The Boy from Betio

 

This is Betio hospital…one of 2 main hospitals in Tarawa, the capital of island nation of Kiribati. I was recently fortunate enough to travel to Kiribati with a team from Australia to share some knowledge with the local doctors and nurses. This was our last day of teaching. What a phenomenal group of people to teach, so generous and thirsty for knowledge.

The formal teaching was done, but some nursing colleagues and I had the opportunity to run through some cases with a group of nurses working in this tiny rural Emergency Department. We had a great time, made some new friends and couldn’t have asked for a more positive punctuation to our teaching trip.

Immediately after this photo was taken, we were sharply reminded of the cruel reality of healthcare in developing nations. As we were saying our goodbyes and loading the car, we were very politely asked to stay and lend a hand with the care of a school aged child who had been pulled out of the lagoon.

Having learned the capacity of the ED, we gathered what equipment we could find and set about preparing for the arrival of a drowned child. I had a handful of oropharyngeal airways in my backpack and we found a bag/mask in the donation bag we were planning to leave at the hospital. As soon as we could locate this equipment, we were met the announcement that the ambulance had arrived. Out of the back of a weathered 70 series LandCruiser, a limp, sand covered boy was gently carried – he could have been no older than 3. He was laid upon the cold steel frame of the single bed in the resuscitation area of Betio hospital where the team set to work.

While an Australian colleague and I managed the child’s airway, I was struck by the nauseating reality that this boy was the age of our own children at home. Very quickly it became evident that the boy was lifeless – despite language barriers and varied levels of expectation, we commenced a vigorous resuscitation effort (knowing very little about the history of the event, but experientially fearing the worst).

Chest compressions began as we filled the boy’s lungs with oxygen. Skilled local nurses set to work cannulating impossibly tiny veins. With limited available medical support on this shift, we looked for comfort in the life support paradigms we knew (and hoped we had taught) so well.

We were thankful for our handful of leftover supplies as the equipment we brought with us was the only readily accessible paediatric ventilation equipment in the department. At the time of our arrival there was no adrenaline in the ED at Betio, so we moved on. We soon learned there was also no defibrillator in the ED at Betio. Thinking as laterally as our minds would allow, we attempted to attach some standard cardiac monitoring to help guide our efforts – but we were unable to remove enough sand to attach the leads. It felt a little like driving with your eyes closed.

What we were left with was a group of fiercely determined clinicians, some manual ventilation equipment, a pulse oximeter, thermometer, stethoscope and the torch from my phone. We managed to perform some rudimentary stomach decompression with a small feeding tube as this was all we could find in the resus room.

We worked to fix what we could knowing that the writing was likely on the wall. Seemingly the resus room of Betio hospital had become the hottest place on earth as I struggled to see through a haze of sweat, sunscreen and insect repellent. As we worked, the background of our patient’s fate became apparent – he had drowned some 60 minutes earlier and was transported 40 minutes to hospital with little option for meaningful prehospital resuscitation (in Kiribati ambulances are purely for transport – there are no paramedics to bring first aid to the scene). Initially the bystanders who pulled the boy from the water attempted to swing him upside down to drain the water from his lungs – as the scale of public education on resuscitation is limited in Kiribati (at least by Australian standards) this is not an unusual approach to bystander rescue.

After at least an hour of cardiac arrest and following an attempt to reverse any immediately correctable causes – the junior doctor staffing the ED that morning met my defeated gaze and with the slightest shake of my head, we found common ground in our understanding of the moment. A few minutes later resuscitation was ceased, and the boy slipped away.

The moments that follow the death of a child tend to invade your sense of self like nothing else I have experienced. A mother’s tears met the sympathetic silence of rescuers who tried in vain to restore some balance in what always feels like a definitively unjust situation. Moments like these find a way through the tiniest cracks in your exterior and stare right into your soul. It’s a feeling that you carry with you long after the images and actions fade from your memory.

When we stepped through the doors of the hospital, the steaming Betio air was almost refreshing in contrast to the stifling resus room. We realised in our haste to help that we had left our car not only unlocked, but running, with all the doors open and one of my colleagues’ handbags on the roof.

The drive home to our hotel was quiet, but reflective. As we debriefed there was a sense that more questions existed than answers. And the magnitude of the questions had grown far beyond those that we were accustomed to addressing in our comfortable Australian lives.

Our time in Kiribati was filled with warm weather, vibrant people, postcard sunsets, generosity, curiosity, earnest teaching and honest learning. But some of the lessons I have learned came harder than others. I learned a lot about what it means to live in a ‘lucky’ country, where at any moment skilled first responders are only a phone call away. Where our friends and family are generally well prepared to respond to crisis through extensively funded education programs delivered through the whole community. Where our health service is far greater and more capable than we ever give credit or thanks for, despite what the papers say.

If I didn’t know it before, this trip taught me that life is fleeting and the people around you matter far more than all the other bullshit.

But I think most of all, I relearned to appreciate and value how precious life can be and how absolutely honoured I feel to be a part of a profession, and a service that does far more good than harm.

And as I sit here waiting to be reunited with my family, I appreciate how much I have taken for granted being able to hug my daughter whenever I want.

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