The Bean

Friday afternoon, I got a phone call from Carlan, our E.R. doctor (American) who said he had a 1 year old girl who had aspirated a dry bean and was in respiratory distress.  He explained that we had only 2 options.  Option 1 - there was one pediatric fiberoptic bronchoscope in Burundi at the University hospital in Bujumubura.  He had already spoken with the specialist in charge of this instrument who said he would accept the child if we could get her to Bujumbura.  Option 2 - have Agneta (our visiting surgeon from Kenya) perform a thoracotomy, open up the trachea, and try to retrieve the bean directly.  After much discussion with Agneta, Carlan, and also Randy Bond (American pediatrician who happened to be visiting from Buja for the day), we decided this child’s best chance of survival was a trip to Bujumbura.  

Getting her to Bujumbura, that is the tricky part.  There is an ambulance at the hospital, however, it is not authorized to leave our district.  So, we decided to drive her ourselves.  We discussed intubating her at Kibuye, then bagging her for the 3 hour drive to Bujumbura.  However, after assessing her, Randy felt that it would be safer to drive her breathing on her own, and have everything we needed in the car to intubate if she decompensated.  But they would need someone to travel with her who could intubate her if she decompensated.  So, I said I would be happy to go.  

So, we loaded up a car with the child, her parents, Randy and Carolyn Bond (who were driving back to Bujumbura at that time anyway) and their friend.  We managed to cram a large oxygen tank in the back of the car, to give oxygen by nasal cannula as we traveled, and I hopped in the back with the child, a pulse oximeter and a backpack full of airway equipment.  We made it safely to Bujumbura, and drove straight to the entrance of the ER at the University hospital (reportedly, the best equipped hospital in Burundi).  The first person we found was a medical student who told us they could not accept the patient, because they did not have any oxygen.  I was extremely grateful to have Randy with me, who has years of experience working in hospitals in Africa, because he insisted they show us to the ER, where there was in fact an oxygen tank (but not much else).  So, we hooked the baby up to oxygen and called the doctor who said he would accept the patient.  He assured us he would be there right away.  After an hour and a half, no one had shown up to see the child.  In fact, the whole time we were waiting in the ER, we did not see anyone except the medical student and some nurses.  There were no monitors, no equipment, just 3 beds and (thankfully) an oxygen tank.  

We gave some money to the parents for food and transportation back to Kibuye.  And we prayed with them.  I found out today, that the child did eventually receive her bronchoscopy and they did retrieve at least part of the bean.  They are taking her back for another bronchoscopy tomorrow.  

When we first arrived here, I asked someone where was the best place to go in Burundi for medical care.  Their response was “just don’t get sick here”.  I said yes, but if I DID get sick, where should I go?  The answer was again, “just don’t get sick here”.  I am starting to understand.  I am grateful for the extraordinary measures that Carlan and Randy went through to save this child’s life.  Sadly, I am sure that there are countless other babies in this country who have been in this same situation and died, because no one would take extraordinary measures to save them.  I am grateful for the team here who has committed their lives to serving here to improve the healthcare system in Burundi.  And I am deeply grateful for their hearts of compassion.