NS, a 4 year old boy came the next day after the 2 sisters were admitted. NS was quite sick. The history was more suggestive of acute intestinal obstruction with severe anemia. And interestingly his mother was also quite sick. The only difference being that NS looked very sick and was almost unconscious.
NS’s blood tests were terrible. Hemoglobin of 4 gm%, 40% of the RBCs filled with the falciparum parasite and a platelet count of 20,000/cu mm. We needed blood fast. A peripheral smear showed all signs of hemolysis. NS reminded of Shalom, my son. He was almost of the same age.
NS was from Phulwaria – a village along with banks of the river nearby. Phulwaria is a common name for villages in this part of the country. The basic characteristic of all Phulwarias I know of is that they are usually the name given to the outer neglected part of the country side. And it is the same with the Phulwaria that NS’s family came from.
Families living in utter poverty and neglect. The only attraction for them to live there is the river that flows nearby. Most of the families live on some odd labourer jobs and most of them are at the mercy of the local landlords. The women live collect wood from the forest part of which is sold and the rest used to cook whatever they can afford to buy. The perennial river ensures that there are collections of pools of water at many places away from the area of water which flows constantly. And this supposedly is the place for breeding of mosquitoes spreading all diseases which the mosquito spreads.
I told the relatives that if we need to save him, we needed blood. Off the 3 male relatives went off to get blood. It was then I realized that I was fit for my next donation and our blood groups matched. And I did not have to give much for a 10 kg child. Off went the donation and the blood was being transfused in no time.
I was with the child for about half an hour as the blood was being transfused. I was looking at the possibility of intubating NS and ventilating him. The other option was to put him on CPAP. But his saturation was maintaining well.
I thought of rushing home and getting freshened up. I had just reached home when I got a call from Acute Care that NS had arrested. Nandamani was in the next room doing a cut down on FD. He had NS intubated but he was not responding to any resuscitation.
By the time I reached ACU, there was nothing we could do. It was not surprising that NS collapsed so fast considering his hematological parameters.
The next day, Angel reviewed the peripheral smear of NS where she found out evidence of severe hemolysis. Most probably, NS had gone in a state of auto-immune hemolysis which is commonly seen in severe malaria.
The saddest part of the story was that the male relatives came almost 3 hours after NS had died. I told them that we had tried our best. As I was conversing with them, I realized that all 3 of them very stinking alcohol and I was talking to 3 fully intoxicated men. I realized the futility of my talking and left them to take the dead boy home.
It was sad. NS was the only child of his parents. As with almost every family in Phulwaria, NS’s family also had a hand to mouth existence. Everybody drowned their sorrows in alcohol which was available plentiful. If the local women did not make the country brew, it could be brought in the nearby Satbarwa village or they could always buy a bottle of ‘English liquor’ which was a bit more expensive. The story about alcohol use would distract you from the objective of my post.
Malaria continues to ravage in parts of Jharkhand in an almost vengeful manner. There are multiple factors which would continue to ensure that the parasite would remain in the communities we serve. Unqualified medical practitioners also compound the problem.
I could only watch helplessly as the nurses removed the almost full pint of blood. They asked me what to do with the rest of the pint. I told them to keep it in the fridge. Maybe, if I got someone else with a A positive group, I could transfuse the rest of the blood. I wish I waited to donate blood for another patient who had a better chance of surviving.