Case Study

Juancito

Jose Ramon, Carmen Emilia, and their children live on a patch of farmland in a tiny, remote northern village of Nicaragua. For more than two years, Juancito, one of their four children, suffered from recurring bouts of pneumonia. He was often running a fever, racked by coughing fits, and exhausted. With the closest health post 15 miles away down a dusty foot path and reachable for the family only on foot, Jose Ramon and Carmen Emilia often chose to treat Juancito with traditional medicines, giving him chamomile tea and rubbing his chest with oil to alleviate his symptoms.

Soon after his fourth birthday, Juancito became severely ill with pneumonia. Recognizing this episode to be more serious than usual, his parents took turns carrying him along the fifteen mile path to the health post for immediate medical attention. The nurse and doctor, who just happened to be there despite only visiting the health post once a week, suggested that Juancito be taken to the slightly larger health center in the nearby village of Murra. As there was no ambulance to take him, Jose Ramon and Carmen Emilia had to scrounge up the money to pay for a ride to the health center. Upon seeing him, the doctor in Murra determined that Juancito needed immediate medical attention and because the health center lacked the nebulizer needed to treat him, the family waited another two hours for the ambulance that would take them to the state capital of Ocotal, four hours distant.

In Ocotal, doctors immediately began treating Juancito with a nebulizer, took x-rays of his chest and gave him antibiotics in a frantic race to save him. During the next three days, Juancito failed to improve and doctors transferred him once more, this time to the country’s largest children’s hospital in the capital, Managua. It was his last hope. Confused and scared, Jose Ramon and Carmen Emilia watched their son struggle to fill his lungs with air during the three hour ambulance journey to the capital.

Juancito was immediately admitted to the emergency room where he was placed in an oxygen chamber. Jose Ramon and Carmen Emilia were so pained and shocked watching their son’s rapid decline through the glass that they couldn’t bring themselves to talk to the doctors about his state. After three seemingly endless days, Juancito succumbed to this final bout of pneumonia. The doctor told his parents that if Juancito had been brought to the capital sooner, he might have lived. Jose Ramon and Carmen Emilia say the tragic loss of their son will haunt them for the rest of their lives.

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Stories and photographs of the case studies are courtesy of the families and children with permission to PneumoADIP for use in educational and non-commerical purposes only. Reproduction or translation of the case studies, requires explicit, prior authorization in writing. Applications and enquiries should be addressed to pneuadip@jhsph.edu.