The letter was written on a page torn from an exercise book. The paper was folded in two and fastened with a single staple.
“Boboto Medical Centre, Basankusu Diocese.
Dear Monsieur Francis,
We have a child here in our care. She was sent from a medical centre in a nearby village, with severe malnutrition. We’ve treated her as best we can, but she really need to have good food if she’s to continue to improve. Please send the following: Special milk powder F-75 (5 tins), rice, corn, sugar, vegetable oil, peanuts, beans, and dried fish.”
It’s not that we wanted to refuse them these essential foods, but our experience had taught us to be cautious. If we’d sent the things they’d requested, it would be the start of a slippery slope. A few of the staff at the medical centre would take a few cups of each thing, to use at home. We can sympathise with these little “borrowings” – perhaps their own children could do with a bit more nutritious food. What we suspect is that next time – and there would be a next time – they would ask for more foodstuffs, and take even more of it home. A slippery slope – and it would leave our children short. I wrote a reply.
“I was very pleased with your letter describing your patient and the care you are providing for her. Unfortunately, it’s against our policy to sent food to other institutions. We would, however, be very happy for you to transfer the child to our care.”
The little girl was Justine, a pale, frail looking 6-year-old. She’d arrived from a village, somewhere on the road to Bokakata, 20 km away. She was painfully thin. A lot of her initial swelling had gone down because of her treatment at Boboto Medical Centre, but she was very pale – and her skin was peeling as if she’d been burnt.
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| Justine just after arriving at my house |
Judith smiled. “She just needs the right food – in a couple of weeks we see a big change in her,” she said.
A couple of weeks went by. Justine was usually lying down next to her mother on a raffia mat, which was on top of her bamboo bed. Judith called me across to where they were so that I could give my opinion. We couldn’t see any change. She just lay there, listless. She started to develop pressure sores where her bony knees, and her hips, lay against her bed.8
“You need to change her position frequently,” I told her mother. “Change the position she lies in every half an hour. Raise her knees and where ever else she has a pressure sore from the bed, by making a cushion from clothes on either side of the wound. Dress the wounds with palm oil – we’ll give you some chloramphenicol to mix with it to avoid any infection.”
Justine’s mother and grandmother did a really good job. They made little cushioning pads to raise the affected parts of her body away from the bed, they changed her position frequently and they painted her wounds with shop-bought palm oil mixed with chloramphenicol powder. (We crushed tablets to make the powder.)
Another week passed, and we still couldn’t see any improvement. Her skin got worse and she couldn’t resist scratching. She scratched her face and removed a lot of skin. She was a mess. Her shoulder blade stuck out like an axe.
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| Justine's condition deteriorated |
“What more can we do, Francis?” implored Judith. Justine had had all the usual tests and treatments. She’d taken tablets for worms; she’d been checked for malaria. Perhaps we’d assumed too much about her treatment at the Boboto Centre. “Let’s take him to our hospital, next-door,” I said.
“But she’s already been to Boboto – what more can they do?” said Judith, obviously worried.
“The doctor knows his job,” I said. “It’s very easily something we’ve missed.” It crossed my mind that Justine could have an underlying condition – leukaemia for example – and not all of such conditions could be diagnosed here. If they could be, perhaps they couldn’t be treated.
I went with Judith to take Justine and her mother the short distance to the hospital. It didn’t take Dr. Eric very long to decide that her blood iron was low, and that a transfusion would help.
I’m always reluctant when severely malnourished children are sent for injections, and transfusions. We had a little boy who had several intramuscular injections, at Basankusu’s general hospital. He developed huge wounds at the site of each injection and died, that night, of shock. So it’s easy to understand my apprehension.
“Don’t worry,” Dr. Eric reassured me. “That’s only a problem with injections into the muscle. We’re not doing that. The blood transfusion will give her some appetite! She’ll start to eat with gusto! You’ll soon see a change in her.”
My experience of blood transfusions in Basankusu, has also left me wary of the eventual outcome. In the past we’ve had both adults and children who’ve improved tremendously after a transfusion, but then gone downhill again after two weeks.
Justine’s mother agreed to the transfusion. She wouldn’t have been able to afford any treatment at all. The nurse sent someone to call one of his trusted donors. Even when they trust the donors, there’s still a risk that the blood could be harbouring some disease or other – but here in the Congo, everything is a risk.
Justine stayed in hospital for 5 days after her transfusion. They wanted to keep an eye on her. Her mother, who was pregnant and had another small child in tow, went home to their village. When Justine came back to us, she told us how nice it was to sleep on a foam mattress. She decided that the mattress had helped heal her pressure sores, which could be true, but it could also be the result of the transfusion. It’s true that she won’t return to one in her home village, but we decided to buy foam mattresses for all our in-patients.
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| Justine with her mother at the hospital |
Justine’s grandmother was becoming more impatient with her stay at my house. She wanted to return to their village. Around this time, we were arranging to travel to Kinshasa. There’d been a national lockdown on all domestic travel, because of Coronavirus, and so this would be my first chance to travel since my arrival, this year, in February. Justine’s grandmother decided, without foundation, that they wouldn’t be fed properly if Judith went to Kinshasa, and so she’d rather return to their village.
I discussed the situation with Judith.
“Yes,” she agreed, “we could send them with food for a few weeks, but I doubt that they’d give it to Justine alone. They’d feed the whole extended family with it – and perhaps sell some of it. Justine wouldn’t make much more progress.”
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| Justine after leaving hospital. Her shoulder-blade still as sharp as an axe. |
I shared my worries about how the good effects of a blood transfusion might wear off after a couple of weeks, and that they should stay with us for another couple of weeks. “If not another month!” added Judith.
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| A photo of Justine taken a few days before she was taken home to her village |
After some discussion the grandmother reluctantly agreed to stay a few more weeks. We flew to Kinshasa and Justine was transferred to our main centre, on the other side of town. A week later, unable to settle at the main centre, they moved back to the accommodation at my house. We were happy that the spent a further 3 weeks to help Justine put on more weight. All her bedsores had healed, her colour had returned and she looked altogether better.
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So here we are in Kinshasa – still working hard, buying up provisions and equipment for the centre in Basankusu.
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