Thursday, February 16, 2006

Emmanual and His Angel:

Emmanual is off the ventilator! He is breathing well on his own, with an oxygen saturation level of 100%. The only difficulty he has is a slightly swollen upper airway, which produces stridor, or a wheezing sound caused by the narrowed passage.

Airway maintenance, which is the A in the ABC’s of basic patient management, is a critical concern, and the doctors and nurses will be watching Emmanual closely to ensure that his throat doesn’t narrow any further and make it difficult for him to breathe. The swelling is likely caused by the ventilator tube that was down his throat for a week.

In his first 24 hours off the vent, hospital staff didn’t feed Emmanual, and this made him mad, mad, mad, which was a good sign. Today they gave him formula. He gobbled it down and wanted more. “He’s refusing to go to sleep,” said John, “Because he wants more food.” He is alert and looks good.

Emmanual’s continuing recovery points up why doing heart surgery in Haiti is so difficult. It’s not just about the surgery, but the all important recovery. A U.S. medical team could have flown to Haiti and fairly easily surgically repaired Emmanual’s VSD. But in Haiti, he never would have survived the recovery period. Haiti doesn’t have the equipment or staff to maintain a baby like Emmanual, post-surgically. And visiting teams typically don’t stay until a patient is ready to go home from the hospital.

When I heard Emmanual had a narrowed upper airway, it reminded me of another child we saw in Haiti this past September. A mother brought in her four-year-old daughter wearing a frilly pink dress with her hair in braids to the Grace Children’s Hospital clinic. The little girl had a more severe case of Emmanual’s airway condition. She wasn’t really conscious and was breathing hard. It was quitting time at the clinic. John brought me in the room to show the little girl to me, saying, “She has a life-threatening problem.” As I watched her, she looked as healthy as could be, except for her labored breathing.

We took her over to the hospital and they hooked her up to an oxygen tank. She was going to need a tracheotomy, and the only place that would do that for her was the General Hospital, the Cook County of PAP, and a fairly notorious place. Once she was stable on the oxygen, the staff began making arrangements for her to go to the General Hospital. We left.

The next day when we were back at the clinic, we asked one of the doctors how the little girl was doing. “She died in the tap tap on the way to the hospital,” she replied.

We thank God for the progress Emmanual is making and ask this little girl to watch down upon him from heaven.

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