It’s 8:00 AM on a non-descript Thursday morning in Mbale.
Which is to say that it’s a descriptly beautiful morning, just the kind that’s all-too-easily taken for granted: blue sky tinged with so-white-they’re-almost-pink clouds, the kind that arc and seem to ripple above the earth; the verdant countryside, grass begging to be laid on, hills lazily rolled down; the deliciously unhealthy aroma of chapatti and mendazi, a scent that can wake a person up a la those old Folger’s commercials. It’s a morning when any type of clothing is just right, where a bit of chill whizzing through the streets on a boda gives way to the reigning, uncompromising sun.
My boda pulls over next to the closed, wrought-iron gate that serves to keep the throngs of families away from their loved ones inside the hospital. They’ll have to wait until visiting hours unless the attendant shines his favor on them, or if they’re white. Which I am, so I get whisked in without hassle.
The Acute Pediatric Unit is a bit busier than usual. Counting the new crop of fresh-faced med students, there are 25 people in the cramped, stuffy, 20×10 room, including six patients: one boy who looks to be about five, most of the med students surrounding him in a half-moon formation; one toddler in the middle bed; and four newborns on the opposite side, in cribs and make-shift cribs.
Training should be quick this morning, 20 or 30 minutes tops. I’ve got lions and giraffes and zebras on my mind in anticipation of the weekend’s safari at Murchison Falls National Park, and am only half at the hospital. A goal for the day is to get a picture of the Embrace WarmPak Heater, which is currently placed in an old incubator – inadvertent marketing gold.
One infant is already in the sky-blue Embrace BabyWrap warmer, a welcome sign that the program is starting to become routine for the midwives and physicians – excellent news. I check the infant, making sure that the warmer is being used correctly. Baby is tightly wrapped, WarmPak is still warm – sweet!
With that infant in the clear (for now), I bring my attention to the heater. It’s in the old incubator – great. I just need to get my picture, talk to the nurses, and then I can head to the Operating Theater.
But there’s something on top of the incubator, a tiny white cotton swathing blanket. I figure it’s just the extra wrap for the baby already in the warmer, so I reach over to move it.
My hand stops mid-grab, and I see a pair of tiny, lifeless brown eyes pointed at me – but not staring, for they have no motive, no motor driving them. It – he? She? – was dead, laid on top of the incubator by a too-busy midwife.
That I couldn’t even tell an infant was in the blanket to begin with should say everything about how small he – yeah, definitely a he – was; no bigger than a kitten, eyes the same size as a kitten’s, actually. His skin was translucent, cyan veins like rivers on a map. Rivers that had run just about dry, now lifeless, destined to stay stagnant.
I asked the nearest midwife, Emma, what had happened, though his body already told me everything I needed to know. He was born perilously early for a Ugandan baby, and had little chance of survival. In the knowing, unemotional way that many of the midwives I’ve talked to speak about life and death, she said that a woman – currently near-death as well due to post-partum hemorrhage – had pre-term twins, and they were brought to the APU in the middle of the night. Both were put in Embrace warmers in a race against Death to keep them alive. The baby on top of the incubator lost, an hour before I arrived.
His twin was alive – the infant I had just checked in the warmer. Shall have no dominion, yet.
I had just enough time to take in all of this before I was asked to help conduct a hands-on training of the warmer, with the living twin serving as the subject. And so I trained a midwife on the Embrace warmer while the dead twin hovered next to me, ensuring I was doing everything possible to keep his twin alive, watching with unmoving eyes as I put on latex gloves, gingerly handled the twin, and did my job for the morning.
After I was finished, Sister Emma took away the dead twin, leaving the live one to fend for itself as its mother fought for her life in a different ward. The live twin was protected only by the Embrace warmer and the too-few staff.
Selfishly, I wanted to get away at that moment, having spent enough time in the proximity of Death for a day, soaked up enough heartbreak for a week. Death conspired with the ward and had different plans for me. Immediately after the dead twin as taken away, a commotion brought my attention back to the five-year-old boy with the phalanx of young med students. His father, as diligent as he was stoic, thin and frail and oddly powerful, stood next to the boy as the doctors tried to save him. Death was still in the ward though, and found it convenient to take two children at once that day.
I never learned what specifically killed him – malaria maybe, or another disease that is so rare and so out-of-sight, out-of-mind to Westerners that it’s called a Neglected Tropical Disease. In that moment, it didn’t seem to matter to his father or crestfallen mother.
As sad as this death was, it’s the first that I suspect will stick with me. His eyes, and his veins, and his twin. His near-death mother and the all-too-real possibility that he’d grow up twinless and motherless, never knowing the latter or, possibly, the existence of the former.
If he grows up at all. If Death didn’t take him that day – something I can’t even be sure of – there are mosquitoes and malnutrition, cryptosporidium and cholera, sleeping sickness and normal sickness. And more – all soldiers in Death’s war with the living.