I moved through the crowded emergency room toward bed 4 where a young man lay with his leg wedged in improvised pillows made of tattered old clothes. He was disoriented and his eyes drifted in and out of focus. His young mother, similarly clothed in a torn second-hand t-shirt, wasn’t sure exactly how old he was but I guessed 11 or 12.
For a brief moment I thought, “We should be playing soccer together with my son.”
But the impressively swollen leg made that impossible, and his delirium told me that the infection in his leg was rapidly progressing through his bloodstream. With a crowded emergency room and outpatient clinic still full of patients to be seen, I hastily told the mother he would need powerful medicines through a “blood-tube” in his arm and to stay in the hospital. She looked a bit lost - as though she had never seen a permanent building before – but there was an implicit (and terribly beautiful) trust in her eyes as she committed her son to my care. I grabbed a nursing student to begin the IV antibiotics, wrote orders for an X-ray and made my way back to the clinic.
The noise of a helicopter made me pause. Time to get changed into scrubs. Our provincial health team notified us earlier that a sick mother was being transported due to delivery complications. As I went to delivery bed number 1, our Papua New Guinean medical resident Sheila was already working with the nurses on emergency stabilization. Her lifeless form was pale and her eyes she searched the room for anything familiar, but quickly rolled into the back of her head again. While she wasn’t actively bleeding now, she had been for the past 3 days when her baby was delivered at her home in one of the most remote corners of the globe. A nearby aid post attempted to deliver the placenta the next day but the cord broke, oozing blood. After another day’s journey to the health center, the nursing officer at a small Anglican clinic at Koinambe managed to radio out for a helicopter and she arrived at Kudjip clinging to life with a hemoglobin concentration of 2.8 g/dL [normal range 12-14].
Dr. Sheila aggressively resuscitated her with IV fluids and 2 units of emergency type “O” blood in addition to strong antibiotics. But we knew that shortly we would need to remove the decaying afterbirth and pray that she responded.