In my line of work, it isn’t unusual to see some horrific things. I live in a developing country and I work for a humanitarian organisation. There are many inspiring stories and the work that is being done by dedicated people and their organisations is fantastic, as a result of this there are many inspiring stories. Sadly, this story is not one of them.
I have recently returned from facilitating a health camp in one of the villages we do work in. The doctors have a policy that when we have competent volunteers, such as on this occasion, I am not to do treatments, this allows my body to rest. Instead I take vitals and screen patients as they come through.
It was the end of the day and things were beginning to wind down. I had screened all the patients and the final few were waiting for treatment.
This is when Pratapi Bai, one of our famous Gunis (Traditional Healers) reached over to pick up by blood pressure cuff and stethoscope and mentioned for me to follow her. We followed the dirt road into her village and finally to a mud house with goats and buffalo tied up outside. Also outside was an elderly woman laying on a charpoi (traditional indian bed), with a wooden frame and handmade woven string criss-crossed all the way along in order to hold a person’s weight. Pratapi Bai motioned me towards the women and told me she had a fever. I recognised the women straight away, she is a patient that I have treated many times before in this village. A very lean women, grey hair, cataract eyes and in her 70’s. But that wasn’t what caught my eye. Lying next to her was what I can only describe as a very, very sick child.
Pratapi Bai opened my bag, took out my stethoscope and placed it around my shoulders, she then took out my blood pressure cuff and themomester and handed it to me. I was still transfixed on the child. I took the women’s BP, pulse and temp. She was on the low side of normal, dehydrated and only a slight fever. Pratabi Bai was satisfied with this and began to administer her treatment.
While she did this I turned my full attention to the child, a little girl.
She looked about four, but had severe malnutrition. Usually in these cases we use a measuring tape and measure the Mid-Upper Arm Circumference (MUAC) recommended by UNICEF and the WHO. It is quick, easy and affordable way to check the severity of malnutrition in children ages 0-5 years. In children who come under moderate (Yellow) to severe (Red) will have a MUAC value below 125mm and 115mm respectively. Looking at this little girl I could tell straight away she was in the red category.
I asked the family if I could look her over to which they consented. I pulled out my measuring tape, gently stroked her bony hand and began to ask her name in a very soothing voice. She screamed. She was absolutely terrified of me, which is understandable. I decided the best way for me to assess would be to observe and get some subjective information from the family. Unfortunately, I did not have a translator with me so I had to rely on my own Mewari skills (the local language).
I managed to establish that she was in fact 7 years old, not 4. They could not tell me how or why she was like this but did tell me that they feed her a bottle of milk twice a day. I asked to see the bottle which was only 225ml. My heart sank.
She could not walk and her legs and arms looked permanently transfixed in the fetal position from naturally reverting into that pose due to abdominal discomfort. She had the tell-tale pot belly often seen in malnourished children, she had protruding ribs, sunken teeth, and she was covered in ulcers which I suspected was Cutaneous Leishmaniosis. I asked to if I could take some photos to which they obliged. I told them she needed to take her to a hospital. They asked if they could just take her to the local hospital, about 30-40km from the village, I said no, she needed to go to the Malnutrition Centre in Udaipur. They weren’t too happy about this but agreed which I suspected was a ploy to get me to leave. I told them that if they did not take her to the hospital that I would be back the following day.
That evening I had a discussion with my doctor friend, Dr C.P, about the little girl. He listened to my concerns and took me to the local hospital to get some medicine for the Cutaneous Leishmaniosis, as well as some complex B vitamins, liquid paracetamol, and protein powder. I figured if the family flat out refused to take her to hospital and we could not physically remove the child from their care, then at least we had something to try and help her.
The following day we were busy with a health camp in a neighbouring village. A little boy came in with a fractured arm due to a fall he had two days before. The parents were doting. A stark contrast from the little girl I had seen the day before and I could not help but wonder if her gender had played a part in her suffering.
The little boy, too, was terrified of me and began to cry even before I had touched him. I needed to establish exactly where the fracture was in order to make the recommended referral. With the help of the parents and two of my lovely volunteers who distracted him with stamps and toys, I managed to find a fracture in the Olecranon process with an implication of the radial head (although without x-ray this was unknown). He needed to be sent to hospital in Udaipur for X-ray and treatment, which they happily consented to and we put them straight on a bus.
By this time Dr C.P as well as Dr R.K had turned up and I brought up my concerns about the little girl again, I showed hem the photos I had taken and we agreed to visit after the days patients had been seen.
That evening we made the journey out to Pratapi Bai’s village and picked up the child’s grandfather on the way. While walking down the dirt road I kept reiterating to Dr R.K that this little girl was “very very sick”,
“Yes Aly, I understand, this girl is very very sick” he said too calmly for my liking,
“No, Dr R.K Ji, you don’t understand, she is going to die if we don’t do something”
“Yes Aly, I understand, she needs treatment” he said with a little more ergency for my benefit.
As we approached the hut, the charpoi the girl was sleeping on was surrounded by goats.
“Where is she?” Dr R.K asked me. I pointed to the goats.
“Oh… OH.” He said, as he moved the goats out the way to reveal the little girl. “She is very very sick”.
“I KNOW” I said with frustration. “Dr R.K ji” I begged, “She needs to go to hospital or she will die”.
He nodded his head, “You brought your camera?” He asked.
“Ji” I responded.
“Good, we need to document this, you take many photos” He said as he began to scowled the family about the girls condition.
On his orders I began to take photos. The grandfather lifted the girl up so I could get full body shots, the whole while feeling ill to my stomach. I lifted her top to get images of her ribs, close up shots of her pot belly, tried to extend the legs to get images of the self-induced deformity, and took as many photos as I could before it got too much for me.
Dr C.P asked me for the medication we had purchased the day before but Dr R.K told us to put it away. This child needed a hospital and no amount of medication, vitamins and protein powders were going to save her. She needed a feeding tube, an IV and a hospital bed.
As we left the village I asked Dr R.K why this girl was not already in a hospital, dreading the answer.
“You don’t understand” he said.
“No, I don’t understand” I interrupted “How on earth can you have such a sick child in your care and not take the initiative to take her to a hospital, a doctor, or even Pratabi Bai. This is her village and she had no idea about the child”.
“No, Aly, you don’t understand” He said shaking his head.
“Make me understand” I challenged him.
He stopped, turned around placed his hand on my shoulder. “This is a lazy tribe, her grandfather is lazy”.
“What?! Lazy? No, I don’t understand… I honestly don’t get how a child can be dying under your care and you can do NOTHING about it, what would have happened to her if we hadn’t had found her, she would be dead in a few weeks”.
This argument went on for a while. Dr R.K could have stopped it at any time but given the fact that I was supervising 15 volunteers and I had 5 more health camps to facilitate he saw it in our best interests to let me vent my frustrations on a dirt road in a remote village rather than at a later date. For this I was grateful. We finally got back to the jeep in silence.
When finally about half way back to base camp I asked quietly “Dr R.K Ji”
“Yes ji?” He replied.
“If she was a boy child, she wouldn’t be in this situation would she?”
He sighed “No, she wouldn’t”.
We sat there in silence staring into the darkness for the rest of the journey.
I fear that there are three scenarios here. The first that had we not intervened she would have died. The second that the family chooses to ignore out threats and she doesn’t make it. And third, that she is taken to the hospital but it is too late. Either way, their will be tears in my pillow tonight.