Yesterday I decided to discharge one of my scrawniest little patients, Jerrad. He is the age of the toddlers on our team but half their weight (reality check number 1). His mother had been staying in the hospital with him to get treatment, food, and milk. She was very pregnant, so we thought at first that explained his problems (children who don’t breastfeed a full two years usually don’t thrive in this low protein culture, so when he weaned at less than a year old from his pregnant mom, he did not grow). But even with food his improvement was minimal, and he continued to have nightly fevers and a terrible cough. So we presumptively diagnosed TB and saw a margin of improvement after he began treatment. Then his mom delivered her next baby, a girl, and went home leaving him irritable and lonely with a grandmother. I took pity on his bereaved wailing and decided he would be better off with his mother, so should go.
Reality check number 2: he is my neighbor. When I started asking about where he lived, hoping it was close enough for frequent follow-up, I found out he is the grandson of one of the elderly men whose land borders ours. His father died this year, which now makes the whole picture make more sense. This child with his pale hair and fragile stick-like legs, his bleeding lips and desperate whine, lives within a stone’s throw of our milk-producing cow. Wow. I felt that like a punch in the gut, that I did not even know about him until he was admitted to my hospital ward.
So today we bought him his own pitcher, and I took him a liter of milk. I was passed from one guide to the other (“here, take her to Friday’s, she’s the doctor’s wife”) skirting around the edges of our back pasture, through a cocoa grove, then houses, back to a larger path, then through crowded compounds littered with scraps of discarded plastic containers and strung with ragged clothes. We found the house: chalked on the side of the mud wall was “WFP World Food Program”, no doubt copied from a discarded oil tin or flour bag from our food distributions. Jerrad clung to his mother when he saw me, probably fearing I was there to whisk him back to the hospital. We sat for a while in the windowless house, on low stools. They tried to get Jerrad to drink the milk I brought, but since it had been in my fridge all day it was unpleasantly cold to him and he pushed it away.
So reality checks continued: here is a lady with a newborn infant, a dead husband, and a critically ill toddler, also responsible for several other kids, living in mud surrounded by bare dirt and weeds, smiling very graciously at my visit and thanking me for the milk. Here is my neighbor, the one that Jesus told parables about when self-righteous people like me wanted to justify themselves. Here is one of the most pitiful looking children in Bundibugyo and he’s growing up (or not growing) right out my back door.