Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Hospitalito Atitlan 2

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Each day working at the Hospitalito Atitlan brought new challenges. At every opportunity, the staff rose to the occasion. They were resourceful to the maximum, and by the end of the week, I fully realized that I had received much more of an education than I had contributed.

A young mother brought her 10 day old baby to us because it was feeding poorly, with little interest in breast-feeding. The infant weighed only 2 kilograms (4.4 pounds), was breathing shallowly and rapidly, had a weak pulse, rapid heart rate, poor cry, was jaundiced (yellow in skin coloration), had an obviously infected eye covered with swollen eyelids draining pus, and had a low body temperature. The tiny child was clearly dehydrated and hypothermic, which are often signs of sepsis (an overwhelming systemic infection). If the source of the infection was the child's eye, then a likely culprit would be the bacterium Chlamydia trachomatis, for which we did not have a rapid test available. If the baby had a Chlamydia eye infection, there was a good chance that it also had pneumonia caused by the same organism. We took a chest X-ray, which did not show a pneumonia, but that might have been because of the dehydration, which would not allow hydration of the infected lung tissue, and so prevent it from "blossoming" in appearance on the radiograph.

It was our impression that this child was in a very precarious situation. Indeed, if the visit to the Hospitalito had been delayed a few more hours, the child might have died. First and foremost, the child needed to receive life-saving fluid. Its inability to feed made it essential for us to place an intravenous catheter for fluid administration. I searched the tiny arms and didn't see anything that looked like a vein. I was fearful that we might need to perform a "cut-down," an incision through the skin to find a vein that we might cannulate, but one of the young Guatemalan technicians who performed many tasks at the Hospitalito gently caressed and patted the baby's arm, then slid a tiny catheter into a vein that none of us could see, and only he could feel. It was an awesome, and for this child lifesaving, performance.

We administered fluid, but realized that this child also needed nutrition. Another staff member suggested that she place a tiny feeding tube through the child's nose and into its stomach, through which we could push small amounts of breast milk provided by the mother. This was done, and now we could begin to give the child nourishment. Two antibiotics were given through the IV, and a third (necessary for the eye infection) was given through the feeding tube. To warm the child, we bundled it in blankets, and had the mother hold it close to her body. We had the option to transfer the child to Guatemala City, but decided that it was in too critical a condition to send on a four hour car ride without constant medical observation. It was going to survive at our Hospitalito, or not make it.

Fortunately, the child did not stop breathing. By the next morning, the infant offered small sucking gestures, and began to weakly breastfeed. It grew stronger over the next couple of days, and survived what I hope will be its closest call with death. Only time will tell what effects this episode will have on the child's development.

In America, we live in a relative haven where there is a neonatal intensive care unit around every corner. Mothers for the most part enjoy excellent prenatal care, and it is relatively rare for an infant to be in such a dire condition before it is brought to medical attention. That is not the norm in many other parts of the world, where infant morbidity and morality are much higher, and accepted as a fact of life. It is a worthy cause indeed to address the inequities that exist because of lack of education and finances, and differing social and moral values. All doctors should spend time thinking about these things.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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