How do you know when to give up and when to keep trying?

In the US medical system, there are all sorts of rules and testing to tell you this patient will live or this patient will die.  If patient X has this, give this medication.  If patient Y has that, give another medication or do this other test.  Here....the same rules don’t apply.  We are limited.  But God is not limited.  He is the same God here as He is in the US.  Even against all odds, He can still work miracles.  

This past month I had four premature babies, who were on the brink of life and death, die.  I knew it was probably hopeless, but I still tried.  The “shades of grey” baby lived for 5 days and then died.  All that his mom said was “Grande merci” after all of that.  (Thank you very much).  

I had another baby that was born at 1.4 kg also...and died after 2 days.  The mom had delivered on her way to the hospital.  The baby survived the night without a warm incubator.  He screamed.  He had vigor.  We bundled him up and put him in our “box incubator” with warm water bottles.  I thought he might make it.  He lacked a sucking reflex so we put in a feeding tube and started a line for antibiotics.  He died later that day.  

Then I had a mom come in presenting with labor and a non-cephalic presentation.  She said she was “9 months.”  We brought her to the preop area to prepare her for a surgery.  While I was waiting I did an ultrasound just to be sure it was a term baby because with the vaginal exam you could just feel small parts moving.  The ultrasound showed that she was only 7 months and had twins.  I explained that we weren’t going to do the c-section because these babies could deliver vaginally and probably wouldn’t live very long.  

She delivered soon after and both of her babies were 1.4 kg.  And both boys.  They were small.  They screamed.  They looked perfect.  Both of them!  But the last 2 babies that I tried to save didn’t make it.  Was it even worth trying?  

Of course it’s worth it.  We still try.  Even when it looks hopeless, we still try.  It was cold.  It was pouring rain.  I ran to get the box incubator and some new, dry blankets from home.  I’ve been using zane’s old cloth diapers to keep the box babies dry and warm.  I boiled some water and filled the plastic water bottles.  

The two baby boys were already starting to get tired.  Each breath was harder and harder to breath.  They were just too small.  There was a village midwife who has been observing in maternity this month.  One baby died.  I encouraged the mom to hold the baby who was still living to show her love for him while he died.  The village midwife laughed.  “Let him die, don’t prolong the mother’s suffering to watch him.”  I knew I was probably going against culture, but the mother seemed grateful to hold her baby boy.  She had just delivered.  She was tired.  But she showed her love to her dying baby boy.  She just held him close to her.  Skin against skin to keep him warm.  She was grateful and tears ran down her cheeks.  

I imprinted both of the babies’ feet with ink on a small piece of paper to go along with some grieving kits that a friend is providing.  

It is all very sad and I wonder if I’m trying too hard to save the little ones.  In a place where it’s even hard to save the term babies, am I trying to hard to save the little ones?  I have two term babies on maternity right now that are probably going to die in the next couple of days.  

Then I had a couple of follow ups.  

This baby's name is "Doctor".  He was born at 1.4 kg and is now 6 months old. 

Two days ago I had a woman come to my house because her baby was sick.  He’s 3 months old with a fever and no other symptoms.  Almost always malaria this time of year.  He was born at 1.5 kg.  I had told her that I would pay for this little one if he ever got sick.  I was trying to encourage her come to the hospital and not just to stay home until it’s too late.  Now I’m just in awe that the little guy is still living at 3 months....and looking chunky big (the mom’s not giving water to her baby).  He survived at such a small birth weight!  I wrote for an IV quinine drip for 3 days and felt encouraged that little ones sometimes live too.  They all don’t die.  

Today I have another follow up.  I have a mom here who has breastfed exclusively for 6 months.  Six months ago she had a baby boy.  Her first baby.  Her baby boy weighed 1.4 kg!  We gave him iv antibiotics and eventually discharged her.  

Now she is back with a 7 kg healthy baby boy!  It brings happy tears to my eyes.  I took a picture of her and told her to come back next week to get the picture.  I explained to her that she could start giving her baby bouille (liquid rice hot cereal) and to enrich it with fresh peanut butter (we would never get away with that in the US at this young age).  And that now she was allowed to give her baby a little water, but only if it was boiled.  I wish I could tell her to give him fresh fruits and vegetables little by little, but the reality is that people just don’t have the money to buy that stuff.  They are lucky to buy rice.  

Somehow this little guy has conquered the first challenge here in Chad.  Birth and the first 6 months of life.