little bits.

that boy, the one whose bone we drilled into with an hypodermic cannula, the one who i used as an example of our small therapeutic successes, the one who came to life after lying dry, drooping in his mother’s arms, he died. i was told the next day. the cannula had stopped working, but he was drinking. an hour later, when the nurse next went to check, he was dead. a husk.

diarrhea is a killer. i see it nearly every day. it kills children, turns them to husks. the work it takes to keep their machinery turning
with the desert outside and one inside, is simply too much. they cave in, exhausted, and creak to a stop.

this past month has been difficult. brief spates of rain provide groundwater, then the clear, hot days that have followed have allowed it
to stagnate and teem with bacteria. the mothers, themselves undernourished, supplement their childrens milk with unpasteurized cows
milk. they develop diarrhea, and water falls out of them faster than it can be put in.

several children have died this month. it weighs heavily on me. dying of dehydration in the hospital seems an unforgibable crime. we have water.
water, water, everywhere. plain water, boiled water, filtered water, chlorinated water, oral rehydration solution, resomal, intravenous
ringer’s lactate, normal saline, dextrose 5%, dextrose 10%. everywhere.

so i have been watching carefully. my team, the nurses. i sit with the mothers of the children, watching the drips, the sips.

when a child is conscious enough to drink, we allow him to replace his own fluids, helping out intravenously only when necessary. we give the
mother a syringe, and a cup of oral rehydration solution. we ask her to give the child enough to replace the losses from the diarrhea, and a bit
more to replace what has already been lost.

i was on call last night, and watched a mother help her child, around 10 months old, drink. she took the cup of ORS, and held it to the childs
face, and poured it into his mouth. he drank greedily, pulled the cup closer, and she poured. he started to cough. she stopped. he gestured
for more. she poured, he coughed. and coughed. still coughing. he grabbed the cup. more. pour. cough. more. pour. cough.

this mother, perhaps 20 years old, watched her child slowly cave in for days. she watched, and hoped the diarrhea would stop and he would be
whole again, that he would laugh and cry and grow. when he didn’t, when he was so dry he could no longer lift his head, she tied him to her
chest, bundled what she could and stacked it on her head, and walked for three hours through the hot afternoon to abyei. there is a place in
abyei, she was told, where sick people go.

so she left her home in the brush and came here. it was not easy. she has 2 other children at home. her neighbour reluctantly agreed to watch
them (“but only until tomorrow! i have four of my own.”). the town is different than hers. noisy, dirty, so many things at the same time. the
people are different too. faster. she knows noone. she walks to the main road, and works up her courage to speak to a man waiting to board a
rusted bus. my child is sick, she says, there is a place? over there, he half points over his shoulder, indifferent. no, over there, someone
behind her says, and takes her by the elbow and turns her around. there.

she arrives through the front gate of our hospital and it is chaos. people are lying on floors, others are pushing to get them registered.
someone jostles past her with a bag full of bright pills. she takes the bundle from her head, and sits beside it on the floor, her dry baby tied
to her chest. she cleans the diarrhea from her dress, from his buttocks, and she waits.

after an hour, the crowd begins to thin. a nurse walks by and asks her what she wants. my child, she says, is sick. diarrhea. she uncovers him,
and holds the drooping boy, his eyes half open, up to the nurse. did you register, the nurse asks. what? nevermind…..come with me.

her boy is taken past all of the patients, directly to the nursing room. she follows, wiping embarassedly at her stained skirt. the nurse lies
the child down and starts poking in his skin to find a vein. he finds one. a doctor is called, and an infusion is started. bright, clear water
drips into her child’s limp arm. after some minutes, he stirs.

now, the nurse says, handing her a cup of ORS, your child is dying of dehydration. he needs this water. he doesn’t have enough. it is from the
diarrhea….if it continues, and he doesn’t get enough water, he will die.

she is taken to a bed on the ground. she sets her bundle beside it. she sits down, picks up the cup, and holds it to the childs lips. he drinks
greedily. cough. more. pour. cough. pour. cough.

it is obvious that he is aspirating. his thirst is so strong, he will take in water until it fills him completely, fills his stomach, his
veins, his cells, his lungs, until it drowns him.

i stand up, and walk over. slow, slow, slow, i say, and take the cup from her hands. i retrieve a syringe from the nursing room, draw up some
ORS in it. i put it into his mouth, and push out a few drops. he grabs the back of my hand, thursts the syringe all way to the back of his
throat, tries to swallow it. i pull it out, and wait. after a minute, i put it back, and he pulls it in, gnawing it with his dry blunt bumping
gums. a few more drops. just small, i say to the mother, small small.

i ask the nurse on duty about the child last friday. did he die coughing? yes, i think so.

just small small, i tell him. little bits at a time. like our successes.