Family,  Sri Lanka,  Stories,  Travel

5 mistakes resulting in a hospital admission: lessons learned for managing dehydration in kids whilst travelling in a developing country.


This is a confronting piece for us to write and share. This is a full disclosure post. All of our mistakes outlined, what we’ve learnt and how you might avoid a similar situation. If this post helps just one family avoid the situation we were faced with it will be worth reliving the heartache. We are not medically trained, all we have is our lived experience to share.

Mid January 2019 our family of 5 left Australia for Sri Lanka to commence a planned year of travelling through South East Asia. With 3 daughters under 5, we had taken the time to have extensive consultations with a specialised travel doctor (Thanks Dr Tse @TMVC) to ensure that we were vaccinated, had a well stocked medical kit and were informed of some of the likely challenges we would face. We knew that illnesses would arise on our journey, just as they would at home in Australia. What we were not prepared for was how early in our trip it would occur and how confronting it would be.

*Please do not comment if you only have negative things to say. This is a post to inform those who may be faced with a similar situation as to how we would have changed our actions*

We arrived in Colombo, Sri Lanka on a Tuesday and took things slowly, allowing the girls to adjust to “new time”. There were lots of naps, park plays and swims in the local school swimming pool. Evie, our youngest,  took her first steps and had her first tuk tuk ride all before she turned 1 just 4 days later. Her 1st birthday “party” was celebrated at a cafe with cake, party hats and a candle and all in all was a relatively non-eventful day. Evie is a typical third child, curious about everything and wanting to be a part of everything her sisters are doing and exploring her surrounds (on all 4s). This is most likely how she contracted her viral gastroenteritis.


Mistake number 1: Considering her condition as “mild”

Evie appeared to have a relatively mild (or so we thought) bug. She had 1-2 episodes of diarrhoea a day over 2-3 days and a similar amount of vomiting. We had the added complication of having changed formula on arriving in Sri Lanka and considered this as a contributing factor. By Monday morning after 2 days of symptoms we were worried enough to take Evie to a private hospital in Colombo to be assessed by a Doctor to see if;

  1. She needed antibiotics
  2. She needed assistance with hydration
  3. If antiemetics (to stop her vomiting) would be beneficial

Mistake number 2: Being unaware of the cultural differences in developing medical care plans.

Culturally Sri Lankans are very respectful and do not question a Doctor’s treatment plan. Always clarify what treatment they would prefer you/your child to receive.

Coming from working in the Australian hospital system I am used to thorough discussions of treatment plans including conservative and invasive options as well as the pros and cons. This was our second mistake. With the added benefit of hindsight (and the 20-20 vision of the alternate journey for Evie) I wonder if the fact that the knowledge of doctors that we had onward travel plans influenced the treatment we received at the hospital. (i.e. not wanting to upset us and our all important places)

We received prompt and I would say thorough treatment. On arriving to the ETU the Doctor suggested admitting for IV fluids. I mentioned that “if she needed admission I would need to let our driver know” and subsequently a Paediatrician was called down to review Evie and an alternative treatment plan commenced. She was given an anti-emetic (anti nausea suppository) and oral anti-emetics as well as a local hydralyte (Jeevenee) and pro-biotics. After 2 hours of observation and with no vomiting we were discharged with instructions to keep her hydrated, ideally with the Jevenee 500-1000ml in 24 hours. Reassured that she was on the improve we continued with our onward journey to Hiriketiya Beach a 3 hour drive from Colombo.

Mistake number 3: That Evie sleeping was evidence of her improvement.

Evie slept most of the way, very unlike her and was quite docile and easily distracted.  We thought she was sleeping to recover as most of us do when ill. All in all she seemed to be OK.  She was interacting with her sisters albeit a little more frustrated than usual.

Mistake number 4: That hydrating Evie with water only was better than nothing or the risk of vomiting.

Throughout the day she continued to refuse to take anything orally other than to sip on plain water. At 7pm, after a bottle of formula, she vomited again – the first time since 3-4am that morning. With her refusing the hydralyte and vomiting the formula we resorted to a bottle of plain water and she went off to sleep as usual. She woke 1-2 times overnight, and at both times, rather than risk her vomiting – we filled her bottle with water rather than ORS or formula.

The morning of the hospital admission

We woke as normal to a chatting Evie. Our 2 other daughters were awake and the normal chaos of the breakfast routine of a family with 3 children under 5 commenced. We cooked toast and made a coffee. Within 30 minutes of Evie waking things took a dramatic and frightening turn. She started closing her eyes and drifting off to sleep in our arms. She was having difficulty focusing and her head was what I can only describe as lolling around. She was relatively limp. It was obvious that she was seriously unwell and we needed to get her medical attention URGENTLY.

