Sutugunba

Recently I accompanied the vaccinator at my clinic on one of our routine polio campaigns, where we go from village to village and compound to compound administering the oral polio vaccine to all children under five. (I’m not allowed to give vaccination shots, but am allowed to assist with the oral vaccine and accompany the staff on campaigns). I really enjoy going out on these forays because they give me a chance to meet people in the surrounding villages–who somehow invariable know my name even though I’ve never seen them (one of the many upsides to living in such a rural area: EVERYONE knows you.) Anyway, we had gone that day to Goumbala, a village even smaller than my own, and had reached nearly all the huts in the village.
We came to the last compound where there were a group of four or five children playing, using sticks to draw in the sand. While the vaccinator went to go find the parents to ask them to round up the kids, I watched the group. Whenever I’m out and about now, I always try to keep my eye out for kids who might be undernourished,  and try to make a point to encourage the moms to take them to the health center. Almost all of these kids looked normal, healthy–except for one.
She was a very, very dark child, with close cropped hair and three earrings adorning each ear. She was laughing and playing like the rest–but when they got up and started chasing each other around the compound, I was astonished. From her height I guessed she must be six or seven, but she was truly nothing but skin and bones, which became clear as soon as she stood up–she was insubstantial enough to blow away in the wind. She tried to keep up with the rest, but moved more tentatively, slowly, as if she had to expend an enormous amount of effort in putting one foot in front of the other. Her face was beginning to have the aged look that severely malnourished children often acquire when they go too long without treatment.
This kid has no strength, was my first thought. And the dangerous thinness–she probably had marasmus, the form of malnutrition in which the muscles waste away because of the lack of sufficient food intake. At the health center, I’d seen a number of cases of kwashkior–those children suffer from a specific protein deficiency and often have bellies that appear big or legs and feet that appear swollen. But this was my first time to have personally encountered a child with severe marasmus, someone who just isn‘t getting enough to eat, period–and it was dramatic and, from the looks of it, in the advanced stages.
I told the vaccinator to take a look at her, so her called her over, and pulled down her eyelids to check for paleness under the eyes–a classic sign of the anemia that often comes with severe malnutrition. Her  eyelids were exceptionally pale, pink-white.  She was dangerously anemic. “She’s very sick.’ he told me, and. she should go to the doctor. He told the girl’s mother, and advised her to take her in for treatment. Meanwhile, I was busy still watching the girl, playing with the others. She caught my eye at one point and smiled, and I was reminded that she was just a kid, a little girl with the same playfulness and the same dreams as any others, but it looked like she was clinging on the life that her peers were bursting with.
But, perhaps she was braver than the rest of them; amidst all the kids’ giggly murmurings of “tubabu” from a safe distance away, this girl was the first to make “the approach” (to be the first kid to touch the tubab has, after all, got to be a scary experience.) She finally came up to me and took my hand. “Awa, I ni ce,” she said, calling me by Malian name with a shy smile. I returned the greeting and asked her her name. “Sutugunba.”
Sutugunba translated literally means “big trash pile.” When I first got to village and heard that this was a fairly common name given to girls, I was confused, to say the least. Why on earth would anyone choose to leave their child with that legacy? Later, villagers explained that it’s a name commonly given when the mother has a very difficult time conceiving or during the pregnancy. My understanding is that giving that name is a sort of way of warding off further misfortunes with that child–a way of giving luck.
Well, this particular Sutugunba needed all the luck and hope that she could get. I looked down at this little girl, still holding my hand now.  and said a silent prayer to God, Allah, or whatever great power we may believe to exist in the universe, that this girl would pull through, that I would not hear later that it was such a shame, that it was too late to save her. Her big eyes watched me, not in fear, just studying me, curious and perceptive. She said nothing else until the vaccinator announced we were finished and could head back. “K’an ben,” she said, see you. And I couldn’t help but think, I really, really hope that I do see you. We walked away, and with nothing more than a smile, Sutungba went back to chasing her friends.
I’m often struck in this experience that amidst the blur that is created by the events of my day-to-day routine and existence in village, certain people begin to stand out vibrantly, their experiences and stories–the little pieces of their lives that they share with me for however brief a time–leave footprints on my heart, and make it so that I cannot forgot. These interactions make my time here feel exceedingly rich, whatever other obstacles or frustations I might face.
I really can’t explain why our short interaction affected me, but Sutugunba–her perceptive but innocent eyes, her fragility, and her obviously intact spirit–stayed on my mind long after I left Goumbala. I see a lot of kids in various states of malnourishment on a regular basis, but this particular one caught hold of me. And it’s impressions like these that push me on at times when I question whether anything I’m doing here could actually change people’s realities. This is why we weigh babies and advise mothers; this is why we talk about oral rehydration solution and adding locally-available proteins to porridge. These are tiny, baby steps, a drop in the vast ocean of obstacles and problems that keep Mali‘s child mortality rate one of the highest in the world. But they can be powerful, can even, in some cases, save lives. And if more people got the message, we wouldn’t have to see otherwise bright and brave kids like Sutugunba in a heartbreaking state of weakness.
I never did find our what happened with Sutugunba–I never saw her at my health center, although my hope is that she went to the reference hospital for special monitoring and feedings.  Whatever the case may be, meeting her was an important reminder  of why I chose to be here and why I need to continue in my efforts, however individually insignificant I may feel at times, at change.