On Wednesday we accepted a transfer from a district hospital outside of Kigali. The patient was a 5 year old girl who had been hit by a car 2 weeks earlier. She suffered a skull fracture and CSF leak. With minimal surgical options at the district hospital, she was medically treated and kept in the hospital, intubated and in critical condition for almost 2 weeks. She was transferred to us after “deteriorating further”- high fevers, worsening mental status, etc.
She arrived to us intubated and completely unresponsive to even painful stimuli. A large pocket of pus could be felt under her skull and she was leaking CSF from her ear. It was clear that she was suffering from meningitis, and honestly I was shocked that she was even alive. With her being completely unresponsive, having no respiratory drive, and minimally reactive pupils, I pushed for palliative measures. We decided we would give her one more day on antibiotics and told her father that she would likely die that night.
I arrived at the ICU this morning expecting to find her bed empty. But I was shocked to find that she was improving! She was starting to follow commands and had improved respiratory function. She still has incredible obstacles to overcome if she stands a chance to survive this, but there is hope for her, especially now that she will have the opportunity for neurosurgical intervention.
Unfortunately, this patient is representative of a major problem in critical care in Africa- ineffective triage and failure to transfer patients to more capable hospitals before it’s too late. If we could improve the triage process of critical patients at the district hospital level, we could save many lives here.