The beginning of April is also the beginning of the rainy season here in Zanzibar and also means we are seeing a lot of children with respiratory infections, including pneumonia and bronchiolitis.
A two year old boy presented to Kivunge one evening with a three day history of cough, difficulty and breathing and fever. When he was admitted he had signs of pneumonia, and so was started on antibiotics. However when we reviewed him the next morning on the ward round we found that his oxygen saturation (level of oxygen in the blood) was low at around 90% (normal is above 92%). We planned to start him on oxygen therapy, but the mother refused, believing that giving oxygen would cause him to die. Despite a long discussion with the doctors and nurses and providing evidence against this idea, we were unable to convince her to accept the treatment and agreed to observe him. Unfortunately the following day his condition had worsened, with saturations of 80-85% and increasingly laboured breathing. Without oxygen, we felt that this boy’s condition would deteriorate further with a very sad outcome. Another long discussion followed, and with the help of other mothers who have children on oxygen at the moment we were finally able to convince this boy’s mother to accept the treatment.
We are lucky at Kivunge to be able to give oxygen therapy to patients who require it, but sometimes still face challenges coming up against strongly held local and cultural beliefs about healthcare. It can also be difficult for us, coming from Europe, to accept that we do not have the same laws here requiring us to always act in a child’s best interests, even if it means going against the parents’ wishes. This case led to an interesting discussion about medical ethics with the Kivunge team and, in the end, due to everyone’s involvement we were able to give the child the best treatment. We hope that if a similar situation arises again going forward, the team will be equipped to have this discussion and convince the parents to accept the best course of treatment!