Fieldset
Yemen diary, part one: The dilemma

With war raging and the economy in collapse, people in Yemen are facing increasingly impossible decisions. As she and the team race to save a tiny patient, Dr Georgina Woolveridge meets one of them...

Walking toward the Emergency Room, shouting ricochets through the corridor. 

This is not uncommon – anything of importance in Yemen seems to be communicated decibels above the norm – but this is louder.  Angry.

We hurry.

“I have 10 children at home – it is better one dies than all ten!”  

Ahead we can see the shouting man. The translator begins to give the interpretation, but I’ve already read the man's body language. Wild gesticulations, the look in his eye: he’s exasperated.  He looks like a man backed into a corner.

Flooded with patients

The work week in Yemen begins with Saturday, and it’s guaranteed to be busy.  The halls are flooded with patients, queuing for the Government-run out-patient department, and our own Emergency Room is pumping.  

Our in-patient department is as full as I’ve seen it, with a backlog of patients from the days before. The weekend brings sicker patients than weekdays, and they often arrive later. This is likely compounded by the recent fuel scarcity.

The yelling man is encircled by various staff, beyond whom stands his wife cradling a bundle of blankets.  

baby_hand_sq.jpg

The baby's tiny hand

We’re acquainted, these blankets and I, from an hour ago in the resuscitation room. A tiny, emaciated arm extends beyond those blankets to shake with injustice as I stand beside, shaking my head at the same.

His breathing rapid, heart racing as a fever wreaks havoc on his malnourished body, weighing a meagre 3,200 grams at five months old.  That’s around seven pounds – less than half what he should be at that age.

“An energy at odds with his size”

But he screams with an energy at odds with his size, something his mother says he’s been dedicated to for three months, since her breast milk dried up.

The eleventh child of two poor parents from rural Yemen, they’re struggling to feed him.  Not only starved of food, with basic access to heathcare more difficult since the conflict began, he’s unvaccinated too.

An hour earlier, we had scrambled to stabilize him and start antibiotics, severe malnutrition having left him at risk of opportunistic infections. Unfortunately, these were temporary solutions to a systemic issue.  He needs admission to a therapeutic feeding centre, and the closest is an hour by road.  

We informed his mother and began the process of referral, adding another piece to an ongoing game of Tetris with our single ambulance.  The best laid plans.

“This is not the first time”

An adult must stay with the baby at the therapeutic feeding centre. Enthusiastic protests in the face of reason continue from the father when he is informed about this – his culture dictates his wife cannot go alone and he cannot leave his other children.  

With doctor, nurse, and health promoter all lining up in attempts to talk to him, we explain the severity of his child’s condition, the potential for deterioration and possible death if untreated.  

At first he is a wall of anger.  Then he begins to crack.

“I have 10 children at home – it is better this one dies than all ten,” he repeats, calm but defeated by this dilemma.  

There’s no other family, no support for the ten other children in his village.

The father explains that he must return with the baby home to his brood, offering a late-in-the-game promise to come back when he has enough money to support the family in his absence.   

We pull together what we can for treatment, the father's ink-stained thumb a symbol of defeat for all of us as he stamps the discharge paperwork.

Yemenis are not unacquainted with the consequences of a broken system, but this man's hands are tied.  I get the impression this is not the first time he has had to barter the survival of one against the lives of many.

At first I had thought he didn’t understand, but now it’s me who struggles with the nuance.

Georgina continues this story here.

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Top image was taken in Al Salakhana hospital, Yemen, in 2019.