The power of family

I have always known that family was important. But I didn't know that here in Afghanistan, family is not just important, but it is crucial for the survival of children in the hospital. Not that our nurses and doctors are incapable of taking care of children; it's just that kids heal so much better when their families are present.

The 5 year old little girl with the penetrating head trauma has been in the hospital for several weeks now, and she has been getting feedings through a tube inserted into her nose. We have been trying endlessly to get her to take feeds by mouth, offering everything from applesauce to yogurt to milkshakes. Not only would she take nothing, but she would spit out the semi-solid food in disgust. She would not sip from a straw, and the only way we could get her to take any liquid was by squirting it into her mouth using a syringe. In her case, there are three reasons why she might not be eating:

(1) she's not hungry - this seems possible given that she's getting tube feeds and therefore her stomach is rarely empty

(2) she cannot eat - this doesn't seem likely given the location of her injury and the fact that she is able to swallow her own secretions

(3) she doesn't like the food - always a concern with these Afghan children; their diet is very different from the "typical" American diet we offer them in the hospital

We tried to "fix" problems #1 and #3 as best we could by offering her a wide variety of foods and slowing down her tube feeds to attempt to artifically create some hunger. But all of our efforts were to no avail; she still would only take a few ounces of liquid per day, nowhere near as much as she would need to in order to maintain her hydration and nutrition. A few days ago, it seemed that we had met an impasse.

Meanwhile, a few days ago, her uncle (who had been her guardian since a few days after the injury) needed to return home to take care of some personal matters. She was far less happy during his absence, and did not want to interact as much with the nurses. She no longer spoke or played. However, everything turned around once her uncle returned last night.

When he walked onto the ward and saw her sitting up in a chair (almost) by herself, he literally started crying. She had made a ton of progress in her rehabilitation since he last saw her. She was returned to her bed with her uncle at her side, and a few hours later the nurse went to check on her. Would you believe that there was an empty box of juice on her tray? When questioned, the uncle stated that she took the entire box - and she drank it by the straw! She was provided with a nutritional shake and a half banana, and with some help from her uncle, she took those too! Amazing.

This morning when I saw her, she was eating yogurt from a spoon. It was quite a happy sight, with her opening her mouth for more food and her uncle shoveling the yogurt in. (The trauma surgeon said that it reminded him of a little bird opening its mouth for food.) She will be transferred to a Red Cross rehab hospital today, and will follow up as an outpatient next week in order to track her weight, blood protein level, neurologic status, etc.

Thank goodness for happy endings!