Arriving prematurely, the little being has had problems from the start. No one knows exactly how old she was at birth, but seven months is the agreed upon number. Premature babies are on their own here. There are no incubators, no special accommodations for their fragile immune systems, no specially trained medical staff regularly checking her vital signs. But preemies will live here if they survive their first week, says Martha.
The baby’s first week came and went before trouble arrived. Richard was reporting what sounded like diaper rash. “This baby is as hard as stone,” said Martha, returning from a subsequent house call. Dehydration. Some sort of blisters in the baby’s armpits. The baby, not yet named, is not being bathed or regularly breastfed, she reports, hinting at parental neglect. I filter this news through the knowledge that Martha, hardened by war and personal loss, views many of her fellow Sudanese as lazy and inept, not to mention that she has had many clashes in the past year with Richard. This is the first birth for Richard’s wife, all of 18, which might explain why she seems unsure of how to care for the baby. Both Martha and I wonder aloud why her mother, her aunts and neighbors are not providing advice. Perhaps they are and the mother, who Martha implies is spoiled, is not heeding it. Perhaps also there is some sort of taboo cautioning against the naming and bathing of preemies. This is not my culture, I remind myself in an effort to abate my unspoken comparisons between medical care in developed and undeveloped countries.
A few days later Richard is asking Alfred to break away from a four-day orientation training session he is conducting for our health facility staff. The baby is having difficulty breathing. Later that day she is hospitalized for severe dehydration.
Tonight the darkened hospital room is void of medical staff. Unused mosquito nets, bunched like heavy clouds, hang above the dozen or so sleeping patients. “No, no, no, don’t,” cries Richard’s wife, holding out her arm in defense, taking a few moments to realize her surroundings. Alfred has awakened her from a fitful slumber. I hold the room’s sole lantern aloft above the bed so that the Doc can see the small bundle nestled next to her. He peels back the heavy blanket. Like a blind person seeking an unmarked escape route, my mind stumbles and feels around for an explanation. I have never seen a baby so small or fragile. A small bird with a head of black hair. Pale, flaky skin. Her jutting ribs moving up and down with each breath and gasp. She does not open her eyes when Alfred’s immense hand touches her petite forehead.
Alfred is frustrated. The staff of the hospital, which is not operated by IMC, has removed the baby’s IV, brought from our stock room and painstakingly inserted by Martha into the baby’s microscopic veins after many failed attempts. The Doc fears that it has become contaminated and chooses not to reinsert it. A new IV bag must be brought in the morning. “Every 30 minutes through the night and then every two hours tomorrow.” Alfred is advising the mother to breastfeed. It is the only salvation in a country without bottles and formula – and most importantly, clean water.
As we leave the room and begin picking our way through the darkened corridor, I grab Alfred’s hand. “Doc, is this an emergency? Do we need to get the drugstore key from Martha and go to our compound to get a new IV bag and come back here?” No, the baby, is much improved,” he answers. “She will survive the night. But, if a new IV bag is not brought tomorrow this child will certainly die.” The night breeze glides over our unspoken thoughts as we ride, the windows down, in the ambulance to our waiting beds.
In the morning, Martha takes a new IV to the baby. She instructs the mother to pump her breast milk into a cup and to feed it to the baby. They’ve come to realize the tiny girl is simply too small to breastfeed. Two days later, the situation worsening, a feeding tube is inserted into the baby’s nose for administration of breast milk. While it seems a setback, it may be the best solution“After three days there will be changes because that baby I don’t think is dying,” says Martha. “It refuse to die.”
Martha