So, with our minds in overdrive with concern we remained calm (for the sake of her siblings). I do not remember either of us raising our voices, crying or anything dramatic. We seemed to shift into action. I called our airBNB host who happened to be an expat Australian and explained our situation and the urgency. He responded with generosity and care and by the time we had gathered our passports, immunisation records, money, phone charger and nappies he was waiting to take Evie and I to his trusted local Dr. With Adam staying at our accomodation with our 2 daughters, I was left to make some big decisions in an unfamiliar environment alone.

8am. Stop 1.

The local Doctors’ clinic appeared open – it was 8am and the waiting room was buzzing. The receptionist informed us the Doctor would arrive at “maybe 8.30”?.

8.20am. Stop 2.

Emergency Treatment Unit at the local Dikwella hospital. A very basic hospital. Very Basic! The Doctor spoke great English and her treatment plan was clear. IV fluids for 4 hours, if no improvement we will transfer her the 45 minutes to the larger regional Matara Hospital. I accepted – I had a sick, listless, limp child that needed urgent treatment. I followed the non-english speaking nurse, past the dogs, into the children’s ward. A large open-aired room with 15-20 metal cots without sheets. Empty. With one nurse. The nurse asked me if I had a sheet? No, I replied. She then proceeded to take a sheet off another bed and offer it to me to smell for cleanliness. I felt uneasy. Concerned. Unsure. Alone.

8.30am. I decided to bypass this hospital and take Evie to Matara ourselves. It turns out this was a good decision, but at the time, turning my back on immediate care with only the unknown ahead was heart wrenching.

9am. Stop 3. Asiri Private Hospital Matara

We arrived, with Evie still barely rouseable, to the ETU at a private hospital in Matara. We were seen promptly. A paediatrician was consulted over the phone and a treatment plan was proposed. IV fluids with glucose and in addition anti-emetics, zinc (for gut health) and pro-biotics.

9.30am. Moved to a ward. No IV as yet.

1st attempt to get an IV into Evie’s foot failed. She was too dehydrated. This is when I realised that my decision to bypass the local hospital without a resident Anaesthetist was a good move. Had we stayed we would have been delayed potentially another hour.

9.50am. Anaesthetist arrives to cannulate Evie successfully into her right hand. It is splinted and bandaged so that she cannot remove it. At this point in time she has no interest whatsoever in it.

10am. IV fluids commenced. Evie asleep. Mum relieved.

In Australia the best practice guidlelines for rehydration is via a Nasogastric tube, however in “SHOCKED” children, which I believe was Evie’s case IV fluid “resuscitation” is indicated.

Over the next 24 hours, Evie received a total of 19 hours of IV fluids. She received a suppository in her bottom containing anti neausea (Ondansetron) medication and did not vomit. She had one large episode of diarrhoea, no fever and no vomits. Her wet nappies improved significantly, to the extent that it was only then that I realised how much her “wet nappies” had dropped off. This is an EARLY SIGN of dehydration of which we were asked about in Colombo and I could not answer accurately.

Lesson 1:
Be persistent and pedantic about oral rehydration!

According to the Royal Children’s Hospital (RCH) fact sheet, our first step for treatment should have been:

First 12 hours replace formula bottle with an Oral Rehydration Solution (ORS) at 20mls per hour. Evie was fussy and refusing ORS, we persisted with formula bottles.

Give it by syringe, icypole/iceblock (not available in chemists) – we could have frozen iceblocks and would do this next time. Be creative and don’t be complacent, small children become dehydrated very quickly. Try alternative flavours – we have since found a lemonade flavour as opposed to the orange that Evie prefers.

Lesson 2:
Be patient and be clear that you want the best treatment regardless of travel plans!

Use clear language. Cancel onward plans, or do not mention them until a treatment plan is confirmed. Time can be very fluid in Sri Lanka and most developing countries, be patient and don’t ask for a timeline. In Australia you would always expect up to 4 hours in an Emergency Department situation.

Lesson 3:
A change in your child’s energy levels, combined with reduced oral intake and in conjunction with diarrhoea should be considered as URGENT!

If this happens, seek medical attention right away. Do not assume your child is recovering. Do not persist for 12-24 more hours at home without follow up. PLEASE trust your parental instincts, you are not a hassle and your child’s small body may need help recovering.


Lesson 4:
Using plain water diluted Evie’s body of the electrolytes needed for her system to function correctly!

In basic terms, we flooded Evie’s body which made it difficult for her vital organs to function. This is why ORS exists, the formulation contains the right electrolytes at the right concentration when made according to directions. Which goes back to LESSON 1.


Lesson 5:
Keep track of wet nappies!

Information is key to medical professionals and assessing a patients level of dehydration relies on knowing their urine output. Count them over a 24 hour period, feel the weight of the nappy, check the colour. All of this information is important.

We have learnt so much from this experience and are lucky that Evie recovered so quickly.

Have we missed anything?  And…more importantly have you learnt anything from reading this? If you feel this has been helpful or would benefit other travelling families, please feel free to share this.


