On Friday morning, a mother came to the clinic clutching her child of two months. She seemed emotionless. The child weighed a mere FIVE POUNDS. In almost 8 weeks, the child had not gained an ounce, and even lost weight since birth. Sam, the most senior staff member and nurse, came to Dr. Lisa for guidance. Dr. Lisa has mainly been busy reconstructing the administrative side of the clinic and making sure no one is cheating the village of their right to health care or embezzling money. Little things like that. But today she was a clinician. And a woman caring for a child. And a concerned community member.
This woman has given birth to 8 children. Four have survived. She is unable to breastfeed the child and in the eyes of the culture it is almost that there is something physically wrong with her. In order for the child to survive, it must have some source of nourishment. The western way would be to get to the market and buy this child some formula. Or maybe find another mother who can nurse this baby back to a healthy weight. But in rural Uganda, these are not options. The family cannot afford to buy milk and the only condition another mother would nurse is if the biological mother has died.
So we look to the Community Health Educators. I have been teaching these representatives to get to the homes of their neighbors and assess the conditions. Educate them on what it means to eat a healthy diet…Where to put the chickens at night instead of next to their child…How to obtain clean and reliable water…Where the patients can receive help if it is needed. The CHE’s were reluctant to help this woman and but were receptive to encouragement.
Down the mountain we went. Past the clinic, past the moonshine pots and the market, past the school and the field, and any passable roads. There she was holding her baby and next to her were her three other children. She yanked on the arm of the next oldest, maybe two years old. She brought him to his feet as he wobbled and his malnourished belly began to show. He was outfitted the same as his older brother: just a dirty t-shirt. The oldest daughter smiled as if to have no idea of the devastation surrounding her.
I was led by two CHE’s. One was Patrick, the assistant director, and the other was Joseph, a representative of the area. We talked about most importantly getting food for this family. The infant is the most pressing need but the two younger boys are not in good shape. The mother cannot breastfeed because she is not eating.. A heartbreaking cycle. And the conditions of the home. I choked down the emotion as I toured the sleeping arrangements, the kitchen, and the latrine. Mom and dad sleep in the bed a few centimeters larger than a twin and the children are on the floor next to the chickens.
Tuesday’s teaching was a continuation of Maternal and Child Health. It was similar to the rest of the trainings where I was jumping around using “ooh ooh ooh” sounds to illustrate a woman in labor. I’m glad Jake’s video footage didn’t include that one. But this meeting was slightly different. Ugandan shillings started to pile on the table in the front. The community has agreed to come together to help this woman. It was also a teaching moment. I told them that this money only bought them time. They will need to come up with a long-term plan to educate this woman and involve her absent husband. Developing countries do not need white people to come in and give them money. They need a plan of sustainability and careful approach to uphold tradition and culture.
For now, the family will eat. Forever, they will be in my thoughts.