The ‘yellow babies’ day
Jaundice affects about 50% of term babies and 80% of preterm babies. Globally over 100,000 late-preterm and term babies die each year from jaundice. To achieve the targets of the second goal of the SDGs widespread public education must be undertaken on neonatal jaundice.
The stifling heat of the NICU was exceptionally intense that day. Sweat poured down my face , my neck and into my clothes. My glasses kept slipping down my nose. My singlet was totally drenched in sweat and my yellow shirt was going to follow suit if I did not get the iv access for the jaundiced baby in the next two minutes.I held my breath to increase my accuracy as I inserted the iv cannula into the baby’s arm for the tenth time, but my hand shifted slightly and I missed the vein when a nurse blurted out my name that another baby with jaundice had arrived and was having seizures. “Apart from your yellow shirt you must be wearing yellow boxer shorts and singlets.” , she said. Her colleague nurses burst into uncontrollable laughter, but I was not amused. My long day duties were usually calm but this one had been jinxed. Wearing a yellow shirt can’t harm you in anyway but maybe a yellow boxer shorts and singlet was going too far. No wonder I already had six jaundice cases to deal with. I kept wondering how the nurse knew the color of my boxer shorts.
I rushed to the side of the baby having seizures and requested for phenobarbitone to abort the seizures.This baby already had an iv line . I asked the mother a few questions to establish the cause of the jaundice and found out that she had impregnated all her clothes and even the water she drinks with camphor. For the remaining cases two were caused by sepsis and the other two by blood group incompatibility. One of them was born preterm as well. Their G6PD status was yet to be determined. They all had TCB (transcutaneous bilirubinometer) values that were within exchange transfusion range. I had witnessed only one exchanged transfusion and it was done by the bosses . Five of the babies were already undergoing phototherapy but there was no machine for this new baby to be placed under. I had to rush to the main ward to get one, if they had any that was free. I took of the cover cloth and put on my shoes and run out of the NICU. The main ward had an old faulty phototherapy machine that had not been used in a while. The wires were old and the insulation was off in some places. The machine looked dangerous but I had no time to worry about that. I snatched it and wheeled it back to the NICU.
The history for the sixth baby was a bit disturbing. The mother was 43 years old and this was her first child. She kept wailing that the witches in her family wanted her to be childless for life that is why they had inflicted the baby with jaundice. It was evident that she needed in depth counseling about the causes, prevention and management of jaundice , but I was too hot at that moment. I had to save the precious baby first. My boss had arrived and dealt with the iv line I was unable to set while I was chasing the phototherapy machine. The outstanding problems now was preparing the babies for exchange transfusion and the counseling of the wailing mother. My boss came to my rescue .He was going to take care of the exchange transfusion. All I had to do was to deal with the wailing mother.
I quickly isolated the mother with the help of her husband and one of the nurses. We gave her a seat and waited for her to calm down. The question I was itching to ask her first was her reason for bringing the baby to the hospital so late, but that would go against the rules of counseling a mother who may lose her only baby anytime soon, but the time for that question finally came. She had noticed the yellowing of the baby’s eyes and skin 3 days earlier but had not reported immediately. Instead some ‘concerned’ neighbors had advised her to expose the child to sunlight and she had obeyed religiously for 2 days. The delay in reporting coupled with her unflinching use of camphor had tipped the baby into acute bilirubin encephalopathy. The baby had stopped breastfeeding and started having seizures before she decided to come to the hospital.For now even if the baby survives he had to live with disability. One of the common causes of cerebral palsy was jaundice which had been allowed to run free like a mad cow.
“Jaundice in a newborn may be caused by a number of things including infections and when the mother does not breastfeed the baby. You have to bring the baby to the hospital immediately you notice the yellowing of the eyes and or the skin. Do not try your own home remedies such as pouring breast milk on the baby’s eyes or exposing the baby to sunlight.” As soon as I uttered this the wailing mother looked at me and asked why no one told her all these things until now that it was too late. I was on the verge of muttering something about health education in Ghana being poor but advertisement for alcoholic drinks being all over the place when one nurse barged into the room and shouted that I was needed. I
Apparently the woman’s baby had seized breathing and resuscitation had commenced.In my haste to get to the baby’s bedside I tripped over one of the numerous wires running on the floor of the NICU. I tried to break my fall by reaching out , trying desperately to get hold of something to break my fall. I did get hold of something, a live wire from the old phototherapy machine with uninsulated wires. I felt sudden excruciating pain and burning sensation in my hands and feet before losing consciousness entirely.
I had to wear a prosthetic right arm for the rest of my life. The electricity had burnt it so badly that it had to be amputated. Whenever I glanced at my right hand I reminded my self that no one was to blame , but a small part of my brain held on to the truth, poor neonatal jaundice public education was the culprit.
E.Y.
Great story. Very informative❤
ReplyDelete