Wednesday I called Lisa and asked her if she would come out to the village with me to see the baby. My initial thought was to go early in the day, to make sure the baby was still alive and then, if it was, to bring Lisa in the evening but Lisa made herself immediately available, saying she had not yet been to a village and the three of us -. Deb, Lisa, and I - headed out to Mbewe. When we arrived we found the grandmother, baby, aunt, and a gaggle of children in the yard. We exchanged greetings and then Lisa unwrapped the little boy carefully looking him over, head to toe. She said that his prominent overriding sutures signified brain atrophy. His eyes were clear but she noted that they did not track movement. She said the thrush sores in his mouth would not improve despite the anti-fungal medicine until his general condition improved. She said his lungs and heart sounded good but that their rhythms portended a bad outcome. (She said his heart should have been beating at a minimal rate of 160 beats per minute but it hovered between 100 and 110bpm). She turned him over and what should have been a chubby brown little bum was bony, pink, and raw.
She said he was wasted and stunted, that his diagnosis was “Failure To Thrive (FTT),” and that he would not survive in the village. He was more active than he was the day I first took him to the hospital, but his movements were lethargic and although at times he grimaced, he never cried. Lisa said either way his prognosis was not very good. She asked if the grandmother would go to the hospital immediately but she said she wasn’t ready. We agreed that I would return early the next morning to take them back to KCH and Lisa would meet me at KCH to ensure that they were quickly and definitely admitted to Ward C, the malnutrition ward. Lisa said she wasn’t sure if the baby would survive the night. Even so, I felt hopeful. I was so grateful that she agreed to come along. I learned a lot from her quick assessment and I felt that life inside this baby was fighting to continue and now at least we could give it a fair chance.
Lisa is great. She’s one of those people who confronts desperate situations with determination, a smile, and a sense of humor. She had Deb and I cracking up all the way back to Lilongwe. She told us the story of an infant she had been seeing. The first time Lisa saw her, the girl was incredibly sick and weak and unable to eat. She gave her treatment and scheduled the mother to return for a follow-up visit. When the mom came back, she was eager to show Lisa how much the child had improved. Lisa asked, “Can she eat?” The mother enthusiastically replied, “Oh, yes! She can eat porridge!” Lisa, then asked, “Is she eating?” And the mother, still enthusiastic said, “Oh, no. There is no food,” quickly adding with a proud smile, “but if there were food, she would be eating!” There are countless small horrifying incidents, and if your proclivity is to cry, the stream of tears will be endless. It’s good to remember that laughter is an alternative.
I returned Thursday morning, arriving in the village at 7am. We were supposed to meet Lisa at 7:30 but in my planning I forgot to account for the village concept of time (or rather the absence of a concept of time) and so by 8am we were just getting in the car to return to Lilongwe. Lisa of course was there to meet us and helped expedite the admission process. The baby weighed 2.4kg (0.5kg less than a week and a half before). She said the trick would be to hope that he wasn’t wasted and stunted to such a degree that his weight for length actually appeared normal, in which case he’d be denied admission. We crossed our fingers and the admitting nurse calculated that his weight was less than 60% of what it should have been for his length – he was in! Lisa said she would also help with formula and that she would be checking in on the baby regularly. I gave the grandmother a little money for food and told her I would be back soon.
Friday I quickly peeked in on the baby and then went again today. He is looking better. His sutures are still prominent but his face appeared slightly fuller and, to his grandmother’s delight, he met and held my gaze as I spoon-fed him formula. Unfortunately his little bum looks worse, he now has a small ulcer forming. Lisa gave them some Vaseline to act as a barrier and the grandmother is using it but, with the constant flow of diarrhea, it’s hard to keep him dry. (This would be one case for those super absorbent landfill overfilling generally wasteful American diapers that I would definitely approve.) The grandmother was happy to show me how much he improved and was eager to know when she could return to the village. What she doesn’t know is that the baby will not be discharged until his weight is over 80% of the norm for his height, which could take weeks. I’m not sure if she sees my involvement with their family as a blessing or a curse. (If she knew she might be there for weeks, I imagine she’d see me as a curse.) Although the baby is improving, the gain is tenuous and it would certainly regress if she returned. I do feel bad for her though, and slightly (just slightly) guilty about knowing that her stay may be a long one. She sleeps on the cement floor, under the crib her grandson shares with another child, side-by-side with about ten to fifteen other guardians. She has no mat or even a single change of clothes. The ward is divided into various sections by chest high cement walls, which help control the traffic flow, but do nothing to dampen the deafening acoustics of a couple hundred children crying. I imagine she doesn’t sleep much.