Rachel’s child

It has been a real struggle to save his life. He was only 15 days old and he already looked like as if he had reached the end of the line.

Rachel works with us in sterilization, and this made it twice as difficult for me to receive her with the required distance as she was desperately handing out to me her baby crying.

The child conditions were extreme: he was paper white, even though he was not anaemic. He was not strong enough to breastfeed and he had been convulsing without fever.

The blood sugar was ok,

We immediately thought of meningitis and we did the lumbar puncture carefully, however the liquor was clear and the laboratory test on the CSF negative.

The chest auscultation was awesome and demonstrated a bilateral pneumonia.

Hence we right away covered the child with Rocephin, hoping to hit either the germs of the breathing system and possibly some meningitis form that we missed.

Of course we executed the “thick film” for malaria slide: however the result was negative.

According to the continuous pressure of the World Health Organization (WHO), and the Kenya National Guidelines, we abstained from quinine, although the temptation to prescribe it was very strong.

The child remained hanging between life and death for days: every morning I was going very early to the hospital to ask the night staff if the small one was still there.

For a long time he was on oxygen supplement because he was breathing very badly and Rachel was expressing milk from her breast, to feed him with her milk through a naso-gastric tube.

Convulsions were hard to control even with full doses of Phenobarbitone, supported by Valium per rectum when required…and anytime the baby had a seizure Rachel’s heart was breaking.  

Of course Rachel was feeling more and more depressed and by then she was preparing herself for the worse. She was staring at me with pleading eyes but honestly I didn’t know any more what to tell her to give her comfort.

Then one day I remembered that I had received a little donation for an IFAT (immunofluorescence assay test) for malaria.

Despite of the “thick film” negative, I tried that new test which is able to measure out the presence of IgM antibodies against the plasmodium falciparum: I was astonished to see that the IFAT was strongly positive. I rejoiced seeing this result which at least gave us a way to follow.

I therefore hurried up and added i.v. quinine to the ongoing therapy, more and more convinced that even very serious malaria can show a negative “thick film” and can be without fever (the so-called algid malaria).

The third day of the i.v. quinine, at 7.30 a.m. Rachel was in my office.

Instinctively I became stiff and I looked at her with all possible empathy.

In fact Rachel started crying almost immediately, but her words where not the terrible ones I would have expected.

Among tears of joy and emotion Rachel simply whispered in my ear: “he is better…thanks…this morning he breastfed”.

We didn’t stop any therapy, because the child breathing system is still affected by ronchi and wheezes, but the miracle – I am convinced – was done by the i.v. quinine.

Today is the 5^th day of treatment against malaria and the 8^th day antibiotics; the child is definitely doing better. We are thinking of discharging him soon.

Rachel of course is overjoyed.

We deeply thank Divine Providence because she helped us to save the life of this child.

We are also pleased to have now at our disposal a good number of IFAT tests that will help us save other lives.

Also in the matter of Rachel’s child, I recall what Professor Bryceson used to tell us in London: “if the clinical conditions are very serious and they make you think of complicated malaria, you shall never deny the patient i.v. quinine, even though the test for falciparum parasite is negative… I saw many people with negative tests die from malaria”.

For this little kid we made the right choice.

Brother Beppe Gaido