Grieving Harriet

Harriet Thungu will die today.  I made a decision I have rarely been willing to make and the weight of it combined with the grief of defeat has left me drained.  Her parents asked to take her home.  When I arrived this morning she had clearly made a turn for the worse, with gasping agonal respirations.  So I agreed with them, their weeks of anxiety and work needing closure in the comfort of their own home environment.  We sent her home with some milk and medicine but I know she will be dead within a few hours, maybe she is already gone.  She never really woke up since admission, there was no clear response to antibiotics or anti-TB medicine.  Her hot little five-year-old girl body did not look ravaged by disease like so many others, it was just devoid of her person as she lay in coma.  Both parents (and her father’s second wife) were present most of the time, caring, hoping, then despairing.  I wanted to cry with them but felt restrained by the onslaught of other patients and the crowd of the ward.  So I expressed my sorrow as best I could and said goodbye.  

When my niece was in the ICU in America in February, the patient in the bed next to her had a similar presentation to Harriet’s, sudden convulsion leading to the diagnosis of a brain tumor.  This little American girl, though, had immediate scans and referral to the best hospital in the world, surgery by the most skilled surgeon, and was likely cured.  Harriet lingered for a month of guesswork and patched-together care before she slipped into unrecoverable demise.  Having seen both worlds makes it hard for me to accept the suffering of Harriet and her family.  My public health side says that if this was indeed a brain tumor, the prognosis was terrible here in Uganda and the cost of care could be better spent to save  hundreds of lives from simple preventable causes. But my justice side still cries out at the contrast between Johns Hopkins and Nyahuka Health Center, and the irrelevant chance of birth in Maryland vs. Bundibugyo.  Some days I’d rather not know the reality, rather not see the family gathering up the limp body of a still-struggling child, rather not watch them head burdened back to their village.