Diagnosis II

Where was Katie? I wondered. We needed to work on the database for the survey we were conducting, a survey about health education. There wasn't really a rush, though. I set out through the clinic to find her.
There were many people waiting to be seen, waiting for lab tests, and waiting for medication. They were sitting on benches in the waiting room and in the halls, their clothes blending together in my peripheral vision. Part of me is afraid to be too friendly lest they get the false idea I am going to give them something or pay for their care. Another part of me is annoyed that I don’t spend more time listening to them, learning their syptoms and stories. Deep down, I worry that I am just unwilling to reach across the divide between us. I wish the divide wasn’t there, but between languages and between continents, it is. As Allan said a few times, in this clinic the fifteenth century meets the twenty-first.
I walked past the consulting room, figuring that Katie was probably in there with Bailor, but deciding to look in the other rooms first, to avoid disturbing the consultation unless absolutely necessary. To be honest, hardly anyone else afforded the consulting room so much respect, so it probably didn’t matter. She wasn’t anywhere else, so I knocked on the consultation door and said, “Hello? Is Katie in there?”
“Come in!” was the response. So I did.
Katie, Dr. Lenny, Bailor, Bori, and Yusuf were all already in the tiny room. Seated in the patient chair was a young mother, holding her daughter. Her daughter was nearly naked, and perhaps a year old. I could see her ribs struggling against her skin as she breathed. She looked sick. Bailor welcomed me with a nod.
“Look at this pikin. She so pale, she is anemic. You see?” I didn’t see. I couldn’t tell that she was pale. But she had pale lines and red lines on her neck. Maybe that’s why Bailor could tell? More likely was just that I wasn’t observant or experienced enough. I looked at her palms, because they are usually a tell-tale sign. They did look a little pale.
“An’ you see how she breathes – she uses the intercostal space. Beside her ribs.” I moved around the mother to peer at the side of the baby. She began to cry when Bailor touched her side, and she started flailing her arms. “Well, now you can’t see it, she’s crying. But when she’s still, you watch.” In a moment, she was still. But her eyes were liquid with distress. I could see the intercostal breathing – her ribcage flared out instead of merely up and down. Her body was using different muscles than usual to draw in as much air as possible. “And you see how her nostrils, dey flare? She’s not breathing fast, but she’s breathing hard. I think it’s pneumonia.”
“The most dangerous things for a child are respiratory infections, like this, and dehydration.” Dr. Lenny addressed Katie and I.
I nodded and murmured the word dehydration. The little girl had her hair braided upwards around her head, with all the braids ending in short stubs in a circle on the top of her head. It’s a popular style among little girls in Sierra Leone.
“Why are they dangerous?” Katie asked.
“Because they kill the child quickly.”
Bailor turned to the mother. “Oustem de pikin ‘e ge’ sick like dis?” When did the child get sick like this?
“Saturday. No, Friday.” Bailor made the peculiar high-pitched “eh!” noise that all Sierra Leoneans make when they are suprised, appalled, or angry.
“Why you de wait so long for come de gi’ de pikin care? Dis pikin ve’y sick, ve’y sick. Why you no de come Saturday?”
The woman shrugged. Behind Bailor, Bori was shaking his head and looking concerned. It was serious, but Bailor and Bori’s scolding faces were a little comical.
“Now we faut gi’ de pikin drip. Wey you de come na Saturday, we jus’ de gi’ em amodiaquin, she de go ge’ welbody quick quick. But now, we faut gi ‘em drip, i’ more dear,” Bailor was telling her off for waiting because now it would be more expensive, “and you no de make de pikin suffer so, wey you de come na Saturday,” and because it would have been easier on the child.
I looked at the little girl, shaking in the arms of her mother. I was glad she was at the clinic at all, even though Bailor was right.