Nyajang

Nyajang, while being feed in a tube

Hun kommer sammen med sin mor. Hun er 2 år gammel, hendes kjole er beskidt, det er hendes eneste kjole, moderen er gravid igen, og har et trist glimt i øjet. Pigen er syg. Hun er ramt af den Kala Azar epidemi der fortiden hærger dette hjørne af Sudan. Hun er også svært underernæret, og har der til tabt et halvt kilo siden hu besøgte klinikken sidste uge. Hun er lilla om munden, ikke på grund af vejrtrækningsbesvær, men fordi hun har fået Gentian Violet på de sår der fylder hendes mundvig. Savlet står ud af munden på hende, og hun nægter at lukke munden. Da jeg kigger i munden ser jeg at hun i også har svamp.  Jeg insistere på at se hende spise en pakke plumpy Nut, vores terapeutiske føde-produkt, og da jeg tænker at grunden til hendes vægttab sikkert skal findes i de smertefulde sår der fylder hendes mund. Jeg får ret i min mistanke, Pigen vil ikke spise. Jeg forsøger nu at overtale moderen til at lade mig give barnet en sonde. Med en vægt på nu blot 5.8 kg, og intet væske eller fødeindtag, er det væsentligt at få noget i ernæring i hende hvis hun skal overleve. Moderen er skeptisk, synes ikke det er en god ide. Her er døden noget man er vant til, og moderen har allerede opgivet. Men min tolk er lige så insisterende som jeg, og under skrål, og nogen kamp lykkedes det at få anlagt en sonde. Jeg blander og giver mælk, bandagere barnets hænder med gaze for at hindre hende i at hive sonden ud. Og efter at have fodre barnet 2 gange, giver jeg moderen lov til at gå hjem. Hospitalet er alligevel øde om natten, ingen af de ansatte syes at have vagt. Jeg tvivler på at jeg får dem at se igen, for moderen er stadig meget skeptisk. Men næste morgen dukker de op igen, jeg blander mere mælk, giver barnet mælk flere gange i løbet af dagen. Og efterhånden som barnet bliver mere aktivt, begynder moderen at smile til mig. Hun kommer trofast til alle aftalte fødetidspunkter, og en gammel bedstemor fortæller os, at uden vores hjælp var dette barn ikke i live, hun var allerede død, men nu er hun i live. Efter fem dage på sonde mælk, og behandling af mund infektionen fjerner jeg sonden, giver dem 3 små poser med Plumpy Nut og håber at hun vil få nok appetit til at spise dem når hun kommer hjem. Og det gør hun. Da de kommer tilbage, kommer Nyajang gående imod mig med strakte arme for at blive løftet op.

Jeg så hende igen  3 uger efter første besøg. Nu vejer hun 7,3 kilo, er stadig meget tynd, men helt sikkert stærkere og gladere.

Nyajang 3 weeks later

English: She comes with her mother. She is 2 years old, her orange dress is dirty, it is the only dress she has, her mother is expecting again, and she looks sad. The Girl is sick. She has been hit by the Kala azar outbreak that currently ravages this corner of Sudan. She is also severely malnourished, and has lost half a kilo since she visited the clinic the week before. She is purple around the mouth, not because she suffers from difficulties in breathing, but because she has been given gentian violet on the wounds that surrounds her mouth. When I look in the mouth I see that she also has oral thrush. I insist on watching her eat a sachet of plumpy nut, the therapeutic food we use, as I am thinking that the reason she is loosing weight is properly related to the painful wounds in her mouth. And I am right, the girl will not eat. I try to convince the mother to give permission for a feeding tube. The girl is weighing 5.8kg, and not taking food or fluid, it is therefore essential that she get some nourishment, if she shall survive. The mother is sceptical, she does not like my idea. People here are used to death, and the mother has already given up. But my translator is as persistent as I am, and while the child is screaming and fighting me, I place a N-G-tube, mix the milk and start the feeding. And after feeding the child twice with a couple of hours between I allow the mother to take the child home. The Hospital is without staff at night anyway, so it does not make sense to leave the patients there. I am doubting that I will see them again, because the mother is still not happy, and asking if I can remove the tube. But next morning they show up, and the following days the child is feed 4 times a day in the clinic. With time the child becomes more alive, the mother starts smiling to me when she arrives, and she shows up faithfully when ever we have an appointment. And old grandmother tells us, that without our help this girl would not have been alive, that she was already death, but now she is alive. After 5 days on milk in the tube, and treatment of the infection, I decide to remove the tube to see if the child can feed on plumpy nut, giving her 3 sachets to bring home. And she eats. When she returns, Nyajang comes walking towards me, stretching out her arms to be lifted up.

 I saw her again 3 weeks after the first visit. She is nowI 7.3 kg, still thin but a lot stronger and happier than she used to be.