An old man comes into the consult room and sits on the chair. As his vital signs are being checked, the nurse asks, “So what health problem do you have today?”
“My pee is sweet.”
“Really? It’s sweet? How do you know?”
“Because I tasted it.”
Oh. Well, that’s not necessarily what we wanted to hear. Turns out his blood glucose is through the roof and he is diagnosed with diabetes.
—
It is a pitiful scene. They have come from Bodarie, which is about a 3 to 4 hour walk from the clinic, down a deep ravine. Grandmother is small and poorly dressed, her daughter is even worse, and the grandbaby is swaddled in a bundle of blankets. Mom and baby are both here for consults. She is only 19, and she delivered the baby one month ago. Now she is wasted, skin and bones, and covered in a strange rash. We run tests for HIV and syphilis but both are negative. We give her what treatment we can and turn our attention to the baby.
As we unwrap the layers of filthy blankets, our disbelief grows. At the bottom of the bundle is a tiny, wasted boy, covered in dried stool and old vernix left over from his birth. Every skin fold is crusted with dirt. He has obviously lain in stale urine for a long time, and everywhere his skin has been wet is fiery red and peeling. We weigh him: 1.8 kg. That is 3.96 pounds for a child a month old. We fire questions at the family. “Was he born normally? Full term? Does he breastfeed? Why is he so dirty? Does anybody even hold him ever? What is he eating?” The mom and grandmother simply hang their heads and murmur responses. Obviously mom is in no shape to take care of a newborn in her condition so we focus our questioning on grandmother. She insists they bathe him but when we show her the dirt crusted in his hands, she turns away. She says he can’t breastfeed so they feed him sugar water mixed with a little milk in a bottle. She shows us the bottle and we cringe as we dump the brownish liquid down the sink.
We clean up the little guy as best we can. He screams as we try to wipe dried poop off of his macerated back. Finally we get him fairly clean and bundle him up in a clean, dry diaper and outfit. We wrap him in a soft blanket donated from a sewing circle in the States and feed him a bottle. He has one good thing going for him: he still has good strength and takes the bottle well. He calms down and goes to sleep after drinking a couple of ounces.
We give the grandmother formula powder and lots of instructions. We tell her she must keep him clean and dry. She must not let him lay in urine. She must feed him every hour on the hour or when he cries. And she needs to bring him back in a couple of days.
Two days later, right on the dot, she is back. Baby looks much the same but this time weighs 1.93 kg, which is a positive sign. At least he is feeding and gaining weight. We give him more formula and clean diapers and send him on his way.
We lose track of the little guy for quite a while. We told her to bring him back on the following Wednesday, but she doesn’t show up. Our hearts are heavy at the thought that we may have lost him. Where is he? What is she feeding him if she ran out of formula? Is she keeping him dry? Then one day, when the clinic is closed for maintenance, there is a knock at the gate and here is grandmother, holding a bundle of blankets. She had misunderstood the return date and we usher her inside.
Our hearts are in our throats as we unwrap the baby. What will we find? Worse? Or miraculously healed and growing? The truth is somewhere in the middle. The good news is that he weighs 2.19 kg, so he is continuing to gain weight. However, he is weak and his skin is still macerated and peeling. We clean him up again, apply ointment to his broken skin, and feed him tiny amounts of formula. After watching him for several hours, we bundle him up and send him on his way with the plan to see him again soon.
They haven’t been back. What will become of him? What is God’s perfect plan for a baby like this? He appears to have a good chance at life, if only he was in a caring, warm environment. Is there someone that can take care of him? What would happen to him if he was in a home that had all the resources that we Americans are used to? There but for the grace of God go I, and every one of us. Hug your children tonight, and be thankful for your warm dry home.
—
It is late in the evening. The clinic has been closed for hours and the household is winding down at home. Then there is a knock at the gate. Immediately possibilities flow through your mind. Is it a woman in labor? Is it a stroke? Moto accident? Child with respiratory problems? Who knows. We go to the gate to see.
We see a large crowd assembled outside. They seem to be grouped around a young lady who at first glance looks fine. No obvious injury. Standing on her own. “What is the problem?”
“She got shot.”
“Shot? Where?”
They point to her right upper leg. There is a torn hole in her jeans and a cord tied tightly above and below the hole. There is a little blood but no obvious hemorrhage. We open the gate and usher her into the light on the front porch. She pulls down her jeans and tells her story.
She was not fighting or arguing. Other people were and she was just simply in the middle of it. While she was sitting there minding her own business and watching the fight, someone fired a gun and hit her in the leg. As she’s talking, we examine the wound. There is a jagged hole about 1.5 cm across right at the top of her thigh. There is no obvious bleeding, even after we remove the makeshift tourniquets they had applied. And what is really strange is that only about 2 inches away, right under the skin, we can feel the bullet. She claims the shooter was in the same general vicinity as her, but why the bullet would have traveled only 2 inches in soft tissue at such close range is a mystery. Some things just simply don’t add up here.
We come to the conclusion that the injury is very superficial and we can probably remove the bullet just fine right here. There are no bones or major blood vessels involved. No sense in sending her to a hospital in Port. So we go to work, making a small incision over the area where we can feel the bullet and attempting to extract it.
Foreign bodies are notoriously hard to locate and remove, even when they seem so superficial and easy to find. This bullet is the same way. We have a very hard time locating it, and when we finally are able to make contact with a forceps, it simply squirms away from us. What we finally end up doing is to push the bullet along its track and force it out the entry hole it went in. It eventually pops out, completely whole and undamaged. We bandage her up and send her on her way. Just another day in Oriani…
