Determining health

Yesterday late AM, a colleague was called to the NICU for a baby that was not doing well. We had heard about this infant that morning in our staff meeting. She was admitted the night before to our NICU because of prematurity and breathing problems. Mom had malaria just prior to delivering this baby, and was started on the appropriate therapy to help the baby breath better and to stop any possible infection. But the baby was still born prematurely, which in Rwanda and the rest of Africa is a challenge in itself. The infant was doing somehow OK over the course of the AM until she suddenly stopped breathing. The team did the appropriate steps to help the baby, but in the end, the baby died.

The whole team was upset, but the Mom took it with grace. She thanked all of us for our work for her baby. This is a common theme that I have heard during my time here; that of thanks, of grace. And, honestly, every time it gets me.

What gets me most is why did this baby have to die. Why did Mom get malaria? Was she using the mosquito net every night as directed? Did she have a mosquito net? Was it working? Was it treated with insecticide as directed? Did Mom have good prenatal care? Did the other siblings at home have malaria as well, and get treatment? What was the food situation? What was their housing situation? Why? Why? Why... I am awake at night because of these questions.

These are what we call social determinants of health. They are important factors in the US and in Rwanda. They have a direct impact on how well a patient does clinically. For us, we think about these factors all of the time, on every patient, and are trying to help with this. We will continue to fight for patients like this one.

For now, we move on to help the next baby, the next child, remembering the lessons from the previous ones.

Until next time...

Love life, Find meaning, Be happy,

Craiger