Little Seïd

David Ponka, MD, is an assistant professor of family medicine at the University of Ottawa. He has worked with Médecins Sans Frontières in Chad, near the Sudan border. ittle Seïd is going home today, but he almost didn't make it. He had seemed healthy at birth; his parents were thrilled, having lost their three other young children. But he had the misfortune to be born here, in the region where Chad and Sudan meet along a border interwoven by conflict and misery, and his family have been on the move for months. Seïd doesn't have a home: he lives under a standard-issue, white and blue High Commission for Refugees tarpaulin that appeared from the sky one day. The winds can be remorseless here. It makes the sand infiltrate everything, everywhere, even the decent straw hut that I share with the staff behind our little field hospital. When our youngest patients start crying at sunrise we wake up, notice the grit between our teeth and spit it out. But babies are rarely born with teeth, and they certainly can't spit. Seïd's parents brought him to us a week ago because he wouldn't breastfeed. A quick look was enough to tell me he was in trouble: he was breathing quickly, very quickly, and his chest caved and crushed him with every strained and ineffective breath. He also had a fever. This was bad news: he had bronchiolitis, a viral infection that normally takes hold of a baby's lungs and doesn't let go for three or four days. In the state little Seïd was in, I wasn't sure he had three or four hours. We devised a sort of spacing device from some used pill containers to give him some Ventolin, injected him with steroids and adrenalin and looked at each other and his mother, knowing this would likely not be enough. Back home we would intubate and ventilate him, or at least give him oxygen. We were overdue for a massive shipment from our Médecins Sans Fron-tières headquarters and knew we had asked for an oxygen concentrator. But night was falling, and with a pang of anxiety we realized that the shipment would not arrive today — whether because of bad roads or a hijacking, we didn't know. I placed Seïd in the position that he seemed least uncomfortable in and crawled off to bed, but neither of us slept that night. …