I can’t look away, and on some level, I don’t want to. The young boy, maybe 7 years old, arches his back again, his entire body spasming, his face stuck in a grotesque and totally involuntary leer. Sweat pours off his body, running down his neck, pooling on the black vinyl mattress. His mother, standing by his side, moves to support his head, but is stopped by a nurse, who explains softly that she could hurt his neck muscles, and to let the seizure take its course. Not that it matters. This boy has tetanus, and this boy is going to die.Tetanus is treated with metronidazole, diazepam, and tetanus immune globulin, none of which are available in this Level 4 Health Center that serves Kasana and the surrounding countryside. The staff has only comfort measures to offer, and in this “hospital” nothing is comfortable.
It is hot inside the small run down building, sunlight and its attendant heat streaming in though the massive holes in the roof. Add to that the humidity that naturally occurs when you have lots of people, especially lots of sick people, gasping in one room, rebreathing the same air over and over. There is no ventilation, save the afore mentioned holes, and the stench is incredible. And for now, it has all narrowed to this boy, this child and his mother, who can do nothing but watch, her tears adding just that much more moisture into a room already overburdened with misery.
Americans are mostly vaccinated against this disease, and even in those who do manage to acquire it, there is a 90% recovery rate. Not here. Here there is nothing to be done. This hospital does not have the necessary drugs, nor does the bigger one a few towns away. They will transport the boy anyway, to the larger hospital, but it is still hopeless. Even with the needed drugs, by the time the spams, called opisthotonos, have reached this level of intensity, it is almost always too late. They are strong enough to tear muscles, to cause fractures. And they often affect the muscles surrounding the airway, causing brreathing difficulties. This family, at the very least, does have the money to transport their child. Hundreds of others do not. If you do not have the money for drugs or fuel, you or your child dies. That is the harshest of realities. Ostensibly medical care in Uganda is free, but if the hospital does not have the drugs you need, then it is up to your family to procure it from an outside pharmacy. But, what happens when the pharmacy does not have the drugs? You die. Just like this child, probably infected while playing outside in the dirt, just as children do the world over. One child and one mother.
Everyone on our trip is a mother. We have birthed our children into the world, transforming ourselves at the same time. To look at this Ugandan woman, to share in her knowledge that her child is dying, and to be able to hold that seems impossible. How do we even do that? Why don’t our hearts just crack wide open and we all just die right there?
On some level, I think they do. I have held this vigil before, holding babies and children in my arms as they pass from one world to the next. I’ve sat with parents, held mothers as they screamed their grief and anger and disbelief to the universe, when it seems there is no good or rightness in the cosmos. To watch a child die is the unfairest of the unfair, and it is no different here than anywhere.
So I can’t look away. It it an intrusion, to observe someone’s pain when you are in no position to help? I don’t know. Probably in America it would be. Death is seen as private, and grief inconvenient. We are so uncomfortable with death that we try to wish it away, pretending it doesn’t exist and those whom it touches are somehow weak, and perhaps even to blame. But here, death, like life, is communal, part of a rich tapestry of family and community. And so I offer myself as a witness, joining her world for a few moments, a silent chronicler of one mother’s worst nightmare.