One morning I came onto the ward; the intern on duty was already there - a very knowledgeable and conscienctious intern who I really enjoy working with. I asked him if there was any baby particularly worrying him and he said he was struggling with one born overnight after a prolonged obstructed labour.

 

The baby in question looked dusky and it wasn't until we succeeded in getting the oxygen levels up that I realised how blue he had been at first - I never saw cyanosis like this before I came here! I couldn't help the sinking feeling that 'this is not one we can save'. Yet of course you still try. I rearranged the babies, tubes and concentrators so that I was able to use one oxygen concentrator to run nasal CPAP (continuous positive airway pressure) and another one to deliver additional oxygen through a facemask. The baby's oxygen levels slowly picked up and the level eventually seemed to stabilise in the mid80s (respectable I thought as we had started in our 30s). Throughout the rest of the ward round, I would keep coming back to the baby because he would have moments where he stopped breathing and the oxygen level would drop down to the 40s - each time I would stimulate him with some bagging and then adjust the oxygen levels to ensure a better seal. He was already on antibiotics and fluids. Midmorning I wondered if the reason the baby was stopping to breathe was because he was having convulsions (which did not look like convulsions) secondary to birth asphyxia. We gave a loading dose of an anti-epileptic and things seem to stabilise. We had also seen all of the babies in the unit by now so I allowed myself to think things were looking pretty good... 

 

...and then the power went. My heart sank as I looked around at the 10 babies on oxygen, including Baby A who I had been spending a large part of the morning with. We closed all the incubators to keep the smallest babies warm. We removed the nasal tubing to ensure the babies could breathe as well as possible through their noses. I made what felt like 100 different calls and walked around the hospital to find the engineer who is in charge of starting the backup generator (if it is working), having brought money to buy fuel if needed. No luck. And then the skies opened. My heart sank some more because nothing happens in the rain! I eventually got through to the ambulance ('but it is raining doctor, we cannot go' - 'you are in a car, sebbo (sir), what do you mean?!') and took Baby A who was most in need of oxygen (the premature babies were all on small amounts) to the children's hospital.

 

When I got to the other site I was told they were also out of power and furthermore, that the backup inverter system was not working. I stood there at a loss, 'now what?'. Luckily our wonderful engineer-nurse-research administrator N appeared and said that we had a full and available oxygen cylinder (these are like gold dust but maybe we were due some good fortune!). He also happens to be one of the few people who can set it up. When I left that evening, the baby was on a rate of oxygen that was going to last until morning and I hoped fervently that the power would come back on, for him and for all the other babies and children. The next day, I walked with trepidation into the emergency ward because I honestly didn't think he had made it and far too often we are met by a different child's face in the bed.

 

But there he was! with his mother and aunt. I gave them all hugs and spent the rest of the day with a big silly grin on my face, showing him off to anyone who happened to pass and feeling very very grateful!