T Girl

She came at the end of another hot humid day when even a sip of water instantly erupted onto our skin as sticky, smelly sweat. With an exhausted sigh and stretch of cramped muscles, I finished my line of 100 patients in the crumbling structure of Kakata IDP Camp. I was one of three nurses sent to provide consultations and medical care to six of these camps for a month. I was a 25-year veteran of various emergency departments and had been involved in volunteer work for about five years, but never in Africa, never for this long and never doing this type of work.

I and glanced toward the entrance way. There was a thin, ragged child lying unconscious on
a straw mat on the filthy concrete floor. Her breathing was rapid and shallow and not a sound came from her parted cracked lips.

Another child whispered above the cacophony, "She is T Girl." They had played together the
day before. Now her skin was feverishly hot to touch, lips and conjunctiva showed the paleness of severe anemia, and she was unresponsive to voice or touch.

Each clinic was packed with people, with problems we had no ability to diagnose -- no testing, no
Labs, no xray, no textbooks, no idea. Chief complaint: "My skin can be HOT!" Did that mean
fever from malaria with no way to test for it? So many diseases we don't see in the U.S. and without a doctor, a tropical medicine text, or appropriate medications and referral options, we felt lost, alone and impotent to help these people. We only had each other.

English may be the national language of Liberia, but between the accent, gestures and idioms, I
was routinely bewildered. Translations took a moment to grasp like When last you saw the
moon? (When was your last period?) Water from the fish (Vaginal discharge). Got belly
(Pregnant). Peoples' names were nearly as confusing -- Young Boy might be 60, God
Knows, Darling Girl, and my favorite of favorites: Bacteria.

Fruitlessly we searched for T Girl's parents to give consent and accompany us. After what seemed like an hour, but was probably 10 minutes, we finally agreed the teen sister could accompany us for the two hour drive back to the hospital. I thought to start an IV, but to what purpose? Fluids alone would not save this child; we had no ability to diagnose much less treat and no medicines to give her even with a proper diagnosis.

We gathered up the other three or four ill babies and moms, piled our supplies on top of the white
Toyota Land Cruiser and drove off with T Girl in my arms in the front seat with Peter, the driver, and Heather wedged around the gearshift. Peter gently drove as fast as possible weaving the vehicle through crowded markets until we were within minutes of the hospital.

T Girl seized. No violently, not urgently, not the tongue biting, incontinent grand mal seizures
we see in the ER. She seized a gentle, upward gazing, rhythmic twitching for several minutes. I
cradled her in my arms and cheek to cheek softly talked into her ear, quietly singing and assuring
her she was with friends. Heather and I locked eyes in that unspoken language of like minds,
knowing the truth of the situation and what was to come. Heather moved shoulder to shoulder
with me, arm supporting my arm, T Girl's head joining us together to block her sister's view and
the other backseat passengers' so as to not become frightened.

I felt the soft warmth of her urine soak my scrubs. Her pupils dilated and her twitching eased.
She stopped breathing. She had died in my arms, 10 minutes before arrival at the hospital. I
continued to rock T Girl and sing softly with Heather's arms supporting both of us. We could do
no more than console the silently weeping teen sister and wrap the small body in a clean white
sheet, promising to take her back to camp in the morning.

I've tried to look back at the emotions of the time, but all are shrouded in tears and shame and
grief. Children in my world don't play with other kids one day and die the next. Children in my
world have access to medical care, medical tests, medicines, doctors. Children in my world have
abundant nutritious food to eat and schools and clean clothes and homes to live in and parents
who were not killed in a civil war. Children in my world don't live in 8-by-8-foot mud and
straw huts in IDP camps, drink dirty water and eat whatever food is brought by an aid agency
once a month. Children in my world don't die in my arms, impotent to offer more than
mumbled assurances that she was among friends. 42 million people are currently displaced from
their homes by war. 42 million T Girls.

T Girl brought me to commit my life to humanitarian nursing. Since then I've worked many medical missions. I ask myself now, with all the knowledge I've gained since then: What could, or should, I have done differently for T Girl? Hopefully, the organization I co-founded to educate and support international nurse volunteers helps other nurses feel more prepared.