ROSE

Thanks to everybody who has commented and showed compassion for the children in the prison! It really was a good thing to see and experience but every time I think of it, my heart breaks a little. Since Saturday, I feel like a lot has been done, although it really has been only three days. I have been at the hospital working on the Infectious Disease Ward on Monday and today, but I will write more about that tomorrow or the next day. For now, I think it is important to talk a little about Rose, and think about the world through her eyes for a bit.

Saturday night was seemingly a pretty expected night, given that this was Rose's first time in a bed. She and Zefanya were sharing the bed and unfortunately for him, Rose is very sick. She had diarrhea - foul smelling, large amounts of diarrhea - that filled her diaper, the bed, and trailed her all the way to the bathroom. By the time Renske heard her crying, the mess was all over and Rose was just sitting in a pile of crap.

The first time I saw her for the day, Rose was standing with no clothes on in the hallway outside of the bathroom. She looked and me, then looked away, and proceeded to use the floor as her personal toilet. Renske calmly cleaned up the mess and we both assumed she was done. Just as she finished using soap to disinfect the floor, Rose squatted down for another go. If you ready about diarrhea in a medical textbook they will tell you that it is technically 250 grams or more per day of stool. I don't ever measure amounts nor do I ask patients, but when I saw what was coming out, I knew that this girl was well above the necessary number for diagnosis. She continued to make messes all day and we got to the point where we just sat her on the toilet every hour or two to hopefully prevent more overflowing diapers. Maybe all of you moms out there can relate to having a sick kid, but for me, this is a lot of new messes. In addition to feeling not so good, this girl is malnourished and not accustomed to functioning in a house. If she were back at the prison, she would probably not be wearing any clothes below the waist and if she had an episode of losing stool in an odd place, one of the older kids would likely beat her up for it. At least here, she can be sick and we are trying to lovingly correct her.

When it comes to emotions, Rose shows next to none. When food shows up, she perks up quite a bit and positions herself as close as she can to it. Even though she is not feeling well, she wants to eat. When I got home from my run in the evening, she was making little happy cooing noises, which I quickly learned were because she saw Angella cutting a mango and was trying to ask for some.

On Monday morning, after another long night of diarrhea, crying, and adding to it a bit of vomit, Renske was prepared to take her to the clinic that they usually take kids to. On our drive in to drop Zefanya and for me to get to a good place to walk to the hospital from, we heard noises from the back seat and turned to see Rose regurgitate all the mango and whatever liquids she had gotten last night. Renske later informed me that she threw up for the entire hour long ride to Entebbe and made a huge mess in the car. That night, I was happy to learn that Rose has Malaria and probably some sort of intestinal infection, which is nice to know because they can be treated!! She was started on IV antibiotics (which they allow you to administer at home if you are able) and antimaliarial treatment. We have been giving Oral Rehydration liquid as well, and last night there was no vomiting or diarrhea - just crying because of hunger!

Although physically there is a lot of improvement, I am still quite sad about the way that Rose has developed so far in life. She has probably lived on the street (nobody can tell us because there is nobody that brought her in, she was just collected with a bunch of other kids), she might have been abused in some way, she probably went long periods without eating, and she probably never had anybody to just hold her and show her she is loved. She is like a little rag doll that you can shape any way you want. If you sit her down, she stays sitting until you pick her up. If you stand her up, she won't sit down. The only time she moves is if you tell her to come and show her food or maybe a ball to play with. Today, she looks much better, but she still doesn't smile. She reminds me a little bit of our dog, Rocky, who is inspired by any food we are preparing. I was making juice and she didn't leave my side, but just stared up at me with these beautiful dark eyes. We we sit down for dinner, she gets up to the table and wants to be as close as she can to the food. I am just praying that over time, Rose will grow to experience love in a way that doesn't involve a reward system with food. It is likely that she will go back to the orphanage that takes kids from Kampiringisa later this week not that she is not acutely sick.

With Rose, I feel like I have to realize what happens when I child is really sick and malnourished. Having her at home reminds me of all the hard work there is to rehabilitate a child after so long without living in a home environment. As a physician/medical student, we often just see a very small glimpse of what recovering from illness can be as we examine and tell people how to treat. With Rose being here, I have seen some of the daily struggles of helping a little girl like her. I know there are thousands of other children like her, without a supportive family or feeling loved by anybody. It makes me so grateful to have grown up where I did with the family and friends I have around me. I really can't relate at all to what it would be like to grow up without that support. I am trying to show compassion and love to her and hope that she will slow start to feel something.

One final thought was something that Natalie told me on Saturday that really stuck and maybe will leave you with something to think about. "Kids like her don't feel hopeless. They can't feel hopeless because they have never understood what it means to have hope."