On a Turkana stay in September 2011 I visited the paediatric stabilisation centre at Lodwar Hospital. That centre is supported by UK NGO Merlin, whose Turkana team were keen to fundraise for much-needed blood transfusion facilities. I hadn't realised just how needed these were, until I met some of those affected.
They were unable to move. Trapped in a paediatric ward and in every parent’s nightmare, Agnes and Paul Ekitela kept vigil over the gasping and strange-looking body of their son Ereng. Strange because it was wracked by severe malnutrition combined with anaemia, and through this deadly combination had become angular, distant, and struggling.
The family had come from Loima, an area far away on Kenya’s border with Uganda that is not easy to live in. Marked by a cycle of cattle raiding and conflict between Turkana and their old enemies across the border, the Karamojong, Paul and Agnes only feel safe now because all four of the cows they owned were lost in this year’s drought. They survive, just, by making and selling charcoal and receiving occasional relief food. The hallmarks they bear of a traditional life in the remote bush – the way they dress, move, even the way they smell – make them seem out of place and a little self-conscious in the bustling hospital of Turkana’s largest town.
Two days before they brought their son to Lodwar he collapsed with weakness. The middle child of three, Ereng was always the cheerful and alert one who got on well with both older brother and baby sister. He would head off happily to school brother but run eagerly home to rush around his mother and baby sister in the homestead. Recently he became suddenly thinner, weaker, and swollen. On the last day he spent at home he asked for some sugar: his parents were relieved that his appetite seemed back but with no money were unable to satisfy it. After that “he fell,” as his mother put it, her eyes flung suddenly to the ground.
Agnes and Paul walked to the road and then in the direction of Lodwar. Carrying Ereng, their tyre-tread sandals bore them slowly along until a passing Merlin vehicle picked them up and, recognising severe malnutrition with possible complications, brought them to the stabilization centre at Lodwar District Hospital
The ward was full of children in various stages of recovery, mainly from severe acute malnutrition with complications, but Ereng went to an individual room in the intensive care unit. Agnes and Paul watched, transfixed, as he was put on a drip and had his blood tested. The level of haeomoglobin in his blood was a shockingly low 2.6 grams per decilitre – a healthy child’s blood will show 11-16. At this point though, Ereng’s parents seemed to be feeling some relief to have shared their terrible burden, to watch bustling health professionals with uniforms and stethoscopes attend to their son with confidence and a superior knowledge. They even relaxed enough to tell me about the feared Karamojong, cattle raiders who come into your territory disguised as one of you, a Turkana, but can be distinguished by how they wear their blankets and a distinctive fast walk developed in their hilly escarpment home (and imitated comically by Paul).
Ereng clearly had severe anaemia as well as malnutrition and needed a blood transfusion. Lodwar hospital has no blood bank and no blood screening facilities, relying only on trucks bumping scant supplies along a terrible road from Eldoret. So apart from a plasma expander, intravenous antibiotics and medication for the fever now raging in Ereng’s small body, there was little staff could do. Higher up, desperate phone calls were made to other hospitals in the vast district that might have available blood of Ereng’s type. On the ward itself Ereng was fastidiously attended to and many people prayed. A day later he was dead.
With the red blanket he had arrived with now wrapped around him as a shroud, Ereng had finally stopped shaking, hiccupping, and fighting for life. Almost at once his terrified parents left the scene. No one ever saw them again, they didn’t even want to pick up the body.
Other mothers gathered briefly at the doorway, their eyes on Ereng’s still form but every inch otherwise recoiling from it. One explained that when death comes to a place it may linger and look for more victims, so mothers must be extra watchful over their children until death has left. Clearly shocked, a group gathered in the courtyard and discussed how Agnes and Paul had fled, recognizing that being from the deep interior they feared everything about the hospital and town. The women felt for the crushing defeat they suffered to lose their son even after the long journey and the raised hope, and the powerlessness they endured at being able only to watch while nurses tried violently to resuscitate Ereng. But among the sympathy one older woman warned that you should never abandon the body of one of your own: it sits badly with the ancestors, it troubles the soul of the boy itself, and having no burial challenges a grieving community’s ability to re-form and heal.
Ereng died for lack of blood. Fifteen minutes after he breathed his last breath and his parents ran blindly out of the hospital a batch arrived of exactly the right type. It had travelled by road from a hospital in Kakuma which had heard of the emergency and wanted to assist. Tragically too late, but it would not be wasted. It went straight to the hospital’s laboratory to be cross-matched, tested, separated, labeled and readied for transfusion to two other children with severe anaemia in the paediatric ward. They were not as bad as Ereng but like him were also malnourished and weak, and only blood could kickstart their recovery.
Laboratory technologist Mike worked long into the night to get it all ready, finally reaching the paediatric ward at around 10pm with the drip-ready bags and joining forces with the nurse on her night shift who had prepared the two most urgently anaemic children for transfusion.
Shadrack Ekeno had been brought by his brother Meshak from nearby Nadapal, his leg swollen horribly after a traditional scarification treatment had gone wrong and he had lost a lot of blood. With a haemoglobin count of just 2.2, it was suspected that something deeper might be wrong with the nine-year old boy, but the immediate priority was getting him blood.
