“I don’t think she’s going to make it. We can’t even weigh her; she’s too weak to stand up.”
The last time I took a child to hospital, the child had a fractured skull after a confrontation with a brick wielding maniac and he nearly died in front of me after a catalogue of errors by the medical staff just exacerbated an already awful situation. I was hoping it was a once in a lifetime experience.
3 years on I found myself again taking a child to hospital, a child close to death. Florence is 16 years old. You have to go back 8 years to understand how she found herself in hospital as a fragile small bundle of bones and loose skin.
When Florence’s mother herself was facing death after contracting HIV, Florence bore the brunt of her anger with the world. For reasons beyond most people’s comprehension, Florence’s mother infected her child with her blood.
Shortly after, Florence’s mother passed away and her father abandoned her with her mother’s sister. Over the course of the next 7 years, as war raged around her Florence was fighting her own battles against an increasing series of illnesses. Suspicious there was something wrong, her aunt finally took her to an MSF hospital.
The hospital’s verdict – Florence was HIV positive and also suffering from tuberculosis. She remained there for 6 weeks, slowly recovering and beginning an 8 month course of TB treatment and a lifelong course of anti-retrovirals. On a daily basis her aunt was there beside in hospital caring for her, cooking for her.
After 6 weeks, her aunt’s husband, Florence’s uncle, grew tired of his wife being away from home. Enough was enough. His wife was coming home to look after his cattle, keep his home and start preparing for the planting season. And Florence; Well Florence was a lost cause and a burden. He was bringing her home to die. That was as much as he was prepared to do. And his decision was final. He was after all the man of the house; no one else’s opinion mattered least of all Florence.
When Florence left the hospital, against the advice of the medical staff, she weighed 33kg. She was a long way from responding to the TB treatment and anti-retrovirals.
For Florence’s uncle, investing in a lost cause wasn’t attractive. So providing her with the diet necessary to fight the virus and respond to treatment wasn’t top of his agenda either.
Florence has been slowly wasting away since. Meanwhile her aunt has been looking on powerless and her uncle has been growing increasingly impatient and resentful of the burden. There is also some evidence – broken translations of conversations and bloody lips - to suggest she’s also been physically abused or caught up in domestic violence. The official story is that she fell down.
This is the Florence I met. A 16 year old skeletal girl too weak to sit up or speak, with a bloody face, lying on the floor of a mud hut in the middle of an IDP camp.
On Saturday morning I met with the uncle for the first time. He has all the trapping of wealth in the local context – he’s employed as a teacher, rides a small motorcycle, owns several cattle… Potentially, he’s an educated man with the capacity to care for Florence. But instead of being a solution, he’s the problem.
After tense negotiations during which I barely kept my desire to strangle the man in check, he agreed to let his wife accompany Florence to the MSF hospital for a week. On the condition I paid for him to hire people to look after his cattle and weed his land whilst his wife was away. This was clearly a good business opportunity for him.
Transport was the next challenge. In a recent meeting, the District had proudly announced they now had 8 new ambulances. We called. "Ah, unfortunately they’re not yet operational I'm afraid" was the response we got. So we called IMC. All their ambulances were broken; they were borrowing the single ambulance of another NGO and that was busy. What do people do if they don’t have their own vehicle?
As soon as we lifted Florence out of the car, I heard calls of “Florence” and a handful of hospital staff appeared around us. She was fondly remembered.
I wasn’t sure whether Florence was lying in hospital fighting for her life or willing it to end. Assuming the best, we started putting in place longer term arrangements for her stay and care. MSF called and said she was responding well to the improved diet and treatment. Things were beginning to look up.
MSF called this morning though. Florence had died. Their best guess was that it wasn’t TB or any other disease that took her. It was starvation. The accumulation of months of deprivation and neglect. I’m not a father but this is the second child in my care who has died and it hurts.
So today’s ‘To Do List’ looked a little different to most. ‘Buy coffin’. ‘Collect body’. By the end of the day, all the characters in this story had continued in their roles. The aunt grieved and informed me how much was remaining from the money I’d given her for feeding Florence. The uncle asked for money for a goat to slaughter and then later for concrete for a headstone. The white man continued to try to contain his anger and make sense of the situation; he contained himself to telling the uncle that he needed to make peace with Florence and send her off well. And Florence remained silent, but this time hopefully more peaceful.
