Bhibabulu

This is a local term for "intestinal wounds" . . a syndrome that came into my awareness as a belief-disease-entity about five years ago.  I remember the case, twins, one was dwindling, and quite ill, and the parents refused IV antibiotics.  The idea is that this disease causes wounds inside, which are not seen, and must be treated by local herbalists/witch doctors, and if the family instead accepts IV fluid or antibiotics, the child will die.  So they usually stay at home and give enemas using herbs, soap, water, administered into the rectum via a gourd.  The child I first remember seeing did die, which reinforced the belief that hospital treatment is fatal, though over the years I've also seen many respond to general nutritional rehab and recover.  The idea of bhibabulu has gained momentum.  Tuesday we had two children admitted who had been treated for this at home for a week or more using local herbs, and they both died shortly after arriving at the hospital, within 20 minutes of each other.

On World AIDS Day we remember that that illness was first recognized as a syndrome, that alert people had to put together constellations of symptoms and risk factors and recognize that a new disease had emerged.  In a place like Bundibugyo with an extremely high background level of disease and death, how do we know if bhibabulu is anything other than just the end stage of under-nourished children, diarrhea from a hundred causes, some with sickle cell, poor family dynamics, inadequate hygiene?  The kids tend to be under age 2, listless, with fungal infections in their mouths and perineal area (hence the wounds), poor appetites, anemic.  But that describes a large swathe of the population.

What I do know is that staying home and further dehydrating a child with enemas is deadly.  So we preach against it, at every opportunity, encouraging ORS, encouraging prompt evaluation in the health center.  Of course when two kids come in and die, it does not exactly inspire confidence.  One was not yet 2, with a pregnant mother, weaned months ago (way too early), deathly anemic, convulsing, unconscious.  In spite of warming, glucose, blood, anti-malarials and anti-biotics, his body was too far gone.  The other was a motherless baby a couple of months old, whose two grandmothers seemed to be mismanaging him, the one who had been breast-feeding fell ill, so the other one took the baby to her home, and at that age and size a little body can't survive for a week without milk.  Both were of course convinced that they had been doing the right thing to save their children, both involved older women in the family preventing treatment at the hospital, both came at the last minute when the child was dying.

I'm reminded this season of Rachel weeping for her children, of the way that the battle between good and evil on this earth most often sweeps the under-2 infants into death, collateral damage in struggles that involve belief, evil, spirits, sacrifice, trust, mistakes, family conflict, tragically inadequate intensive care in the hospital, etc.  So we will keep pleading for their lives.  And looking for ways to pull them back.