Silent, screaming grief mixes with the hot stagnant air. I
stand beside a rusting hospital bed holding a kitenge. These vividly coloured
wax printed sheets adorn Tanzanian women everywhere, as skirts, headscarves,
baby carriers. Today, the one in my hands is a shroud. A grandmother stands
next to me. She cries as I pull it over the cold, motionless face of a three
month old baby.
The day started badly. I am frantically busy as I round the
hospital alone. All the doctors have been ordered to attend a government
seminar.
We were informed of this by text message last night. If I wasn’t here, I’m not
sure who they would have expected to see the patients. I visit Elena, a 17 year
old girl with typhoid. The disease is endemic here. People do not have well-dug
toilets and raw sewage filters into rivers. They cannot spare firewood to boil
river water to kill the bacteria before drinking it. Typhoid thrives. This
young woman caught the bug, got sick, and her bowel burst open inside her. Last
week we opened her abdomen to scoop out the infection and repair the hole. It
was a mixed success. Her life was saved but several days later the infection
came back and her wound burst open. She now leaks fluid from a small gap in the
surgical incision site. I examine her and clean her wound. She is a shadow. She
has the build of a skinny 10 year old girl, and the face of a much older woman.
Her skin clings to her. Every vessel, bone and muscle is visible.
She sits uncomfortably on her bed staring at the wall. I encourage her to eat
and write some more antibiotics.
Her grandmother is speaking fervently in the local language, Kikaguru.
She is clutching a bundle of blankets, and starts to cry. A student translates-
Elena has a 3 month old daughter which she is unable to feed because she has
stopped producing breast milk. Her family didn’t know what to do. They fed the
baby with unpasteurised cow’s milk, leading to a diarrhoeal illness with fevers
of 42 degrees. They have since been feeding with over-diluted formula milk. A
tin designed to last three days is almost full, one week on. They can’t read
the instructions and want to ration the expensive milk. I flick through the
case notes and no one in the hospital seems to have offered them any other
advice.
I carefully unwrap the child. She is unconscious, thin,
floppy, has oedema from malnutrition, and cannot feed. Her lips are dry and
cracked, covered by the white spots of oral thrush. I carry the fragile, limp
bundle to the children’s ward where we give her glucose, antibiotics, and a
small amount of fluid through a vein in her scalp, wrap her up warm, and
cautiously drip formula milk through a tube in her nose. She carries on
deteriorating, and despite resuscitation dies several hours later.
I inspect the body. It is unspeakably terrible to see a
still, lifeless baby. Is she at peace? I close her eyelids. She almost looks
serene. Her great-grandmother unwraps the kitenge from her shoulders and hands
it to me to wrap the baby. I say sorry. “Pole, Bibi”. I’m sorry, for my
failure, for the failure of the hospital, for the cruel workings of the world
which have led to you wrapping a funeral veil around your great-granddaughter.
Bibi you have been crying since yesterday, and you feel this is your fault for
not caring for the baby well. I feel angry, sad, and nauseous all at once. It
will take me a while to get over this one. I know that you will never really
recover.
They say that two wrongs don’t make a right. Using the same
perversion of moral algebra I guess you could also say that two rights don’t
correct a wrong. But some days working in this hospital is like wading
upstream. Sometimes you have to remind yourself of the successes just to keep
your head above water. This week we are nursing two children back from
malnutrition. Slowly they are improving. My resources are limited. I cannot
afford the expensive malnutrition feeds the WHO recommends so I make up my own,
using powdered milk, sugar, oil, cereals, and added vitamins and minerals.
Children are living.
Malnutrition is the scourge of children worldwide, and contributes to a staggering 50% of deaths of under 5s. About once a
month we see a case of the most severe type- a skeletally thin marasmic child,
or one swollen and lethargic from kwashiorkor. Even with the best treatment, 1
in 3 of these will die. But collectively the biggest burden is from chronic
rates of mild and moderate malnutrition. These children would otherwise survive
an episode of diarrhoea or measles, but deprived of the building blocks for
health- vitamins, minerals, and calories- the balance is tipped against them.
The problem starts with a diet of carbohydrate rich and nutrient deficient
staples like maize, and is worsened by drought and inefficient farming methods.
A malnourished child is more likely to get an infection, which in turn worsens
their malnutrition, leading to more diseases and a deadly downward spiral. The
solution starts with prevention. This year’s G20 focussed on optimising agriculture in Africa as an essential and enabling step out of the poverty trap. The average modern African farm is less productive than an American farm 100 years ago. The continent
is rich with agricultural heritage, land and willingness to improve. Something,
soon, must tip the balance and unlock this potential. Maybe this will be
do-gooders from abroad. I suspect the important change will more likely come
from within.
I end the day covering the outpatient department. My last
patient is a happy,
drooling, chubby-legged 8-month old boy. I joke with his mother that he is very
fat. She glows with pride. The child is in fact not overweight, but merely in
the statistically permissible upper limit of what the WHO would call normal.
But after my 4 months here, and weighing hundreds of sick children, this is one
of an exclusive handful which have either achieved or mildly exceeded their
expected weight. He has pneumonia, but
no danger signs. Because he is well-nourished he will likely weather the
illness well. He escapes home with a
bottle of antibiotics and a follow-up appointment. I wave goodbye to him, and
he grins happily, tied snugly to his mother’s back by a colourful kitenge.
