We often take calls and emails from our remote church planters with medical questions and patients that have been brought to them for help.
This past week, we received a call from one such missionary women who is frequently asked to treat the people of their language group. They are very remote. There is no health aid post, hospital or doctor where they are. If a hospital is needed, they must travel (several days walk or a plane ride) out to the nearest town and hausik (hospital).
But their people are very afraid to go to town. They have no friends there and because they have no friends there, there is no garden for them to get food from and no place for them to stay. They have to pay for these things and there is not much money. Also, often people living in town resent the “bush people” coming into town and are quite prejudiced against them, making life in town hard for the people from the bush and taking advantage of them with higher prices than normal. Fights erupt out of these tensions and people have died. Thus, bush people are often too scared to go to a town and cannot afford to do so.
This past Tuesday, we were called and told that a family from a 6+hr hike away had brought their 3 month old baby to be treated. He was said to be “sick” and “not growing”, that he nursed all day but wasn’t gaining weight. The missionary called us wondering how to help such a sick little baby. Should she give antibiotics?
This is the picture she sent us–truly he is bun-nating (“bone nothing” = skin and bones)! They said that the baby was sick with coughing and congestion in May and they had come but the missionaries were not there. They told her that that is why the baby is so sick now, because she was not there to help!
Well, she was here now and our doctor was able to talk with her by phone, discussing the assessment and the treatment options. Our first recommendation is that he be taken straight to a hausik. He mainly needed high caloric feeds (ideally with formula) and frequently measured I&Os (intake and output) and weights. He may not have many days left to get him there. But we were informed that his family is very afraid of town and that they would likely take him home and wait for him to die rather than go the hausik.
He had no fever or congestion now and despite being very malnourished appeared alert. He was definitely suffering from lack of caloric intake. But why? Was he too weak to suck and swallow? Was there a congenital anomaly causing him to aspirate what he was drinking and thus gain no benefit from it? Or maybe he had a malabsorption issue? Or maybe it’s not him. Maybe mom is not producing enough milk? Maybe her milk is weak and lacking in calories due to her own poor diet?
We advised that the baby be given some oral rehydration solution to assess his ability and willingness to drink. He hungrily drank it all down, no coughing during or after. Good. He has the ability to drink and was truly eager for it, hungry. That’s good. He also has no fever. Likely not running an infection right now. Perhaps a bad virus last month?
We needed to assess what mom was able to feed him but how? Ideally a breast pump for expressing and collecting milk would be the best but that does not exist in the bush. So we advised that she tried to express what she is able by hand. If she is not expressing much milk or the milk is thin/watery, then she needs to find another nursing mother in their village that might be able to feed her baby as well. (This is mom’s 7-8th child and may not have been an issue previously, but as she ages this difficulty may arise.)
Lastly, though young, the boy is swallowing well and could potentially be started on soft foods–rice, cooked sweet potato, avocado (high in fat), egg or egg yolks (also high in fat).
Having given advice as we were able we hung up with her. It is not uncommon for this missionary to treat someone, advise on their further treatment, and then never see them again. We likely will not hear the outcome either. But God knows. And this is the most comforting fact of all. God knows. He sees. And He heals. Praying for this little man’s survival and growth!