The last time I took a child to hospital, the child had a fractured skull after a confrontation with a brick wielding maniac and he nearly died in front of me after a catalogue of errors by the medical staff just exacerbated an already awful situation. I was hoping it was a once in a lifetime experience.
3 years on I found myself again taking a child to hospital, a child close to death. Florence is 16 years old. You have to go back 8 years to understand how she found herself in hospital as a fragile small bundle of bones and loose skin.
When Florence’s mother herself was facing death after contracting HIV, Florence bore the brunt of her anger with the world. For reasons beyond most people’s comprehension, Florence’s mother infected her child with her blood.
Shortly after, Florence’s mother passed away and her father abandoned her with her mother’s sister. Over the course of the next 7 years, as war raged around her Florence was fighting her own battles against an increasing series of illnesses. Suspicious there was something wrong, her aunt finally took her to an MSF hospital.
The hospital’s verdict – Florence was HIV positive and also suffering from tuberculosis. She remained there for 6 weeks, slowly recovering and beginning an 8 month course of TB treatment and a lifelong course of anti-retrovirals. On a daily basis her aunt was there beside in hospital caring for her, cooking for her.
After 6 weeks, her aunt’s husband, Florence’s uncle, grew tired of his wife being away from home. Enough was enough. His wife was coming home to look after his cattle, keep his home and start preparing for the planting season. And Florence; Well Florence was a lost cause and a burden. He was bringing her home to die. That was as much as he was prepared to do. And his decision was final. He was after all the man of the house; no one else’s opinion mattered least of all Florence.
When Florence left the hospital, against the advice of the medical staff, she weighed 33kg. She was a long way from responding to the TB treatment and anti-retrovirals.
For Florence’s uncle, investing in a lost cause wasn’t attractive. So providing her with the diet necessary to fight the virus and respond to treatment wasn’t top of his agenda either.
Florence has been slowly wasting away since. Meanwhile her aunt has been looking on powerless and her uncle has been growing increasingly impatient and resentful of the burden. There is also some evidence – broken translations of conversations and bloody lips - to suggest she’s also been physically abused or caught up in domestic violence. The official story is that she fell down.
This is the Florence I met. A 16 year old skeletal girl too weak to sit up or speak, with a bloody face, lying on the floor of a mud hut in the middle of an IDP camp.
On Saturday morning I met with the uncle for the first time. He has all the trapping of wealth in the local context – he’s employed as a teacher, rides a small motorcycle, owns several cattle… Potentially, he’s an educated man with the capacity to care for Florence. But instead of being a solution, he’s the problem.
After tense negotiations during which I barely kept my desire to strangle the man in check, he agreed to let his wife accompany Florence to the MSF hospital for a week. On the condition I paid for him to hire people to look after his cattle and weed his land whilst his wife was away. This was clearly a good business opportunity for him.
Transport was the next challenge. In a recent meeting, the District had proudly announced they now had 8 new ambulances. We called. "Ah, unfortunately they’re not yet operational I'm afraid" was the response we got. So we called IMC. All their ambulances were broken; they were borrowing the single ambulance of another NGO and that was busy. What do people do if they don’t have their own vehicle?
As soon as we lifted Florence out of the car, I heard calls of “Florence” and a handful of hospital staff appeared around us. She was fondly remembered.
I wasn’t sure whether Florence was lying in hospital fighting for her life or willing it to end. Assuming the best, we started putting in place longer term arrangements for her stay and care. MSF called and said she was responding well to the improved diet and treatment. Things were beginning to look up.
MSF called this morning though. Florence had died. Their best guess was that it wasn’t TB or any other disease that took her. It was starvation. The accumulation of months of deprivation and neglect. I’m not a father but this is the second child in my care who has died and it hurts.
So today’s ‘To Do List’ looked a little different to most. ‘Buy coffin’. ‘Collect body’. By the end of the day, all the characters in this story had continued in their roles. The aunt grieved and informed me how much was remaining from the money I’d given her for feeding Florence. The uncle asked for money for a goat to slaughter and then later for concrete for a headstone. The white man continued to try to contain his anger and make sense of the situation; he contained himself to telling the uncle that he needed to make peace with Florence and send her off well. And Florence remained silent, but this time hopefully more peaceful.
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