Fat babies and losses

Today I took pleasure in holding a roly poly fat baby in a nearby village. Too often the babies and children I have contact with are thin and wan. It is encouraging to see the occasional plump, healthy one. Little Geena was young enough not to realize she was being held by a stranger who was not lactating. She nuzzled around on my chest and shoulder soiling my shirt but bringing me the joy of clasping warm, soft, healthy skin and fat, not minding the sweat forming between her bare bottom and my arm. I enjoyed the smiles and wonder of the other children as they stroked my other arms, gaining courage to touch me freely since I was holding one of their own. The pleasure of this village visit is in stark contrast to some tragedies in my work this month.

Since I've been in Sudan I've nursed, agonized and prayed over several children who I thought might die, most of which God graciously spared and others the parents took home to die so I did not witness when their bodies could maintain life no longer. However, we recently lost two young girls while still in our care.

One of them was Anni. This weak and emaciated child came to us about two months ago malnourished and suffering with malaria. We treated her at the clinic and then admitted her to our nutrition program where she stayed four days, getting medications and special food every three hours--reintroducing nourishment into her body. She responded well to treatment, began gaining weight and was discharged home. Two weeks ago her mother returned with her from their distant village where she had lost the weight she gained plus some, was severely dehydrated and malnourished again and acquired a severe eye infection causing loss of vision in the affected eye. Her mother reported she had not had the strength to walk for some weeks. Sores had formed over her bony hips where the pressure of her body pressing into the bed had cut off blood supply to the tissues. It is difficult to understand why they waited so long to bring her back for help, but this is common in Sudan.

I administered IV fluids and medications for three days and she then was transferred again to our nutrition program. She ate the specialized food and continued the medications, but this time she did not respond to treatment. Too late our visiting doctor recognized she had spinal tuberculosis. We began arranging for her transport to Kurmuk--the nearest town that can initiate TB treatment. She died during the night before the day of travel. We heard dogs begin howling that night but did not at the time realize the cause--the wailing grief of her mother.

Joye was the other child who died at our clinic. She suffered an acute case of cerebral malaria coupled with severe pneumonia. According to her father she had only been sick for two days. They brought her to us when she began having seizures and lost consciousness. We started an IV and administered fluids and Quinine as well as gave her in injection of Artemether to attack the malaria in two different ways. I gave her a strong antibiotic through the IV and administered concentrated oxygen though a machine running on the generator. We prayed for her but tried to prepare the family for the possibility that she would not survive. She had Chain-Stokes respirations and her oxygen saturation hovered in the 60s and 70s in spite of the oxygen we gave her. Her brain and organs were not working at full capacity, lacking oxygen due to the infection in her lungs and the electrolyte problems caused by the cerebral malaria. After an hour or so of IV fluids and medications she began having seizure activity and so we administered Diazapam. To no avail, she never regained consciousness and died within a few hours of reaching our clinic.

Tears coursed down my face as I watched her parents and auntie mourn. Death here is no stranger and the wailing grief is becoming familiar to me. The cries morph into groans and wails, to mournful songs to sobs and back to wails again. The loved one is covered and uncovered, the hands and arms rearranged and caressed and then re-covered and caressed through the cloth and then she is uncovered again for more rearranging. Her name is repeated in the mourning phrases and songs. Perfume was poured on her body and she was wrapped in two white blankets someone thoughtfully provided. I sat quietly observing all this, praying for comfort for her parents (who lost a son last year) and constantly wishing things could have been different.

The fragility of life is so obvious here and from my relatively new experience and observation, the people do not fight as hard for life as I expect them too--perhaps it is because death is so common. I'm so grateful to have been involved in improving the health of over two thousand people in my six months in Sudan, but the helpless feeling of this double loss makes me question how effective we are. It is so hard to lose a child.
This little one is Anni. Dr Rob did a ultrasound on her to get more clues on her condition. She protested weakly and ineffectively. We were encouraged when she recieved the diagnosis of tuburculosis which explained her weight loss in spite of good nutritional intake in our nutrition program. We gained hope because though our clinic is not equipped to treat TB--we knew what she needed and where to send her. If only we had discovered the TB sooner...

(It seems cruel sometimes to take photographs when patients are so ill, so I do not have photos of some of our most desperately ill patients, including Joye.)