Saturday, July 5, 2014

Been a hard few days....

Lorchoro 2 weeks ago, skinnier now. 
I've been up in Lormoruchbae for awhile and the suffering hit me harder than some other times. There are several girls who I often do stuff with because they have the patience to teach me (or I am highly entertaining to them, which is probably more likely).  Lorchoro and Angelnia.  They are both between the ages of 12 and 15.   I couldn't help but notice this time how skinny they have gotten. Neither of them have any extra weight to begin with so it is disconcerting to see them loosing.
 The evening I arrived they brought me a baby who maybe weighed 8 kg (about 18 pounds) and they told me she was sick. As I unwrapped her blankets it became obvious she was extremely malnourished. She is 2.  She looks like a little old lady. Her skin is wrinkled and her little legs are no bigger around than my thumb.  (As a reference point a normal two year old should weigh between 12-18 kg or 26-40 pounds. For those who care she had a MUAC measurement of 80mm- I've never seen that before, even in Amecet kids.)  That night I got her started on ORS (oral salts for re-hydration and to replace electrolytes which you have do to before you can start re-feeding or fatal arrhythmias can develop).  The next morning I met together with the mother and both VHTs. I learned that the baby was from a more remote village and the VHTs didn't know of her. The assured me that if they had known it was that bad they would have intervened. I believe them because I've seen all of the kids within their village and a few are malnourished but none critical. Anyway, "we" decided she needed to be treated at the clinic as she was clearly very ill. I drove them the 20 km into the clinic but honestly didn't figure I needed to stay as I know WFP is donating so they could receive free treatment.
I was very discouraged to learn the mother decided they couldn't stay for inpatient treatment and walked back to the village.  She had received a few plumpy nut packages but I know the clinics can't give them out in any volume as they are used wrongly or sold or whatever. I just hope they go back next week for more. But I also know it is an entire day walking and for the reasons the mother decided not to stay she also may decide not to spend an entire day walking the 14 miles back and forth from the clinic.
The next day I headed out to Nakayot to check on the VHTs out there. I was happy to find one of the guys with a patient.  He asked me to go back to another home he had just been at so I could suggest what to do as he didn't know. Another 2 year old girl. This one with a giant liver. Both the liver and spleen were easy to palpate. She had what looked like acites too, and  non healing wounds on very skinny arms and legs. She was lethargic and they reported she had diarrhea. I know that of the six drugs the VHTs have there was nothing for her and of the twenty I carry there still was nothing for her. I explained that the best place for help was the hospital. The mother just nodded and said nothing. I told them I would provide transport if they changed their mind. The VHT told me they wouldn't go. The mother, who looked less than 18, has two other children and the father isn't around. The hospital is 200 km away and she has no money for food or anything while they are there.
The next day I was back in Nakayot for other reasons and there was so much begging. A group of maybe 30 or 40 people were gathered around asking for food, soap, medicine, clothes, money, anything. Unless you have been in a press of demanding frustrated K-jung yourself you just can't even imagine it. The will grab at you to get your attention, getting louder and louder to be heard over each other.  Pushing, shoving small babies toward you, lifting their shirts to show hollow stomachs. One woman who is well known to CLIDE pushed to the front and showed us her breast. It was large and swollen and had that classic "orange peel" look of advanced inflammatory breast cancer. What do I even say to her?!  Clearly she is in stage 3 or 4 already in a place where NOTHING can be done for cancer.
Just as we were leaving a group of women came running up to us asking for transport to the hospital "now, now!" One lady held up her cupped hand and said a baby that size was very sick. So we drove the truck as near to the house we were being directed toward as we could get and as I got out I was handed a tiny bloody bundle. It was a premature baby who evidently had just been born. He was cold and grunting and had sternal retractions and I didn't see anymore than that as I wrapped him tightly back up in his blanket and asked where the mother was. She shortly also came out looking pale and shaky. I'm pretty sure she had delivered within the hour. We tucked the baby under the mother's shirt, tucked them both in the truck and took off of the hospital. The baby stopped breathing a few times on the way so it was no surprise that within a few hours of arriving he was pronounced. There was just nothing the hospital could do. They are the best hospital in all of Karamoja but they don't have the capabilities to intubate adults let alone premature neonates.
It is all just a lot of sickness and suffering and hunger and death.....

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