It's okay to shout FIRE in a crowded PICU

Our Saturday came to a dramatic ending yesterday when an electrical fire broke out from the air conditioner box right as we were preparing to leave.  First, it helps to know a few things about the picu at Mulago.  It's required to take your shoes off prior to entering the very narrow door into the unit.  So, more often than not, I have to climb over a pile of shoes to get through the door.  Once in the picu, you are standing in small square room with 5 beds (maybe 6, if you have a couple of infants) lining 3 of the 4 walls.  There are windows, so the light is good, but they don't open, so ventilation is poor.  A table sits against the 4th wall, and is usually covered with so much stuff that is hard to tell what's what.  Above the table sits 2 wall electrical boxes, one with switches to the lights, and one with a switch to the AC.  One of our goals this week has been to help the Ugandan staff organize what limited resources they do have in a way to be efficient, and for them to be able to see the supplies that they do have.  However, with the overwhelming patient load, and critically ill and dying patients just appearing in the unit, organizing supplies has fallen down on the priority list.  But, on this morning, there was some time, so I spent about an hour creating a "code cart" for the unit and cleaning off the table.

All of that was destroyed however, when smoke started emerging from the electrical AC box, and sparks started flying.  I immediately thought, "fire extinguisher"....... and then quickly realized there is none.  So, we turned off the power, and quickly turned off all the oxygen to the patients, and removed the patients from the unit, and ushered everyone in the acute care area (which is adjacent to the PICU) outside.  Then I began assessing the patients out on the sidewalk to make sure that when we could return, the sickest were let back in first.

Maybe not surprisingly, the patients and their families did not seem that alarmed or frightened by the whole event.  They calmly went outside and waited.  There was no yelling, no crying, no running.  When I asked one of the matrons (that's what they call their nurses) if this kind of thing happens often, she said "No, this has never happened".   So, why was I the only one who's heart was racing?  Struggle and calamity...... death and tragedy are an every day way of life for the people here.  Yet, there is a resilience and hope and light that can be seen in the eyes of the people.  They find joy in the simple pleasures of life -- a song or  a nap on the grass in the sun.  I am humbled to be witness to the rawness and purity of humanity in this place.

Jenny Boyd