The two smiling, thriving girls whose malnutrition had been cured went home today. Both had been transformed from stick-figures to plumpness, from lethargy to life.
But two others died. Including Mackline, the pitiful orphan who came too far too late. Her first sips of milk and ORS threw off her precarious balance, and the life drained out of her. The other death was of an infant with AIDS--though he had tested negative a few months ago, and his mother weaned him, he must have become infected in the last month, and he dwindled to death in the short course of a week, in spite of IV antibiotics, fluids, and milk.
While the two celebrants packed their belongings to return home from their weeks of hospitalization, Mackline's aunt wept lonely tears as the staff helped her bundle her things for her trek. And that is the way the battlefront looks. Victories and defeats mingling together, from bed to bed. Birungi Suizen came to greet us all today: a whopping 10.8 kg (he used to weigh 5!), he is actually getting close to being a within-normal weight for his age. But as we passed him around, digging up candy from pockets and teasing him, smiling, remembering the miracle of his life, another patient returned, the withered premature infant of a 15-year-old mother, 1.45 kg. Will he look like Birungi Suizen one day? Seems doubtful.
The two deaths made me review our records: 58 admissions for nutrition in the last two months. 6 deaths. About 10%. Of those six, four died within the first day, all children who came from distant reaches of the district, too late. The other two were born to mothers with AIDS. So do we need more case-finding outreach? Better initial stabilization? Is 10% the devil's toll, the inevitable margin of loss? Much of me rebels against that defeatism, but I admit to feeling that way at the moment. There is great value in professionalism (doing the best we can with our resources, first do no harm, and all that), but we as doctors, and as westerners, can also live with the delusion of being able to save everyone.
So, as always, walking the paradox. Rejoicing with those who rejoice, weeping with those who weep, examining my own heart to know if I have been negligent, fearful of what I might find, weary of the war.
1 comment:
I still don't understand why they aren't bringing their starving children to a place where they know there is provision. Are these people from very far away?
I do read your blog everyday and realize there is AIDS stigma, tribal medical practices, and severe limitations on what can be provided - but I guess I don't fully understand why they come so late.
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