Shadrack’s blood type matched the recent delivery so he spent the night receiving iron-rich, deep red blood. He seemed shocked at first to watch it dripping through the line into his arm, but comforted by his older brother and exhausted by his condition he soon fell asleep and let the medicine work.
By morning the previously lifeless Shadrack was sitting up and
even moving around the courtyard with an excited Meshak. The scared look in his
eyes remained and there would be more tests and treatments to come but for now
he had been brought back from the brink and the miracle of blood transfusion
had played out.
Across the courtyard a younger patient Asinyen Itiang had a haemoglobin count of 4 and so became the second recipient of the precious blood batch. She didn’t even register the tugging of canula, tubes and drip stand into place as the transfusion began, so far gone did she seem in a world of weakness and pale shadows. Her exhausted mother Nawokwot watched every detail but she also didn’t move, shocked by the recent death in the ward and exhausted from the long journey she had made to get there. She had carried four-year-old Asinyen in her arms over a flooded river and exchanged the family’s last goat for a ride on the back of a motorbike to Lodwar. She told me how lucky she had been that the motorbike owner had pitied her enough to accept such a skinny, malnourished goat.
In the darkness of their ward mother and daughter waited quietly for the effects of this new, strong blood to be felt, and by morning, with the sun coming up, they were. Asinyen had slept but when she awoke her gaze was freshly focused, her attention direct and her appetite keen. She was still thin and underweight but she had been plucked from the freefall which anaemia and severe malnutrition had thrown her body into. They left a couple of days later and would register for the specially enhanced nutritional supplements Merlin and WFP give to children like Asinyen.
Today the whole district of Turkana is suffering from a
savage drought that joins hideously with rising food prices, poor
infrastructure, and years of inadequate and inappropriate assistance to
undermine the livelihoods – and lives – of pastoralists. In Loima Ereng’s waiting
grandmother and siblings would soon see Agnes and Paul returning without him, a
lost grandson and playmate, and life would have to resume under the burden of
this latest grave loss.
Back in the paediatric ward, the shock would linger for a time and the death of Ereng would touch everyone in different ways. Watching them, it seemed mothers had vowed to wrap their protective care ever more tightly around their children, and staff like Christine the night nurse and Mike in the laboratory seemed propelled to work faster and harder. The hospital and Merlin realized the urgent need to solve the problem of blood for anaemic children and are currently working on how to do this, with safe screening and storage facilities on site.
Ereng died too soon and lies in an unmarked government grave outside Lodwar. His parents, grandparents and even ancestors are distressed, and with the memory of his little body wrapped in a red blanket we must all find the distress and determination needed to ensure that this sort of death can’t happen again – not for blood alone.
Shadrack Ekeno had been brought by his brother Meshak from nearby Nadapal, his leg swollen horribly after a traditional scarification treatment had gone wrong and he had lost a lot of blood. With a haemoglobin count of just 2.2, it was suspected that something deeper might be wrong with the nine-year old boy, but the immediate priority was getting him blood.
Shadrack’s blood type matched the recent delivery so he spent the night receiving iron-rich, deep red blood. He seemed shocked at first to watch it dripping through the line into his arm, but comforted by his older brother and exhausted by his condition he soon fell asleep and let the medicine work.
Across the courtyard a younger patient Asinyen Itiang had a haemoglobin count of 4 and so became the second recipient of the precious blood batch. She didn’t even register the tugging of canula, tubes and drip stand into place as the transfusion began, so far gone did she seem in a world of weakness and pale shadows. Her exhausted mother Nawokwot watched every detail but she also didn’t move, shocked by the recent death in the ward and exhausted from the long journey she had made to get there. She had carried four-year-old Asinyen in her arms over a flooded river and exchanged the family’s last goat for a ride on the back of a motorbike to Lodwar. She told me how lucky she had been that the motorbike owner had pitied her enough to accept such a skinny, malnourished goat.
In the darkness of their ward mother and daughter waited quietly for the effects of this new, strong blood to be felt, and by morning, with the sun coming up, they were. Asinyen had slept but when she awoke her gaze was freshly focused, her attention direct and her appetite keen. She was still thin and underweight but she had been plucked from the freefall which anaemia and severe malnutrition had thrown her body into. They left a couple of days later and would register for the specially enhanced nutritional supplements Merlin and WFP give to children like Asinyen.
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| Asinyen and Shadrack after blood transfusions |
Back in the paediatric ward, the shock would linger for a time and the death of Ereng would touch everyone in different ways. Watching them, it seemed mothers had vowed to wrap their protective care ever more tightly around their children, and staff like Christine the night nurse and Mike in the laboratory seemed propelled to work faster and harder. The hospital and Merlin realized the urgent need to solve the problem of blood for anaemic children and are currently working on how to do this, with safe screening and storage facilities on site.
Ereng died too soon and lies in an unmarked government grave outside Lodwar. His parents, grandparents and even ancestors are distressed, and with the memory of his little body wrapped in a red blanket we must all find the distress and determination needed to ensure that this sort of death can’t happen again – not for blood alone.
