The ones you can't save

I had mentioned in an earlier blog that we had an 8 month old come in for pneumonia and chronic malnutrition. So the first photo is of Roberto, when he came in, weighing 4.2 kilos, lethargic, dehydrated, but at the time with no fever or respiratory symptoms. We went ahead and treated him for a possible pneumonia and sepsis with heavy duty antibiotics (Ceftriaxone). He had a rough time at first, but then progressively got better.








And after a little more than a week, he looked good enough to go home, eating well and had gained a couple pounds.

So we were all surprised when he returned to the center 3 days after his discharge with fever, diarrhea, and this time really junky sounding lungs. Well, now we were flat out of Ceftriaxone, so we put him on what we thought were the best combination we had, but this time it didn't work, he just got worse and worse and 3 days after he came in he died. I'm not used to seeing kids die and this was particularly hard, b/c I had seen him get better and we don't know what happened. This is the second child this mother had lost to a severe pneumonia.

The other patient we lost died right after I left Santa. Her name was Rosa, she was a 35 year old woman who had become paralyzed from the waste down after a tree had fallen on her during a storm. She was doing ok until she got pregnant and then during her pregnancy developed awful bed sores (stage 4 decubitus ulcers). The family took her to their local health post when her sores were very bad and they sent her to Santa. When she arrived it was clear that her sores were severe, her nutritional status was poor and Rosa was severely depressed. She too suffered from our shortage of ceftriaxone. She had some good days, but ultimately, I think Rosa became septic and didn't have the reserve to be able to fight the infection.

These patients, stay with you, always wondering what you could've done differently, how much difference would it have made to have more technology, more medicines, no way to know.