20 Comments

  • Melanie Henry

    Thanks for sharing your experiences. This is such useful information particularly when thinking about cross-cultural expectations. We had a similar (but less severe) episode coming back from China but were fortunate to be on the way home and ended up at the RCH

    • thesmalllane

      Thanks Mel – it’s quite harrowing really. I think if anything we’ve learned to seek medical help early and be conservative. We really do have a duty of care to our kids, and can’t really know their experience (and they can’t articulate it like we can). We hope the post helps other families have confidence in their strategies and seek help early. 🙂

  • Georgie

    I completely empathise with this post and really respect you writing it. We were in Sri Lanka over Christmas and our little one picked up a tummy bug the morning we left London. He had terrible diarhea for 8 days. Thankfully I was able to find some ORS and literally syringed it in to him orally until he was better and he had no problems taking it. Another bonus was that he wasn’t vomiting, but I was still so worried about him ending up in a Sri Lankan hospital for fear of hygiene standards. Sounds like you did exactly what I planned on doing if our boy got any worse (persisting until you find a hospital you’re comfortable with and really pushing for the best treatment!). Really hope Evie is all better now and that you can enjoy the rest of your wonderful year of travel!

  • Karen

    Thanks for writing this. We travel alot and our daughter often falls ill and declines quickly. I will pack the flavoured rehydration sachets in future to make icypoles after reading about your little one. So glad she recovered.

    • thesmalllane

      Thanks for your reply Karen. Dr Tse (at TMVC – Melbourne) suggested that kids need a swift medical response if in doubt, it’s something that we will continue to follow 🙂

  • Tracy

    Thanks for the tips and sorry you had to go through this. We are travelling to Sri Lanka in May and while my daughter isn’t as young as yours all this information is vital to us being able to travel and keep well.

    Good luck with the rest of your journey

    • thesmalllane

      Thanks Tracy. We will. We’re noticing that we need to be across all immunisations and risk factors quite quickly. I.e. she cut her leg yesterday at home and we’re off to Drs again to ensure she’s up to date in Tetanus, etc. 🙂

  • Claire

    Oh Adam & Lisa
    Reading all of this, you did so well! I can’t insgine how scary it was. It’s good to know what you ‘should’ have done in hindsight but it makes it much more difficult when you’re in unknown territory, not to mention a foreign country!
    So glad she’s OK and I hope you aren’t experiencing too much guilt over this!
    Love
    C

    • thesmalllane

      No, I think the reflection is really important, but we know that at the time, our responses were the best we could do, considering our knowledge and what we had available!! 🙂 Hope you are enjoying your travels also.

  • Sinead

    A very brave post which I am sure will help someone one day so thank you for writing it. Hope your lovely daughter is feeling better and mum and dad are looking after themselves too!

    • thesmalllane

      Thanks Sinead – she has improved, but I think will continue to pick up little bugs given her age and curiosity (i.e. crawling everywhere, and putting things in mouth constantly!!). Vigilance will be important.

  • Charlotte

    Thanks for your honest post. You are a blessing to have shared your experience and lessons. We are heading off for a years travel with our 3 girls in 10 days so very timely to have come across this, thank you! X

  • Mandy

    I’m so glad I’ve stumbled across your site. I’m not sure how? Through OTT fb pg I think? We are a family of 6 leaving NZ in 3 weeks for our 12month trip, starting in indonesia – but will be in Sri Lanka in those first few months. I’ve been so very worried about this side of travel with kids. As funny as it seems this is actually reassuring – thanks for sharing. Love your writing style!

    • thesmalllane

      Wow, sounds like an epic adventure. Given the age of our kids, we are finding that a slow and steady approach is best for us (i.e. 2-3 weeks in one place and enjoy the time with family rather than see sights). It also helps us get to know people in the area and what facilities are around. 🙂 Enjoy xx Reach out on OTT (Facebook PM) if you’d like. You can find us at http://www.facebook.com/thesmalllane

  • Regine

    Thanks for sharing this. I’ve certainly learned useful information here. I hope you’re all doing well now and will be able to enjoy the rest of your journey without any further incidents. Fingers crossed !

    • thesmalllane

      Thanks Regine. We are still (like all the travelling families) learning what’s best for our breed. It’s going to be quite a journey.

  • Chelsea Kaur

    Thank you for sharing this, will be very helpful for many parents traveling with their little ones.
    I just want to add here, that no matter which part of the world you traveling, always pack a small bag full of medicines for your kids and for yourself too because the components may be the same but it’s the best to use the medicines you are familiar with. With kids we can never think of traveling very light, need to have a first aid kit as well as medicines ranging from food poisoning to dehydration, I do that always.

    • thesmalllane

      Chelsea, Thank you for the reply. And absolutely agree, it is so important to have medications that you can trust and at the ready isn’t it!

Leave a Reply

Your email address will not be published. Required fields are marked *