Wednesday, July 24, 2013

They Know They Were Lucky: Guy and Rotavirus

[This story is from Israel] 
Guy was 9 months in December 2006, a sweet tempered, mellow baby. A crawler. He was not very vocal – unlike his younger cousin, he did not babble a lot – but he smiled frequently and was a very affectionate baby. His mom, Lilly [name altered to protect anonymity], has just recently returned to her work as a dentist.
It was Thursday, and his grandmother Sara picked him up. Normally, she said, he would crawl straight over to her, but not that day: he was somewhat weak, and she thought at first he had a fever – but he did not. He refused his usual yogurt, refused to lie in bed for his usual short nap, and just curled up in her arms, limp and unhappy, clearly unwell.
That evening, his parents took him to the doctor for the first time. Lilly says: “I was a little concerned because he was a little apathetic from the start of the diarrhea, even though we gave him as much fluids as possible, to prevent dehydration.” The doctor diagnosed rotavirus. “It has a unique smell,” explains Sara. “It’s impossible to miss”.  They took him home, and he seemed to be improving.
The next day, Sara went to visit her daughter, Lilly. She describes what she saw: “Lilly was sitting in her dining area on a plastic chair, a bucket next to her, baby in her arms, and he was throwing up into the bucket again and again, poor little guy, he was so miserable. He did not even have the energy to cry.” They took him to the doctor again. Because it was almost the weekend, the doctor prepared a referral to emergency room, so that if the baby got worse over the weekend he could be hospitalized without delay.
Lilly describes Guy that Friday afternoon as alternating between inconsolable fits of crying and episodes where he was completely unresponsive and limp – “apathetic” – which frightened her even more. Worried, Guy’s parents took him to the hospital. Lilly says “without hesitation they hospitalized him and put him on IV.  It took them a while to be able to find and access his veins because he was getting dehydrated. And they hospitalized us and gave him fluids and monitored him – no medication, because it’s a virus.” She called her mother from the hospital, gave her the news and a list of necessities to bring – since Lilly had packed nothing for a hospital stay.
Lilly stayed with Guy constantly in the same ward, sleeping on a couch next to his hospital bed. She says: “Together with Guy there were ten more babies in the same ward hospitalized because of rotavirus. The door said “isolation”.  Every time someone went in or out they had to wash their hands with anti-bacterial soap.  All the mothers were attached to their babies. It was a nightmare.”
Sara visited her daughter and grandson the very next day. She arrived just as Guy was being taken for an examination by the doctor, and she carried the IV while Lilly carried the baby. She says: “he cried so hard, it broke my heart. He was so miserable.”
After four days in the hospital, Guy was released.  On the way home in the car he started vomiting and having diarrhea again.  Lilly says: “when we got home it continued, and he looked bad – he looked pale, apathetic. He could not cry, he was so exhausted. So we said, there’s no choice, let’s take him back to the hospital. By then it was night time – 8-9pm.” Again, they checked Guy in, again, the search for a vein to insert the IV into in the dehydrated, miserable baby. And three more days of  the ward, with an unhappy baby hooked up to IV, with ten other suffering babies, with bad sleep on a couch, with stress, pain, and worry.
And then he got better, and they took him home, and this time he stayed better.

Lilly and Sara also know they were lucky: living in an industrialized country, with easy access to a universal healthcare system and very good medical care, Guy got the help he needed quickly. According to the World Health Organization, hundreds of thousands of children die from rotavirus every year and millions are hospitalized, most – but not all -  in developing countries, though the numbers are declining, thanks to the availability of a vaccine against the disease. In the United States, prior to the vaccine, “rotavirus infection was responsible
for more than 400,000 physician visits, more than 200,000 emergency department (ED) visits, 55,000 to 70,000 hospitalizations each year, and 20 to 60 deaths.” See also here, for a previous story about and discussion of rotavirus.
Still, even with the best care, Lilly describes the experience as “stressful, painful, worrying”.  “I haven’t heard of rotavirus before this,” said Sara. “I raised four children, and we went through several childhood illnesses – there was no vaccines for some of them, and they had mumps, rubella, and a host of digestive issues. They had diarrhea; I remember a night when my daughters were four or five, and they went to the bathroom in turns for about 18 times, one by one. But I don’t remember anything close to this bad. Since then, just hearing the name “Rota” gives me chills. I think the vaccine Lilly was most eager to give [Guy’s younger brother] was Rota.”
Lilly says, “but there was no vaccine available at the time, if there had been one we would have given it to him. We made sure to vaccinate our second child, there was a vaccine then, and it was never in doubt."

Image from The Public Health Library, Provided by Dr. Erskine Palmer:

Acknowledgements: I would like to thank Stacy Hillenberg, Clara Obscura, Meleese Pollock and Alice Warning Wasney for comments on drafts, as well as my interviewees, Guy's mother and grandmother and his grandfather. All errors are, of course, my own. 


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