Abram

It’s Monday now, and we have a full day planned. Ashley is leaving on Tuesday and there are errands to run, special order necklaces to pick up, and goodbyes to say. There are also three sick babies to visit. Julie tells me that Rachel, one of the Suubi women, has 10-month old triplets that have been at the local children’s hospital for weeks and that they’re not getting any better. She says she’s not convinced they’re getting the care they need, and wants to pass by later to see if she can get them transferred to a different clinic.

We run the first few errands, drop Ashley at home to pack, then head down the street to the hospital with Betty, whom we’ve asked to serve as our translator (Rachel speaks only limited English), in tow. When we get there, Rachel has one frail and listless baby boy in each of her arms. Her older daughter Beth is holding a third baby, a girl, whose fat cheeks and bright eyes only bring her brothers’ illness into sharper relief (Beth, by the way, is nine, and has been taken out of school to help her mother with the triplets). Rachel lays the boys in a crib so she can change Abram, the littlest and sickest of the three. John, the other one, begins whimpering feebly. I look at Betty.

“Can you ask her if it’s ok if I hold him while she changes the other one?” I ask. Betty translates and Rachel nods. I gently slide my hands under John’s little body and hold him close to my chest. I hum a lullaby, the only one I can remember (“Hush little baby, don’t say a word, Papa’s gonna buy you a mockingbird…”) and soon he is quiet, his small head tucked under my chin, his breathing shallow but steady.

Julie begins, through Betty, to explain to Rachel why we are here and how we want to help. All eyes are on us and soon a small crowd has formed. Two men (social workers, I learn) are there, asking questions about who we are and what organization we are with and where we will take the babies. Julie, who has since scooped up baby Abram, is trying to clarify our relationship with Rachel, when I suddenly realize that they think we want to take them from her.

“No, no,” I say. “We don’t want to take the babies from Rachel. We are just wanting to take them from here, to transfer them to another facility. We are concerned that, after being here so long, they are still so sick. We’d like to move them to another clinic, so they can see another doctor.”

The social workers nod their understanding, but by now the small crowd has grown. Now, there are nurses all around, and a large, sturdy woman descends upon us. I can tell right away that she’s pissed. She is the matron, I’m sure, the nurse-in-charge, and she is scowling with more than just her face – she is scowling with her entire dump-truck of a body. And I know that somehow, despite our best, most well-meaning intentions, we have managed to offend her and her entire staff.

Several people are talking at once: the social workers to the nurses; the nurses to Rachel; Rachel to the social workers; Betty to us; us to each other. We are told that we can’t remove the babies without the mother’s permission. In my meekest, most conciliatory tone, I assure everyone that we don’t intend to do anything without the mother’s permission, and that we are only here to help. We are then told that if we do remove them, it will be against medical advice.

I look at Julie, still holding Abram, with John in my own arms, and stammer something unintelligible. I feel helpless and completely in-over-my-head. We are causing a scene (just by virtue of being there and being white), angering the staff, and I’m concerned that Rachel is feeling pressured to do something she doesn’t really want to do. Julie says she doesn’t trust the medical advice or treatment they are being given here and she just wants to get the babies out, she doesn’t care who we offend in the process. The Mighty Mouse theme thrums a sardonic tune inside my head: “Here I come, to save the dayyy!!”

Suddenly, we are ushered out of the ward and into a small room across the hall, the matron insisting that the babies must be tested. “For what?” we ask. “HIV,” they tell us. We explain that the babies have already been tested and are negative, even show them where it says so in their books. We know that they know this, and that they are just stalling, but we don’t know why – other than to assert their authority. I do my best to smooth ruffled feathers, affecting a soothing, almost obsequious tone when I speak and engaging in lengthy greetings with each new nurse we meet, but it’s getting us nowhere. I want to call my brother; I am certain he’ll know what to do.

There’s more talking in languages I don’t understand and then someone else comes in (actually, I’m pretty sure it’s the matron again), asking us why we are wasting their time having the babies tested for HIV. Julie and I share an exasperated look. Finally, the matron dismisses us with a perfunctory wave.

