1AM

Phone calls at 1am can never be good. I woke up to my phone ringing at 1am by Becky (other American nurse here) and she said, “Carson, I need you to go wake up Dr. Ty because there’s an unresponsive kid brought into the clinic.” So I raced next door to where Dr. Ty is staying, and pounded on his door. Two seconds later he was at the door, and we ran down to the clinic to see what was going on. The second I got into the room I could tell the kid was in bad shape.  The child had a nasal cannula in his nose and wasn’t moving. I raced over to his bedside and palpated a very weak thready pulse. He was pale (if black people can be pale) and his hands and chest were cold. Becky ran to get an ambu bag, and I started assisting in ventilations while Dr. Ty did his assessment and while Becky attempted to get the crash cart and IV started. Salina, the Malawian nurse working that night, said “his parents brought him in from the boarding school in Area 15, they said they were called at midnight because their son was not talking,” it was now 1:10 am. Salina was unsuccessful in getting an IV and Becky attempted to find a vein as well. Both Dr. Ty and I tried to palpate a pulse, and we couldn’t feel anything. I started compressions while Becky assisted in ventilations. We were unable to get an IV at all, and Dr. Ty even attempted to administer epinephrine, but we couldn’t find a vein to administer it in.

Jose, an EMT from Ft. Worth here for the summer, came down to the clinic (he was staying in the same house as Dr. Ty arrived and started attempting to find a vein as well. Meanwhile, Dr. Ty asked the parents of the child was sick at all during the day, and what kind of medical problems the child had. The mother was pacing back and forth in the room praying loudly, and other family members were pacing and praying as well. The father said, “we don’t know. We were called at midnight by the boarding school to tell us to come pick up our son. I asked to speak with him and the attendant on the phone said that it wasn’t possible. The attendant told us my son had vomited earlier in the day, but had no fever or any other symptoms. The school attendant gave the child medicine and put him to bed around 8pm. The attendant checked on the child at 10pm and everything was fine.” About 45 minutes had gone by at this point. Again we were unable to palpate a pulse, so Becky and I both told Dr. Ty, “You have to tell us to stop. We won’t stop compressions until you say stop.” Around 5 minutes later, Dr. Ty said to stop. Later we found out that Dr. Ty had never been in on a pediatric code. Dr. Ty just graduated from residency and is a brand new doctor! We couldn’t palpate a pulse, and the child wasn’t breathing. Becky and I covered up the child and took all the equipment off the bed. Dr. Ty turned to the father and said, “I’m sorry sir, we’ve tried everything and there’s nothing we can do.” Then the mother started wailing. In the Malawi culture, it is acceptable to wail loudly when a family member dies. It shows the extent of the grief the family member feels. Other family members were with the mother and father and they ushered the wailing mother outside. It was around 2:15am at this point.

Salina told Dr. Ty that the family would want Dr. Ty to pray for the family and dead child, so we did. After that Salina prepared the body for transport and burial while I watched. We made our own toe tag, and I found out the child was 10 years old and his name was Blessings. In Malawi, the dead body of a family member is taken to the family’s home village for burial. The family requested an autopsy since the cause of death was uncertain, and since it was so late we had to transport the body to Kamuzu Central Hospital (KCH). This hospital is the government run hospital in Lilongwe. It’s also the hospital I was in when I felt called to be a nurse and come to Malawi. Our clinic has an ambulance, so after the body was prepared we packed the body onto the stretcher and loaded it in the back of the ambulance. Our ambulance is a pick up truck with benches, so it’s not the typical ambulance you’d see in the States. Someone has to keep the gurney secure since it has room to roll in the ambulance. As we were getting ready to go to KCH to drop off the body we were told we needed to wait since more family members wanted to go with us to transport the body. The last car pulled up and a young boy about the age of 14 got out and wanted to see the body. He pulled open the back of the ambulance (where Becky and I were sitting), saw the body, and crumpled to the ground in tears. Jose squatted down and hugged the kid as he wept. After he was done crying we drove with a caravan of about 7-8 cars to KCH. When we arrived, about 15 minutes later, we drove up to the morgue and couldn’t find anyone to unlock it for us. We drove up to the casualty area (ER) and couldn’t find any nurses or staff members. Becky, Jose, Dr. Ty and I wandered the halls looking for people when finally Ty found a phone and called a random number. The person on the other line said to knock on door #11 or 12 and wake up the sisters (nurses). We did, and the nurses were sleeping in the room. Kind of different from night shift in the States!  The sisters found an x-ray attendant to open up the morgue for us, but before we could go the sister had to write down the boy’s name, home village, and date of death in a large ledger book. In the States there’s many people to contact when you have a death, the organ donation office, the nursing home, there’s papers to sign to release the body for an autopsy if requested/allowed etc. Yet, this child’s record of death was merely a name written in a book, kind of like an accountant book.

We drove back down to the morgue and the x-ray attendant opened up the morgue for us. Before we moved the body the men family members wanted to help place the body, so everyone put on gloves and the men grabbed the gurney. When the attendant opened the morgue I saw about 13 bodies wrapped in chitinge’s (colorful Malawian material that women use as skirts etc) with body parts sticking out (like toes, legs, fingers, etc.). This room in the morgue was full of bodies of people that had died that day. The men placed the body in the morgue and we let the x-ray tech know that the family requested an autopsy. We had to drive the father back up to the casualty area so he could explain to the sisters that he wanted an autopsy performed on his son. Autopsies are rare in Malawi, but both Becky and I inferred that this family was wealthy, so they could afford to have an autopsy performed. Before leaving Dr. Ty and Becky exchanged phone numbers with the father. Jose, Becky, Dr. Ty and I all told the family how sorry we were, and we wanted to know the findings of the autopsy. We drove off with the family still outside the morgue with Becky and I in the back of the ambulance holding the gurney. After we got home I couldn’t sleep. Dr. Ty lives next door and I could hear him outside, obviously he couldn’t sleep either. 

It’s hard to completely wrap my brain around what happened. In the States, if someone becomes unresponsive, pretty much everyone knows to start CPR. But the school attendant didn’t know to start CPR when he found Blessings unresponsive.  Looking back on this situation now, the only thing I can wonder is if this child knew Jesus as his personal Lord and Savior. Death is a common thing in Malawi. Malaria is a common killer among people, along with HIV and AIDS. With these diseases death becomes a common part of life so the only hope we have is that the person knows Jesus Christ. There’s medicine and such to cure people of malaria and ARV’s to assist people who have HIV/AIDS but the ultimate power is in Christ Jesus. This makes our mission of being in Malawi completely clear. Our being here is about helping others medically and to receive an education they wouldn’t otherwise obtain, but the MAIN goal is to minister to those who don’t know Jesus as their Lord and Savior.

It’s all about You, Jesus,

Carson