Save the Money to Transport the Body

There was a patient on the wards yesterday who we rounded on because she was very sick.
She had come in overnight, seven days after delivering a stillborn fetus at 36 weeks. She was extremely jaundiced, weak, and nearly comatose.

There is no glucometer, so comatose patients are usually given some IV glucose as protocol. She responded to glucose pushes, but repeatedly became comatose. Her eyes were yellow.

The suspected diagnosis from the on call team was hepatitis or malaria. Her blood pressure had not been measured. No labs had been checked, because labs are billed to the patient and the patient is poor (a routine lab, like a CBC or a chemistry, is about 14,000 shillings, or about $8.).

On rounds we checked her blood pressure - it was 160/105. Magnesium was ordered, and labs were requested.

Over the course of the day, she became comatose more than 10 times, but responded to glucose pushes. Eventually, they ran out of D50 to push or even to make a D10 infusion. They checked medical ward and pediatric ward - none. They gave Ringer's Lactate, which was all that was left, but the patient deteriorated. Imam, the postgraduate on call, asked the husband to go with him to a store to buy some IV glucose solution, but the husband refused. He told Imam that he was saving the money to transport her body home; he could not spend it on medicines.

This morning, the interns and Imam tell me the whole story. The bed was empty this morning, and they thought the patient had died. But on inquiry, the patient disappeared sometime after 10pm last night. They tell me that probably the family wanted to transport her home before she died, because transporting a corpse is much more expensive than transporting a live person.