We hustle out before she changes her mind and clamber up into the Mystery Machine, Rachel holding Abram, Beth holding Eva (who by the way has been sucking on the first two fingers of her right hand the entire time and it is the freaking most adorable thing I have ever seen) and me still holding John; Betty climbs in with Kymbi. Rachel’s husband, whose name I have forgotten (it’s something lyrical and multi-syllabic, like Sulongalonga), stays behind to wait for her mom. We pull out and head for Rippon Medical Center. It’s private, so it costs more money, but Julie’s mom has deposited money in her account to cover whatever medical expenses they incur.

At Rippon, we are seen almost immediately by the doctor. Dr. Christine is large, like Nurse Ratchet, but soft and round where the nurse was hard and square, and she is smiling a kind smile. I feel better already.

Julie leaves to check on her sister so I am left to explain how it is we’ve come to be here. Dr. Christine listens quietly, then examines each baby. She tells me malnutrition is the primary presenting condition, but orders a full blood work-up on all three to be safe.

The lab, however, is closed. And this is where I am reminded that, in Africa, time is not your own. Here, you are at the mercy of God or the Universe or that one lab tech who will take every second of his well-deserved afternoon break, by George, no matter how many desperately ill and hungry babies are waiting for him to stick them, again and again, rooting around for their tiny, atrophied veins in search of the blood that will tell the story of their sickness. And so we wait, on benches in the hot sun. It feels like forever before he returns. I want to scream.

He does return, though, and by then Julie is back with Ashley, so she takes Abram and follows the tech inside while I check messages on my cell. I hear Abram start to cry, and rush in after him. And there is Julie, seated into a corner, holding Abram while the techs (there is a second one now) hover over him and search fruitlessly for a vein. He is wailing – an agonizingly insistent, if faint, howl – and would flail his free arm in protest if he could but he is too weak to do much more than flap. He’s got a stent in his arm already, from the IV drip he was on at the other hospital, and we ask if it’s possible to draw from that one but the techs shake their heads. I watch, crying, my own fists clenched to keep from flailing, until I can’t stand it any longer. I run outside and cry some more.

When I come back, Julie is standing with Abram; the techs have given up. She looks at me. “Do you want to hold – ”

“Yes,” I say, and scoop his tiny, birdlike body into my arms, rocking him gently and cooing in his ear. At ten months, he weighs even less than my niece, herself a preemie, did at five. He has no hair on his head, but his long lashes are tinged with orange, the tell-tale sign of malnutrition. His head fits neatly in the palm of my hand and I can feel each of his vertebrae through his thin onesie, like a row of skittles beneath his skin. I hold him close and hum a lullaby, then a hymn.

I wait in the office with Abram while the techs repeat their torture on John and Eva. Julie sticks her head in and asks if I mind staying. She still has a long list of things to help Ashley with before she leaves and they are running out of time. “Of course,” I assure her.

When they finish with Eva, I stand to leave, but now another doctor is there, and he is saying they must try again with Abram. “We didn’t get enough,” they say. They need more blood to conduct their tests. I sit back down and hold Abram tightly while the doctor ties a rubber glove around his pencil-thin arm; this seems to pain him even more than the needle. I close my eyes and press my lips to his forehead. I don’t think I can watch him endure this again.

The doctor leans over and spies my own veins, swollen from the heat of the sun and pulsing with my anxious heartbeat. “Ah, but yours,” he says, pointing at my arm. I smile wryly. “Yes,” I say, and wish I could offer my own veins instead, a vial of my own blood.

The doctor sticks Abram again and he keens. I pull him closer, and begin humming again. I look at the doctor. “Do you think maybe he could rest?” I ask. “Do you think maybe we could try again tomorrow? He is just so dehydrated and – ”

“Yes,” the doctor says, straightening. “His veins are very tired. I think maybe we will try again tomorrow.”

“But … he can stay here tonight, yes?” I ask, but he is not listening. He is looking outside, at Dr. Christine. They consult through the window and agree that Abram can stay the night. I hurry outside and confirm with Dr. Christine. She tells me that they will keep him overnight so they can re-hydrate him and start him on treatment, then try again to draw blood tomorrow.

“And the others,” I say. “They can stay, too?”

“Yes,” she says. “I think we can manage.” I thank her profusely and ask her if she will explain to Rachel and her husband what is happening. She does, and promises to also explain to her how to prepare a rice porridge that will be better for the babies than milk (milk, it turns out, only exacerbates the diarrhea). Then we follow the other doctor to a private room where a nurse is putting clean sheets on the bed and another is readying the IV drip.

