Dr. Briana Cranmer’s Chisang Clinic Experiences (Vol. III)
It is a hot April day in the village Chisang Clinic. As I am praying for rain or even just a soft breeze the curtain shifts and a mom enters with her child. Mom is young, maybe 18, she looks tired and slightly unsure of herself. Using my limited Nepali I tell her “bosnus, sit down.” I then turn to my wonderful translator Geeta and ask why mom is here. The baby has been sick, not eating, not drinking, and vomiting constantly for the entirety of her 17 days of life. Mom is at a loss. She says she is breastfeeding every hour, but only for five minutes at a time. She has tried supplementing with formula, but every time baby feeds, she “vomits.” This is mom’s first child, the pregnancy was normal, the delivery went smoothly, but baby only weighed two kilograms
(4.4 pounds) at birth.
I peek over mom’s arm and glimpse a sleeping baby girl. I gather her in my arms, shocked by her lightness. Medical school lesson #1: when evaluating a patient always determine, sick or not sick. Tiny warning bells sound off in my head, this baby is sick. Removal of each layer reveals a malnourished, underweight, lethargic baby girl in dire need of medical attention. Medical school lesson #2: never use the term “lethargic” when describing a baby unless you truly mean it. The warning bells are deafening, this baby needs immediate medical intervention. Baby’s fontanel is sunken and her heart is racing implying dehydration, her breaths are quick and shallow, but thankfully no sounds of pneumonia. She is tiny, skin and bones, and barely holding on to her two-kilogram birth weight.
I consider the options available in this rural clinic, 1.5 hours and many kilometers from the nearest hospital. I remind myself that the clinic has only been open for two weeks and we are currently in limbo with regard to our ability to manage sick patients. If their fundraising efforts are successful, the Chisang Clinic at its peak in a year or two, will have a 4-5 bed inpatient unit for severely/acutely sick patients requiring 24 hour care and a 10-15 bed obstetrics labor and delivery ward. The clinic will have IV fluids and nutrition, heart and oxygen monitors, an extensive pharmacy, and all of the medical resources necessary to nurse this baby to a proper weight and health. Although, construction is underway and funds are being raised, I am currently without the necessary resources. My options are either to attempt to manage baby with my limited supplies or refer her to the hospital in Biratnagar.
In America, when you make a referral it is typically because you believe a different facility or doctor may have the knowledge or skills more fitting to the needs of the patient. I quickly learned that this was not true when it came to the hospitals and physicians nearest to the Chisang Clinic. Often, I discovered patients received lesser care or no care compared to what I was able to offer. So when I was faced with a medical challenge involving one of my babies, I did the only thing I could think of. I asked advice from the most reliable source I could think of – my sister, a pediatrician in Seattle, WA. In my anxiety over the severity of my baby’s condition, I forgot the twelve-hour time difference to the U.S. and she received a 4:00 a.m. consult call from Nepal. Ooops!
Ultimately I recognized that without IV fluids and proper nutrition this baby girl might not survive. Her needs were beyond my ability to provide care. I sent mom to the hospital with a detailed medical note and instructions to return if there were any problems. As they walked away, I sent a handful of prayers after them in hope that they would receive the medical attention they deserved.
It has been a week since my encounter with the 17-day-old baby girl. Suddenly, while on my weekly home visits, I find myself standing on her front stoop. An elderly lady sits next to a bundle of blankets. As I approach, a tiny hand shoots up out of the mass with a second tiny hand following close behind. My heart jumps as I peek into the bundle and see baby’s sweet smile. I gather her into my arms, forgetting to ask for permission in my excitement. Baby did in fact receive care at the hospital and she was finally eating better and gaining weight. I look forward to the continued development of the Chisang Clinic and their future ability to manage patients such as this baby girl. Soon enough as the clinic continues to grow, the people of Bhawanee village and the surrounding areas will be saved the 2000 rupees cost of transportation and the stress of being far from home. Instead, this community will be provided with caring healthcare providers who offer patience, a kind ear, and advanced medical care.
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