A Tuesday Lament

Kwikilija Jakobo, age 6, died this morning, killed by inefficiency, apathy, corruption, poverty . . . I walked into the paediatric ward at 8:30 and his distraught mother pushed her way into the front, waving papers from Bundibugyo. In a reversal of referral patterns the staff at the district hospital had referred him to our smaller health center with the scrawled note “severe anemia ? Cause . . History of having got treatment in Bundibugyo Hospital, there no blood and for possible management by medical officer.” I took that to mean that the hospital was out of blood, no surprise, since our lab staff had failed to obtain the weekly supply from Fort Portal and the hospital administrator had twice this week sent for blood from the regional blood bank there but been told it was “finished”. In a classic waste of time and money, the patient’s condition probably deteriorated further because of being sent to Nyahuka, when a phone call would have confirmed that there was no blood at our health center either (or even a short conversation with any other staff would have revealed that patients with the same problem had been transferred earlier that day in the opposite direction).

First I called the regional blood bank’s officer . . Only to be told that the earliest we could get blood would be tomorrow. Upon further questioning he claimed that the entire western region’s blood supply was nil, because they had run out of bags. BAGS????? Whose fault is this? Is it the blood bank staff who fail to notice that they are using their last carton of heparinized sterile bags to store donated blood? Is it a corrupt or careless staff member who pockets the money for new supplies, or just forgets to process the order? (Evidence of both in other items this week, a disbursement of medicines listed as being worth more than twice as much as their real value, and hospital staff “borrowing” medicine from our health center to supply AIDS patients at the main hospital because their requisition forms were “lost” so that they ran out of medicines). Is it an entire country living on the margin with no reserve, so that one week the stock of an essential item can simply be gone? Is it poor communication, is it the barrier of deplorably maintained roads, the lack of fuel to transport personnel and supplies? Is it an over-zealous AIDS testing policy which, as in western countries, takes the risk of viral transmission in transfused blood from 1 in a thousand down to 1 in a hundred thousand, never mind the fact that the risk of a child dying from anemia increases from 1 in 100 to 1 in 10???? We live in the epicenter of sickle cell anemia in the world; we live in a valley where malaria is so endemic that almost 90% of children have some level of parasites in their blood; we live in a district where iron deficiency is universal, where diets are poor and intestinal worms remove tiny increments of precious heme on a daily basis.

So Kwikilija, like so many children before him, dwindled, until his heart could no longer metabolize enough oxygen to keep the watery blood circulating in his body, even as we scrambled to try and save his life, too little too late, the wailing relatives throwing themselves on the ground in grief. Raw lament from his mother; anger and frustration from me. I struggle with how to enter the fray with Jesus-style table-turning zeal, but without my own prideful self-righteousness hurting those who are already victims of injustice themselves. How to allow the waste to wring my heart, without hurting others.