Butha

Today I discharged a little malnourished girl for whom we have been providing care for over a month. I couldn't hold back the tears when her mother, Tubia, walked away with her. Instead of a "discharge" due to resolution of an illness, we discharged her because there is nothing more we can do for her. We referred her to a facility where she can receive TB treatment. We cannot officially diagnosis TB without lab and x-ray, but due to the process of elimination and the treatment we provided for all the other possibilities, we are pretty sure that is the problem. Unfortunately the closest TB treatment is a few days walk away. They are trying to catch a truck going that way this evening. Leaving the village to come to our clinic is one thing. But to go some days away to a strange city is a big emotional and family challenge for pretty much anyone we refer to Malakal. There is big fear of the unknown among the Mabaan. Many choose to allow death to occur in the sick person rather than to face separation from family and village for an unknown length of time.

Butha has persistent Kwashiorkor type malnutrition--that is the kind where the body swells due primarily to a lack of protein in the diet and a breaking down of the blood vessel walls.
It can also be related to severe anemia or tuberculosis infection. Butha has consistently had edema (swelling) in spite of medications for malaria, worms, giardia, thrush and pneumonia. She also gradually developed a good appetite--but the edema didn't go away as it does in most children when they go through our program.