Management of cases in a Paediatric ICU is an area I have not had a lot of experience in during my clinical training so this week I chose to spend my time on this ward to further my knowledge of this specialty. It was explained to me by the consultant early on in the first ward round that the most challenging aspect of managing children on the ward is discussing end of life care due to the Sri Lankan emphasis upon the sanctity of life.

There were two cases of infants suffering prolonged hypoxic brain injuries due to the long travel distances between the rural areas serviced by Karapitiya Hospital and the fact that CPR is not common knowledge in Sri Lanka. In both children the level of hypoxic injury meant that they were unlikely to have a good prognosis. The PICU consultant explained to us the difficulty in communicating this to the parents and his relative inability to advocate for withdrawal of life support due to the risk of legal action if the parents’ were not in agreement.  This was re-emphasised by a case of a Downs’ Syndrome child with respiratory failure due to pulmonary hypertension. Despite the parents’ being told that there was no possible treatment available for their child they chose to sedate and intubate her for ventilatory support. Again the consultant tried to argue that this would only prolong the child’s suffering.

All these cases were put into perspective when I read later about Charlie Gard and his parents arguing via the courts for the trial of an experimental treatment, seemingly at whatever life quality it may be for the child. It made me realise that perhaps the value placed on life is both self- and culturally-determined and that choices around its’ preservation are too personal to judge. It really brought home to me the importance of understanding the patient and how their socio-cultural context informs their decisions in healthcare. 

The Sri Lankan value placed upon the health and welfare of children was re-emphasised by our family’s weekend journey to Kandy for the first night of the Esala Perahera. The streets were lined with thousands of families waiting for the giant parade of elephants, dancers and musicians celebrating the sacred relic of the Buddha’s tooth. We were told that the first night is particularly lucky for children as it brings them good health and good fortune if they see the parade. Our daughters were captivated by the spectacle of elephants lit up with LED lights and dressed in ceremonial costumes. However it was especially moving to see the number of families who had brought their obviously sick and unwell children out in the hope that they be blessed with better health and healing from their illness. Seeing the hope and comfort given to these families through this act of spiritual faith was a striking moment in my placement here in Sri Lanka.