Public Health

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I will never forget little M. (not shown here) – the wide-eyed 9 month old boy who arrived a month ago white as a sheet, apparently gasping his last, sent from the hospital because they didn’t know what to do with him. He was profoundly anaemic, and a transfusion at that point saved him. However, it gradually emerged that he had been transfused twice at hospital, having had numerous nose bleeds, and over the coming days he had more nose bleeds and finally started to decompensate, requiring a further transfusion. He started to show tiny bleeds on his palate and pinpoint bleeds on his legs, and when he started to pass blood in his stool it became clear he was thrombocytopaenic (a lack of platelets, which are essential for blood clotting). By the time we finally diagnosed the cause of his thrombocytopaenia and started him on treatment, he was requiring transfusion every day. In the end the illness was stronger than him (and us) – nothing could control the bleeding, and he died awaiting transfusion.

It can be sad to watch a child die slowly, when you know that with access to the care available in the west he would survive (in this case Haematology Specialists, Platelet Transfusions, Full Blood Counts). Yet we must be more pragmatic than that. We cannot devote all our energy to saving one child, when that energy can be better spent on those other children who have a more realistic chance of survival. This ‘public health’ outlook is convincing in theory, but hard to adhere to in practice, when you are struggling to deal with the immediate emotional impact of each situation.

At the end of the week I developed a fever. I worked until Saturday lunchtime, and thankfully the hospital was quiet enough for me to take to my bed that afternoon. I find myself very boring when I’m ill. I want to tell everybody about it, and wait for their sympathy; but of course they’re struggling with their own illnesses, and can’t understand what you’re making so much fuss about. As I lay there on my own I added up the symptoms in my head and decided it was a toss up between Malaria and Giardia. But I need to admit to myself that stress plays a major role in my symptomatology. As I sweated out the fever yesterday, perhaps it was also the memory of M. and all the others that I was exorcising. Today I feel weak, and yet I feel as if the events of last week are more or less behind me.

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