a part of daily life in Sierra Leone. The death of a child, that would bring masses of people into action in both the hospital setting and the home setting in the developed world, goes by almost unnoticed here. And why is that? It is because unfortunately 1 in 5 children do not reach the age of 5 years in Sierra Leone. Of course the death of a child does affect people here, but it is different. I’m starting to believe it has to be different, or people will not cope.
The mothers wail to the point of throwing themselves to the ground in uncontrollable sobbing but then they seem to move on more quickly than one might expect. They are told to “bear,” which means “to put up with” or “endure.” They are told not to cry. To me this seems inhumane, but there must be reasons for this. Maybe it’s simply because a wailing mother will cause the other caregivers to start worrying about their own children. Or maybe it is easier for everyone else involved to cope with the death better. Or maybe it is because in a place with so many child deaths, a mother somehow needs to accept that this time it was her child. Sadly, I think that because child mortality is so high, many mothers realize that the chance is big that one of their children will die and I am sure that any time a child dies in the Emergency Room, the other mothers present are worried that their child might be next. What an unsettling thought that it is likely one or two more children will die in the emergency room today.
Of course the doctors and nurses are affected as well, but rather than the death of a child being a shock to them, they sometimes don’t seem phased by it. I am not saying this to be judgmental but am trying to point out the demoralizing affect that child deaths have on the staff. Of course it hits them but they usually let this go unnoticed. They are frustrated with the lack of diagnostic facilities or treatment options to save a child’s life. They are irritated that caregivers tend to delay so much before bringing their child to the hospital. They are saddened that the situation is changing ever so slowly. When a child dies, the doctors and nurses tend to step back in silence but I think inside they are hit hard. How long can they continue to give your all when the outcome does not seem to change?
Where the average doctors and nurses in the developed world rarely experience pediatric deaths, these doctors and nurses are faced with children dying every single day. How does one deal with children dying on a daily basis? I think that the only way one can continue to work under such circumstances is to distance oneself from the patients and guard one’s emotions. Clearly in a profession devoted to caring for people it is difficult to find a good balance between building a relationship with the patient and maybe even becoming attached to distancing oneself from a patient and becoming indifferent. When faced with death everyday one has to find ways to cope.
Hopefully one step at a time, the care at Ola During Children’s Hospital will improve and child mortality will start to decrease. Maybe someday deaths will not be a part of daily life in Sierra Leone. One day. I just hope that until that day comes the doctors, nurses and other staff will continue to cope under such trying circumstances.
Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.