Baby Taanda

This is the story of one of the babies I checked yesterday which we mentioned in the last post. We checked 15 babies as there were many born over the weekend. I call this one baby Tanda as this is the Bengali word for cold. When I went to check him I found no one in the bed space so I went to the verandah to find the family. I found them sitting outside with the baby so I called them in. I noticed the baby was slightly lethargic when I examined him. His respiratory rate was slightly high and his temperature was 35.9 on my cheap thermometer but he was otherwise normal.

I thought the baby was probably too cold so I explained this to the family with the help of a student nurse. I demonstrated how to wrap the baby and told them it should be wrapped if it is outside. I discussed baby Taanda at lunch with Shubhro and he agreed that he was probably cold.

The next I heard of this baby was 6 hours later when he was collapsed with a distended abdomen. Jenni and I arrived as Shubhro began to resuscitate the baby. He was breathing quickly, his heart rate was falling and he was poorly perfused peripherally. The distended abdomen indicated necrotising enterocolitis which is a devastating condition in the UK never mind Sarenga. Shubhro thought he heard a faint systolic murmur which had been too subtle for me during the check. The temperature was normal at this time. Shubhro gave fluids through a needle in the babies bone enough to allow a cannula to be placed. From there he gave fluids , antibiotics and oxygen. We did not ventilate as there is such limited monitoring here that the baby would be brain damaged in the unlikely event he ever came off the ventilator.

Shubhro told the family the baby was likely to die that night. Culturally the husband and grandfather break bad news to the mother so she was not present. The grandfather was a tiny skinny man who was devastated by the news. He kept bowing and thanking Shubhro and us. After the bad news the grandfather returned with a box from the pharmacy with NG tubes, saline and cannulas in it. He presented these to the nurse by placing them at her feet and bowing lots to show respect. This was a really sad sight for us and made the situation personal and emotional where before we were only focused on the medical problems.

Baby Taanda died 2 hours later. It is likely that he died from a heart malformation but it could well have been infection or a metabolic problem. I felt that I should have been more worried for the baby when I examined it. It is an important lesson in being vigilant of small babies who are slightly knocked off. It can be very hard to spot a sick baby as the signs can be subtle as they were in this case. It is unlikely that recognising how sick he was earlier would have made a difference.

In the UK this baby would have been ventilated and would have likely to hve survived. He would have been monitored so much more closely and kept in a warm clean environment. He may not even have got sick in the first place. We mentioned in an earlier post that mothers often put poo on the babies forehead. This baby was found the day before with poo on his forehead which may have caused the infection. Mothers are poorly educated so they don't know how to care for their babies properly. This baby was too cold, had poo on his forehead, had no mosquito net and his mothers hands were dirty. These are problems endemic in this area and result from poor education ans deeply ingrained cultural practices.

I learned a lot from this baby about medicine, but I learned more about the Bengali culture and the challenges Elisabeth and Shubhro face on a daily basis. I pray that the mother will learn from this and change the way she cares for her future children. Baby Taanda was one small baby who died as a result of massive problems in Indian culture. I am so thankful for the work of KSN as it lessens the injustice of healthcare, the deficit of education and tries to chip away at cultural problems. It is a huge task and it happens only by the will of God. Neil