The Unwelcomed Angel

I will never forget Amna..

I was a first year resident when my colleagues and I received a twenty month old baby girl in the emergency room.

At first sight, she looked dead… LONG dead. She was not just pale… she was dead pale, white as the white washed walls…. cadaverous. All her bones, her cheekbones, collarbones, ribs and those of her limbs were clearly visible. Her cornea was dry, her mouth gaped open and her weight was just 4.5 kilograms.

Then she gasped… and that made us realise that life was still there in little Amna, although barely hanging by a thread. CPR was started, IV dextrose water was given. All emergency life saving measures were immediately carried out by the team, while one of us kept asking the parents for history.

The father wasn’t there. The child was brought in by her mother and maternal uncles. This mother was unlike any I had seen. Usually mothers are distraught by a simple fever or diarrhoea of a child, and here a mother had brought a little one who was nearly bereft of life and she remained unfazed. However, considering the severely neglected state of little Amna, it wasn’t that surprising. Horrifying, yes, but not surprising.

The mother said that the child was “perfectly fine” a few hours ago and then she was all of a sudden unconscious. After a lot of probing it was revealed that Amna had vomiting and diarrhoea for the past 3 days. She was the youngest of 6 siblings and was a result of an unplanned pregnancy. She was being fed over diluted cow milk since birth. No mother feed was given, no weaning was ever done.

Amna was revived in ER, and shifted to paediatric ICU for ventilatory support. She remained there for the next 7 days and was treated for severe Sepsis (an infection involving blood and entire body). She was given respiratory support and also inotropic support, which gave her tiny fragile heart strength to keep beating. We didn’t expect her to survive. But she was a little warrior. She started breathing on her own, and her frail heart gained enough strength to beat by itself.

She gradually became good enough for oral feed. It was that stage when she was shifted to my ward. I started a diet which is specifically designed for such severely malnourished children. She was conscious now, but all I could see was a little human with no spark of life, and no vigor of a child. She was too weak to play or interact. Heck, she was too weak to move except a little. Her dull eyes showed misery no child her age deserves to bear. She was in pain... physical and mental, and that too at the hands of the people who gave her life. She was a harrowing image of a child who had no say in coming to the world and yet was unwelcome and unwanted. She deserved to be loved and nurtured like any other child, and she wasn’t getting it.

I asked my seniors where to go and report this severe neglect and I got no guidance. There was no service that would take away this child or punish the parents. There was a room with the tiny name plate of “Child Protection Services”. It was always locked and I didn’t even know what it was doing.

I still wanted to give the mother the benefit of doubt. I kept probing her for family history of tuberculosis or inherited diseases and other causes of such severe malnourishment, and got nothing. I did get the tests for some of these illnesses done but they all came negative.

Then I asked the mother something directly, keeping my tone as polite as I could, “Do you want to give Amna up for adoption?”

She stared at me… I couldn’t understand the expression. It was blank, and I wonder if I’m wrong, but I saw a hidden “yes” in there. But her words said something else, “It’s not something you give away.”

Finally, unable to find a way to get the child taken from the parents, and ruling out all possible causes of secondary malnutrition, I decided to make the child better, good enough to start thriving and eating before going home. She gradually started gaining weight. She was able to take small amounts of calculated diet.

Then, on the fourteenth day of her admission, came the father. The father… who was supposed to love and protect little Amna, came to the hospital that day, like a death omen.

“I want to take Amna home,” he said. “She seems fine now. Why don’t you discharge her?”

“She isn’t completely fine yet,” I told the father. “She is severely malnourished and needs help to eat better. Once she starts tolerating solids and starts gaining weight, I will discharge her.”

“I have a job in another city,” he said stubbornly. “Just make the discharge paper.”

Despite a lot of counselling, even begging and finally a show of anger at his lack of concern for his own daughter, he didn’t budge. I asked my seniors and ultimately had to let them go with a signature on the “LAMA (leave against medical advice)” form.

About 3 months later I was checking another child in the ER when I recognised the attendant.

“Have you been here before?” I asked.

She hesitated for a second, then said, “Yes. I am Phupho (paternal aunt) of Amna, the weak little girl you treated. I came here to visit her.”

I was afraid to ask, and still did, “How is she?”

Tears flooded into her eyes. She looked down, with pain and embarrassment.

“Gone,” she said, “they never wanted her. She was an unwanted baby and her mother never fed her. She used to cry and cry and was never fed. I wish someone would take Amna from them. I wish her father listened to you.”

I took a deep breath. I think I knew Amna wouldn’t survive, the way she was being treated by her parents, and how she was discharged. I made myself busy with other kids. I had to. I had to keep myself strong enough to keep working.

In a better country, this matter would be taken up by CPS and even by police. It wasn’t the case in my country.

When I was in the final year of my residency, a workshop was held by an organisation made for children, headed by the general secretary of Pakistan Pediatric Association. He was a passionate man and he finally started taking the matters to a higher level. However, it will still take a long time before my highly populated country, with the majority of people living below poverty line, would take the rights of children genuinely vigorously. The religious belief that contraception is haram and lack of abortion rights will bring on many more little angels like Amna.

Nevertheless, I do have hopes from the CPS started in Pakistan. Things may get better in the future. But I will never forget Amna.