I stay with the family until they are settled. I notice John and Eva’s wet bottoms, and gesture to Rachel. She shakes her head – she has no more diapers. I tell her I am going and ask if there’s anything I can bring her. She asks for milk. I promise to be back soon.

I walk home and pack a bag with new cloth diapers that someone had donated a while back, then set off for the market in town. Back at Rippon, I present Rachel with the milk and clean diapers, then collect the pile of soiled ones she’s wadded in a ball and stuff them in my bag. I will wash them myself. I kiss each of the babies, and Beth, shake Rachel’s hand and head home. I am drained, but I feel lighter. I know that everything will be ok.

At the house, I boil water so I can soak the soiled diapers, only two of which are actual diapers, by the way. The rest: a faded onesie, an old toddler’s t-shirt, a piece of a bed sheet, a threadbare dishtowel that Rachel ties around her children’s tiny middles. They reek of vomit and diarrhea, a sickly sweet, almost yeasty smell. I scrub until my fingers are red, boil more water, and scrub them again.

On Tuesday morning, Julie and I share a piki (a scooter) to Rippon – I straddle the seat behind the driver and Julie perches, sidesaddle in her skirt, behind me. The diapers I’ve washed aren’t dry yet – we’ll have to bring them by later – but we want to get over there first thing. We are anxious to see how the babies are improving.

When we get there, we are met by the two doctors from yesterday, Dr. Christine and Dr. Needle Stick; they inform us that the family is no longer there. They were transported, we are told, back to the children’s hospital from whence we removed them, in the middle of the night. Abram’s treatment was failing, we are told, and the night duty staff thought it best to send him to a facility that had more experience dealing exclusively with children.

“But … they weren’t giving him the right treatment there!” Julie splutters in protest. “We took him out of that place, and brought him here so he could get the treatment he needs!” She shakes her head, exasperated. “I am afraid that if he stays there, he will die,” she says. The doctors have nothing to say to that. Then, after an awkward silence, Christine says she will make a call and inquire after Abram for us.

Julie and I thank her, but we are seething. And though I can’t speak for Julie on this, I am also scared. I know how much we angered the matron and her nurses yesterday and I am worried that Abram will be punished for it. We stand on the corner and debate our next move. She wants to go over and remove him, to transfer him Al Shafa, the last best clinic in Jinja. I am certain that removing him will only make things worse. “For whom?” she asks, and says again she’s not worried about who we might offend. “If he stays there, he’ll die,” she repeats. I know she’s probably right, but I can’t help but think that swooping in again will have other larger and less immediate, but more lasting consequences – for Rachel and her other children, for any other woman we might want to help at that hospital – even if I can’t seem to articulate why I believe that.

I feel, if it’s possible, even more helpless than I did yesterday. In a fit of desperation, I text my brother and ask him to call me. Scarcely a minute has passed when a matatu pulls up to the curb and Rachel and her husband spill out. I am relieved, and greet her warmly, but her face is impassive.

“Where is Abram?” Julie asks.

“He is dead,” she says, and flicks her hand, a vague, faraway gesture, her eyes squinting into the morning sun. I am speechless, and feel very suddenly and very violently ill.

“We are so sorry, Rachel,” we both finally say. “So very, very sorry.”

*****

I walk home from Rippon in stunned silence, weeping. I am irrationally angry – at Rippon, for failing him; at the matron, for being such a bitch; at Rachel, even, for not understanding that milk was only making him worse; at myself for knowing it and being stupid enough to buy her more; at Julie, for thinking we had any right; at myself, again, for not agreeing with her.

And then I am ashamed – ashamed that I could have wasted a millisecond worrying about how I might spare someone offense when a life hung in the balance. Not that it would have made a difference – he was dead already when we had that argument.

I am ashamed, too, for thinking we could fix it in the first place and then ashamed that we didn’t, that we failed. And I wonder if Rachel is angry, if she blames us.

And I think, still, of that fucking nurse.

And then I am just sad, wishing I could have held him one more time, hummed him one more hymn, felt the tiny weight of him.

And then I am gripped, suddenly, with a terrible fear, wondering crazily if the last time I held him, I held him too tight; if in holding him still for that last, fruitless needle prick, I squeezed an indispensable breath from him, a breath that might have made the difference.

And then I am home, and the day must begin. There are Suubi women to visit, and flights to catch, and diapers to press and deliver, and two other babies that still need us.

We pile into the Mystery Machine and head out.