Too Little, Too Often

At least once a week I meet a child suffering some form of malnutrition. Usually, I’m seeing evidence of protein and/or vitamin deficiency (common among the poorest PNG’ians surviving on only sweet potato and greens), but sometimes it’s outright starvation. The sickest malnourished patients are infants without access to breast milk. Sometimes the mother has died (birth complication, illness, trauma), but more commonly, the mother has abandoned the baby to the care of her family – unable to care for the baby herself (drug addiction, illness), or due to some social issue (baby’s father dies and new husband doesn’t want the child). Out of ignorance, many of these adopted infants are given whatever liquid can be found as a supplement – “Milo” is the usual culprit, a widely available chocolate energy drink devoid of protein and fat. When the baby is finally brought to the hospital, usually due to some illness superimposed upon the malnutrition, the caregiver rarely understands where things might have gone wrong. In most cases we then admit the child for rehydration, a slow advance of nutrition, and just as important - a lot of education for the care provider.

“Whoever welcomes a little child like this 

in my Name welcomes me.” – J.C.

(Matthew 18:5)

In the case of “Mama” Ruth, only communicable disease was to blame. Being a busy morning in clinic, I was moving patients quickly (doing my best “Dr Erin”), and my mind was already processing the possible diagnoses of the thin woman walking down the hall toward my room. She had a couple wasmeri’s with her, a sister and aunt, and in usual PNG style, all of them carried bilums (bags) of various sizes. By the time Ruth had sat down in my room, I had narrowed the list of possibilities to cancer, TB, or HIV. She was cachectic (rail thin), pale, and appeared weak. Being from the middle of nowhere, her disease had progressed substantially in the few months it had taken her to get to the “big” hospital. While writing out the orders for Ruth’s chest x-ray and lab tests, I was offered a second scale book. It was new, said “Mama Ruth” on the cover, and I looked puzzled at the other two ladies, sizing them up for some hidden ailment. One of the bilums was then brought forward, and I immediately recognized it as one built for carrying a baby.

I have been very happy to cover the Pediatric Ward over the last month, and I’m always pleased to see a child is next in line when I’m in the clinic. It’s not just that my Pediatric training makes caring for them easier, it’s the pure and simple fact that kids bring me joy! I love their little personalities, I love making them smile and laugh, and I love seeing them get better. When I opened Ruth’s baby bilum, the fearful face that peered out at me broke my heart. The more I uncovered and undressed, the worse my suspicions were realized – this kid was even thinner than Ruth! The questions tumbled out of me, and it all came together – Ruth’s illness had begun 5-6 months earlier, shortly after she had given birth, and as the disease progressed, her milk had dried up. For at least three to four weeks, the baby had been sucking on dry skin, and only getting a little supplemental Milo.

While Ruth went out to get her labs and x-ray done, I worked on admitting the baby to the Pediatric Ward for a slow advance of adequate nutrition and whatever counseling would be needed. When I inquired about the baby’s name, the Aunt told me they had not been sure the baby would survive so never named her. I suppose “Mama Ruth” was the best our patient registration staff could come up with.

Ruth’s labs and chest x-ray were consistent with Tuberculosis, and she decided to go home on the TB medications, leaving little “Mama” in the care of her Aunt while admitted. I enjoyed visiting Mama Ruth every day, watching her gradually take more and more formula, gaining weight, even smiling. When Ruth had still not returned after a week, I asked the Aunt for an update, who happily shared she would now be adopting the baby since Ruth was too sick to care for her. She had born three boys herself, and was ecstatic to have a girl. I was happy too – the baby would be going to a good home, with a woman who knew a lot about mothering, and had the resources to purchase formula.

“If anyone gives even a cup of cold water to one of these little ones because he is my disciple, I tell you the truth, he will certainly not lose his reward.” – J.C. 

(Matthew 10:42)

The commonly used expression “God works in mysterious ways” comes to mind. Ruth and (now named) baby Maria are counted amongst countless who have endured significant life hardship – another ripple in the lake of corruption that extends from the sin of Eden. While we might be quick to demand justification from God for these trials of life, I believe we can trust that God is at work in all of our lives, working in and through each situation to reveal His Love. Though we should seek His wisdom every day, it’s not our place to fully understand and put our stamp of approval on God’s ways. Instead, as little children trust and obey a parent, so we too might grow in Faith and persevere through every trial, as we learn to rely on Him.

“I praise you, Father, Lord of heaven and earth, because you have hidden these things from the wise and learned, and revealed them to little children. Yes, Father, for this was your good pleasure. 

All things have been committed to Me by my Father. No one knows the Son except the Father, and no one knows the Father except the Son and those to whom the Son chooses to revel to Him. 

Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.” – J.C. 

(Matthew 11:25-30)

 ~ baby MARIA upon her return to clinic ~