Korotoun

Rainy season is bitter-sweet in Mali. It's a time of rejoycing in the planting of the new harvest. The hungry season has come to an end, the heat lets up after a refreshing rain-storm several times a week. In fact, the rain is so sacred to the Malians that I once got in trouble for joking about it. A strong wind came and everyone said that it was going to down pour. I said,"Nah, it's not going to rain". And it didn't. This happened a second time when I joked that I told the dark clouds to go away so that we could go on a vaccination expedition. The clouds let up and vaccinations were back on. Yet the farmers were angry- "Where's our rainstorm Aminata? You chased it away!" I continued the joke and out of the blue said, "Don't worry, we'll get a big storm Saturday night." What a coincidence it was, I was 3 for 3 and we got a steady, soaking rain on Saturday night. I stopped my weather forcasting after the rumor spread around village that perhaps I had some strange powers that could control the rain. "You gotta stop telling people you're stopping the rain!" Shaka says in all seriousness, "If the crop is bad this year, they'll all curse you!"

But now that we're well into the rainy season, not even I can stop it. Yet as much as the rains are giving life here, nourishing millet fields with puddles, these storms also bring the winds of death. Rain means mosquitoes. Mosquitoes mean malaria. Rain means everything is dirty. Uncleanliness brings intestinal disease, diahreah or worms, which also take the lives of kids in sub-saharan Africa. We've seen a lot of hardship at the CSCOM lately. One example, women and girls get up before dawn to go harvest the nuts of the shea trea far out in the brusse. I begged my host mom to let me go with her everyday. She refused- "It's too dark and dangerous out there!" When a young girl returned from a shea nut expidition and died from a snake bite two days later in our CSCOM, I stopped asking.

And the most frusterating is just when we feel like we're starting to get through to the women about malnutrtion, it skyrockets. It's amazing how the kids who have been in our program for a long time have recovered. I love taking out their sheet and putting them in pile of successes. But for every kid we let go, lately, there are 3 or 4 new ones that are referred to us. Some are fighting or recovering malaria or diareah, some are referred by our relais who are really stepping up their work in the community, and others are just simply not fed. They are strapped on their mother's backs all day to work in the fields. No time to specially make ameliorated porriage for the baby. Drink until the breast goes dry.

I registered 4 severely malnourished children (defined as less than 70% of the median weight for its height) in two days. But none was quite as bad as Korotoun. At 20 months, Korotun was barely 5 kg (about 11 pounds). In my 10 months in Dombila, I've only seen 3 other kids as bad as Korotoun. Each one we recommended in-patient treatment. Each one, the family refused. Can we really drop our lives and scrounge up the money to support ourselves to live in the dusty old sick-ward in the CSCOM for an indefinate period of time? Each one died.

But Korotoun's case was exciting because the family accepted in-patient treatment. We explained to the parents that they were to stay with Korotoun here as our staff carefully measured and prepared vitamin-enriched milk to be given her. She would also be given a coctail of medications and vitamins so that her body would eventually stop throwing up everything given to her, and that she would keep well hydrated and protected against vulnerable infections like malaria or rougeole. The father left in tears to walk back to his village, Dio, to collect their things. Of course, I felt so much pity for the child and the family. But I was more hopeful and excited as I had ever been. A father, sitting with his sick child, being so moved... that doesn't happen every day. A child is a woman's buisness. And if she can't feed him right, it's her fault, never mind the father. To see their courage and trust in us. Even the child's grandmother came, and the three of them set up camp in the sick room next to Laji, the guy who's had a gash on his foot for months.

I went straight to the book and planned out Korotoun's diet regimine for the first few days of her treatment. "We have to feed her every hour," Irene says. "Well, not necissarily," I said, "It might be better if we split it up every hour and a half so that she can get her calories gradually throughout the day." Of course, Irene is not refering to the handbook but only to the training she went to last year. "Believe me, I know, I went to the training." Well ok then. We'll feed her every hour.

Korotoun's case came at a time when I was looking for something to keep me busy. And honestly, I could have sat with that little girl every hour, feeding her the warm milk. But I was scared to. I was scared to take on all the responsibility that should be on the permanent CSCOM staff. But mostly, I was scared of getting to attached. Korotoun was so fragile. The day I met her, she couldn't even hold her head up by herself. He eyse too, kept rolling into the back of her head. Her cry was a pained, suppressed whimper, that was lost in the thickness of stuggles she must have been feeling. Yet she drank the milk. She drank it every hour. I left in hopeful confidence at about 2:00pm, Irene assuring me that she would administer the remaining 4 meals of the day.

I came in the next morning to find that Irene only had time to give one of the four meals of the afternoon. "We had a woman in labor! We were in there for a long time. We didn't have time to give the other meals. Besides, the kid was full anyway!" Are you kidding me? It's not about the kid being "full"! It's about carefully calculated calories, protiens and medications portioned out by scientists for her exact weight and height that should be enough to help stabilize her but not too much to overwhelm her system. You can't just wing it.

Cool it, Em, I thought. At least she's here. She got a lot more nutritents yesterday than she did in a long time. She's being helped and besides, she looks a lot better today. Her family was also optomistic. Her eyes were steady, and though too large for her sunken face, were stable and alert. She only lost a little of her food from yesterday, and had a good night's sleep. I began talking to Boary about switching her over to the transition phase, a post-stabilizing regime that initiates the weight-gain process. He said we would start that in another day. Even after I weighed Korotoun to find out her 5.1 kg had dropped to 5.0 kg since yesterday, I wasn't too worried. Today is the day she's really gonna start eating.

The CSCOM staff all signed up for slots to feed Korotoun so that she wouldn't miss a meal. I took the last two, number 7 and 8, so that I could go to market with Caroline during the day. I came back late afternoon to find that Irene had already given her her 7th meal. Her appetite had slowed down a little just before afternoon, but she had eatedn well during the day. I hung around until meal number 8, when I came in with the warm milk that I had made with UNICEF'S packaged powder. He mother spoon=fed her ever so carefully. It was 9pm and Korotoun was tired. She would give these little pain whimpers in between drinks. And I found myself wanting to sit with her forever. I concentrated so hard, on each sip she took. When she would turn away, I would look into her eyes. Very deeply, connecting with the life hidden inside her broken body. "Drink it," I whispered, "Drink it." And without taking her puddle eyes off me, she would calm her crying and drink. It took a while to get the whole meal down. "Drink it, drink it," I said, trust it.

I happily announced to Boure, our chef de poste, that Korotoun had had all 8 of her meals today. "Great!" He said. "Tomorrow we'll start her on the transition phase." Shaka, who had come to watch TV at Boure's, and I walked home about 9:30pm. "You were right Aminata. That baby's really skinny!" He said. "Yeah, but she's doing better today."

The next morning, I stopped by the CSCOM before work on my morning run to see how she was doing. I met Irene at the gate. "How's our baby? How's the family?"

"They left. She died last night. 10pm."