The view from the front line

The view from the front line is horrific.  It is like a nightmare.  The room is hot and damp with the smell of vomit and urine.  The walls are filthy, and crawling with insects.  Children lie, as many as eight infants to a hospital bed, on wet chitenjes, filthy tape securing dubious IV lines in awful places.  Some children are on bubble CPAP, and have large plastic tubes secured with graying bandages occluding their noses and forcing in oxygen.  Anxious mothers, many of whom cannot read or tell time, are entrusted with giving all of the oral medications, and feeding their children through nasogastric tubes.   They sit by their bedsides, filling the narrow spaces between the beds, among the beeping machines which run from extension cords that cross the room.  Rusted IV poles, which come disconnected from their stands when you touch them, teeter over the bedsides, with often-neglected, empty IV bags hanging from them. Oxygen is divided among children using a “splitter”, so that each child’s oxygen input might be less than ideal, but is better than none.  The mothers do not sleep.  Children seize, or vomit, or thrash in feverish delirium.  Some die, and new ones always arrive.  Sometimes there are no nurses for the 40 patients, and often there are few doctors or clinical officers.  The sharps containers are on the floor, and are often overflowing.  There is garbage everywhere, and flies land on the eyes and mouths and sores and bandages of the sweating, dirty children.  Cockroaches scurry underneath the beds, and yet still the women sit on the floor to eat or try to nap.  There is a guard who stands at the door to the makeshift “emergency zone”, and he tries to minimize the crowding, but still the room is full and hot.

On the first bed is a boy who breaks my heart. He is 11 years old, and he has the haunted, hollowed-eyed look of starvation.  He weighs about 35 lbs.  He is very bright, and wants to be a doctor. He has been having profuse, watery diarrhea, which we have been unable to stop, and has become severely malnourished and dehydrated. I am fairly certain that he is dying.  And still, when you ask this sweet child how he is each day, he is unfailingly polite, and slowly opens his eyes and says, through cracked lips, “I am fine, and how are you?”

His “gogo”, who is probably in her seventies, is mostly toothless, and is sharp as a tack, stands by his side, day and night, fanning him with her cloth to keep the flies away. She feeds him oral rehydration solution, and now fortified milk, from a plastic cup. She gives his meds, probably about 25 total pills per day, as scheduled, and she never complains. She laughed as she showed me her ankles today, which are swollen almost to the knee.  He lies sometimes with his head in her lap. He lies on his side and you can see every bone in his body, every vertebrae on his back.  His hip bones are alarming, and he is often mostly naked, as he is unable to control his bowels and must be changed frequently.  Although he is 16, he has no dignity, no privacy. He is so weak, and so thin, and he has had such diarrhea and so many fevers.  He lies on that bed in the unrelenting noise and filth, and suffers. I hate watching him suffer. I hate watching his patient, courageous, trusting grandmother suffer. Although I know the odds are against him, I pray so hard that he survives this. I pray that his pain and suffering end, that his dreams of a future are realized.  I wish for him strength and peace, courage and a life into adulthood.