Chednaline is a 4 year old girl admitted to our malnutrition center last month. She was malnourished and had edema, presumably secondary to kwashiorkor. She also had a fever and cough and her oxygen saturation was low. She was started on oxygen and antibiotics for pneumonia in addition to treatment for malnutrition. The edema resolved quickly, but she continued to require oxygen. Her lung exam changed often, making clinical diagnosis difficult. She needed a chest x-ray to help clarify what was going on. Unfortunately, her oxygen saturation dropped when using the portable oxygen concentrator. She needed to travel about 30 minutes to get the x-ray. She was transported in our truck with her mother, a nurse and the large oxygen concentrator and a 3000 watt generator in the back of the truck. There were some hiccups, but the x-rays were obtained and she returned safely to the malnutrition center.
The x-ray showed what appeared to be a very large heart. The next day, we did a virtual echo with the aid of Emily who is a U.S. based pediatric cardiac sonographer. This revealed that Chednaline’s heart was functioning normally but she had a large amount of fluid around her heart. This is called a pericardial effusion. This condition can be very dangerous because the fluid can put pressure on the heart and limit the heart’s ability to pump. We needed to get Chednaline to a hospital that had a specialist that can drain the fluid if needed. But where? And is there a specialist remaining in Haiti that could do the procedure?
A flurry of emails, What’s App messages and telephone calls ensued. A lot of people contributed to find help for this girl. L’Hopital Petites Freres et Soeurs in Port au Prince said they would accept her and could do the procedure. Miracle number 1. Next, how to get her there? More telephone calls and messages and emails. Ambulance transport was out of the question, because an ambulance could not get through gang controlled territory between us and the hospital. Air transport was not available due to a helicopter being out of commission. Private vehicles are not allowed to pass through the gang controlled territory, but public buses are. Public transportation would be risky. There have been manifestations and road blocks. Our employees have had to walk, take side streets on motos, and wait for hours on buses when traveling to Port au Prince. And Chednaline’s oxygen decreased sharply when using the portable oxygen concentrator. We looked into borrowing an oxygen tank from another hospital- 80 pounds and 4 feet tall and not safe on a moto if they needed to take a moto. God, what should we do?!?!?!?!? We all felt led to proceed with the transfer.
Chednaline maintained normal oxygen saturations while using 2 portable oxygen concentrators- this does not make sense medically, but it worked. Miracle number 2. She was transported to the hospital with 2 oxygen concentrators, her mom, a nurse and another employee. They made it to the hospital in record time- less than 2 hours from leaving the clinic. Miracle number 3. We couldn’t get there that fast when we drove when Haiti was peaceful. Doctors were waiting to receive her at the hospital.
Unfortunately, further studies revealed that the fluid surrounding Chednaline’s heart is very thick and fibrinous. Tuberculosis is strongly suspected. She was started on anti tuberculosis medications and prednisone. The fluid cannot be drained easily. She will need to go to the operating room and have a more complex procedure done (pericardial window) in order to have the fluid drained. The cardiologist at the hospital said they can do this procedure if necessary, but they want to give the medications a chance to work, but they will watch her carefully in the ICU.
Meanwhile, Chednaline’s dad came to visit. He was 3 days late. Chednaline’s mom had tried to reach him numerous times before they were transferred to the hospital but he was not available. He came with his older brother who appeared to be heavily involved in voodoo. They were very angry that Chednaline was in the hospital. They didn’t seem to care that she needed a higher level of care. Lori and our staff spent hours talking with them. They wanted her out of the hospital. But they were not very excited about traveling to Port au Prince. Chednaline’s father spoke with her mother for several days and finally decided that he would let her stay in the hospital but he did not want her to have surgery.
In summary, Chednaline is the hospital receiving medication for presumed tuberculosis. She has a large pericardial effusion that has the potential to interfere with her heart beating. She may require an operation to remove the fluid from around her heart, but her dad will not consent. We praise God for the multiple miracles that took place to get Chednaline to a hospital that is able to give her the care that she needs. Please pray with us that the medications will work and that she will not need a pericardial window. But if she does, pray that God will change the heart of her father and that the medical team caring for her will be able to save her life with this operation. Thank you for praying.