Chris is a nurse working for Médecins Sans Frontières / Doctors Without Borders (MSF) in Mile 91, a town in the north of Sierra Leone.
I’m sitting in the consultation room with Michael the community health officer and Mohamed the nurse.
We’re discussing a patient when a nursing assistant comes in to the room to inform us of an “emergency case”. Mohamed and I leave the small room, past the overcrowded waiting room of mothers holding children to their chests, and in to the four bedded ward.
On the first bed is a boy with blue and brown fabric wrapped around his waist. He is lying on his back and staring at the ceiling. He is too exhausted to move his head; his eyes flicker towards me as I approach his side.
His eyes tell me that he wants to cry, but he can only gather the energy to groan.
Mohamed attempts to insert a small plastic catheter in to a vein in the right arm, whilst Michael has now joined us and is attempting the same in his left.
Our assessments confirm what we already know. This child has fever, severe malaria, anaemia, and pneumonia.
The child attended a small health unit several hours ago and vomited the medicine he received on his return home.
We need to administer sugar to raise his low blood sugar, antibiotics to combat pneumonia, and anti-malarial medicines. He will then need to be transferred to hospital to receive a blood transfusion and oxygen to support his tired body.
I listen to the conversation between Mohamed and the boy's mother as he continues his attempt to insert an intravenous catheter. The child attended a small health unit several hours ago and vomited the medicine he received on his return home. The mother then attended a local healer who gave him a concoction of herbs to swallow, before making her way to this clinic as his condition deteriorated.
His name is David and he is three-years-old.
After a few unsuccessful attempts to pass the intravenous catheter, we decide to pass a tube through David’s nose and into his stomach. We administer medicines through this tube and by injection.
It is common for children to enter the health clinic in this condition. The majority go on to make a full recovery. I expect that we’ll stabilise David and refer him to hospital.
Instead, David’s eyes glaze over, his face still.
Someone behind me lets out a cry. I turn around to see a girl no older than six standing in the entrance to the ward sobbing loudly into the skirt of a woman. David’s six-year-old sister is the first to show her emotion at his death.
I look at David’s sister and think that this little girl has just lost her best friend. That she will be returning home without a little brother to play with.
Next to break down is his mother, standing over him on the side of the bed opposite to me, Michael, and Mohamed.
Michael stops writing notes as the grandmother breaks down.
I look at David’s sister and think that this little girl has just lost her best friend. That she will be returning home without a little brother to play with. This thought causes something to rise from the pit of my stomach and flush red across my face.
I push this surge of emotion out through puffed cheeks. Michael notices this, and returns a nod and look of sympathy.
David is wrapped in the blue and brown lappa that was formerly around his waist, and his mother cries loudly as she carries him outside. His sister and his grandmother follow.
They will stand on the road until a motorbike driver takes sympathy on them and agrees to transport the body back to the village.
At first I did not want to read this entry. I felt it would be disrespectful to David’s relatives to share the reaction to their son’s death. I felt conflicted that people may read this with curiosity, the way we twist our neck to look at car crashes.
We have a busy health centre. A child’s death is not uncommon.
The international staff have a role, but we’re not the main players. The local staff from Sierra Leone were here long before MSF and will remain here when we leave.
It’s easy to write about the children that recover; the malnourished children who gain weight, the kids who we send to hospital for a blood transfusion. Sometimes even children in David’s condition make a miraculous recovery once we correct their blood sugar or reverse severe dehydration.
This is due to the local staff here; the health workers working in Sierra Leone before MSF and who will remain when we leave.
It’s also thanks to the millions of donors that believe children like David should receive free medical care and the chance of a full recovery.
The international staff have a role, but we’re not the main players.
Thanks to these combined efforts, thousands of sick children who have visited the clinic return home to play with their siblings.