I am very aware of my colour, my weight, my relative wealth, my cultural background and my education as I work out here. It’s impossible to hide it, and a bit disingenuous to even try to, but I do try to be as aware of my impact when I am out in communities and be respectful of local custom and culture. This week was the first time since my visit to the local malnutrition ward (see ‘Carry On, Doctor’) that I really felt like a colonial memsahib, Lady Shat-Beazel, on a mission in a village.
The main aim of the outreach work is to ensure that children a) survive their childhood (which 1 in 5 currently don’t) and b) that they do so in the care of their own family, not in an institution.
Even when these two came in 2 weeks ago, 2 months premature and one month later no heavier than their birth weight, with a mother in psychiatric care with puerperal psychosis and her younger sister having to leave her job in a hotel to care for them, we still prioritise training the aunt to make up feeds and send them home.
But one week later and no weight gained and an aunt who said she just slept through the night and didn’t get up to feed them, I requested that we made a home visit.
Scrambling up a hill, on our hands and knees at times, to the family’s home we were met with a small pitch-black coal-hole of a room. I could hear someone crying on the floor and, when my eyes adjusted, found the twins’ mother, released from the psychiatric ward, off her meds, having lost touch with reality some time before and terrified by the sight of strangers in the home. After I’d calmed her down and tried to explain who we were, she hugged us and scrambled back over the mattress on the floor to sit behind the pile of blankets -which it turned out was covering the twins – rocking and giggling like the first Mrs Rochester at the sight of lit candle.
We took them out for a look and found them very dehydrated and limp. Aunt had no watch and could not tell the time anyway and had no phone to set alarms. She only fed them if they woke up and cried which was not very often! And on that day they had gone over 4 hours without a feed. She made up some bottles and we fed them, trying to suggest ways to remind her to feed them such as on every mosque call and every time she ate, when she woke up and when she went to bed but with no light in the room she would not be able to make them well in the dark anyway . Leaving them behind felt beyond dreadful, knowing that they were unlikely to survive. Frankly, leaving the whole family behind felt dreadful, with the mother a real target for rape if she wandered too far out of the house and the young aunt, who was not the full shilling herself and whose life had been turned upside down just a few weeks ago.
But the bottom line is there is a healthy female carer in the house so it is very hard to persuade Social Welfare to remove children in this situation, partly because it is so common.
Fortunately, the next day the Saturday social worker on emergency cover at Social Welfare headquarters, Pamela, was in a good mood and the managers persuaded her to issue a care order so 2 hours later Helen, a volunteer ex health visitor, and I were scrabbling up the hill once more with Hassan. Trying to be as subtle as possible (in terms of being very quiet at least and respectful – you can’t get away from groups of small children following you and shouting ‘wazungu!’) and telling the neighbours we were taking the children to hospital to save face for the aunt, we picked up the twins and marched off back down the hill to the landrover, feeling with every step ever more like Lady Shat-Beazel and her friend, the Honourable Figgy Rothchild du Broadbottom, carting off the little black babies amid the curious gazes of every villager we passed.
One nasty moment when one of the twins stopped breathing for longer than was comfortable in the back of the car and then we were back at the babyhome. The twins are ‘incubated’ – as in swaddled in blankets and kept in isolation with minimal handling by one designated mama.
Both are now able to suck so can be fed by tiny bottles.
And hopefully aunt has taken mum back to the hospital for a re-assessment and prescription (and actually filled the prescription)
Aunt can visit whenever she wants and the twins will go back, but realistically, and hopefully, not for a couple of years.
Update: 3 weeks later and both twins are over 2 kg now and will be out of isolation in a couple of weeks time if all goes well.