My first Liberian "Transport"

The range of patients that come through the doors of our emergency room is pretty incredible.  You just never know what the next taxi is going to drop off or who will come stumbling through the door next.  Katherine and I were called the ED entrance a couple of days ago to see a 3-day-old infant that was transferred from another facility.  We were taken aback when the nurse shoved a handful of sheets in our faces and unveiled an infant with severe defects:  her brain was not covered by skull, she had a cleft lip and palate, her left arm was missing, and her right arm had only 2 stubby fingers.  She was breathing fine, kicking her feet, and had supposedly been tube feeding just fine.  The sight took our breath away for a moment, but I managed to utter, “well, bring her to the NICU” and started to make my way there. 

Today, a 6-year-old boy was brought in with respiratory distress after having “swallowed” a marble.  He was stridulous and working very hard to breathe.  John, an emergency resident from University of Chicago, saw the patient first.  Knowing that there wasn’t much we could offer the boy here (we have no endoscopy or pediatric surgery), started asking around about who could help this patient.  Within a matter of minutes, one of the JFK physician assistants was on the phone with an “ENT” doctor at Firestone Hospital, about 1.5 hours from JFK.  He agreed to see the patient.  So, John and I gathered up gear for the ride (a laryngoscope, ET tube, sedation, IV set up and materials for an emergency crico… yup, definitely almost sh*t my pants thinking about having to trach this little guy to save his life….) and got a taxi!  We don’t have an ambulance here, so a taxi would have to do!  The taxi we got was just like all of the taxi’s here: old and barely functional.  John was nice enough to let me have the front seat and he sat in the back with the boy and his parents.  My gaze quickly shifted from the boy’s chest to the speedometer as we started to dart through traffic… only to quickly realize that the speedometer, of course, did not work (nor did the windows, vents, defogger, etc).   I took to my mom’s favorite soothing activity to do while riding in a questionably safe car: praying the rosary.  About half way there, the boy coughed suddenly and swallowed deeply.  My body cringed as I swerved around expecting to see him blue and gasping for air.  Instead, he scooted back into his seat and started to breathe more comfortably!  I have no idea what happened… he could have swallowed it, or dislodged it enough to allow for air passage…. But, whatever happened, he was stable for the rest of the ride.  Which left me to focus on the road… Oy…

We made it to Firestone safely, got him admitted for observation and scheduled for a scope in the AM if his symptoms recurred.  The taxi ride back to Monrovia was, well, exciting for sure.  The rainy season here is just starting…. And this rain is far from a sprinkle.  I may have feared for my life a few times on the way back… but, all in all, I feel good about it.  Another adventurous day here on the West African coast!