Tears blurred my vision as I pressed my face against the chain link fence and watched the twin engine plane bump down the narrow gravel runway. My concentration was so intense that I was barely aware of the native family crying and embracing to my left, or the newly arrived tourists piling into the back of a big truck on my right. The plane became a speck in the sky. I willed it to turn around and give us one more moment with him, but I knew we would never see baby Jacob again. I turned to my sister and we embraced, then turned from each other and blindly climbed into the back of the truck with the rest of our family. We drove down the road, which was more pot-hole than road, leaving clouds of dust floating in our wake. As I bumped up and down, the mango trees lining the road melded into one green mass. I closed my eyes and wished the beauty of the day would consume the solemn feelings in my heart. The tears passed but the feeling did not. The past few weeks had left an impression that I knew would last a very long time.
Two Week Earlier...
I sat in a chair underneath the only fan in the cinder block building that had been my family's home for the past couple of months. The heat was intense and I felt lucky to have claimed this coveted spot. From the front window I saw my dad trudging towards the house, back from his morning rounds at the hospital, a five minute walk away. He walked in, placed his stethoscope on the table beside a map of Tanna, the island we were living on, and sighed deeply.
“Anything interesting going on at the hospital? Did you notice if any women were in labour?” My sister and I were always interested in any new maternity patients. Since we had moved to Vanuatu for a six month period while my dad worked in the hospital, Shaina and I had been learning how to deliver babies. We would wander up to the hospital at almost any hour of the night or day and assist the nurse on duty with the seemingly endless flow of pregnant women in labour.
“Actually there was a baby born prematurely last night. He's only three pounds, the midwife just told me about him, apparently he will not nurse. He's in an incubator and I inserted a nasal tube into his stomach so that we can get some food in him. We think maybe his mouth is too small and weak to nurse. It is too bad we have no infant formula, the nurses are giving him glucose water and . . .”
As he rambled on, I listened half consciously, unaware of the baby's precarious situation.
“. . . anyways I was wondering if I could show you girls how to feed him, since he will need to be fed every two hours for the next few days.”
When I stepped into the maternity ward, the familiar smell of disinfectant, damp laundry and something less pleasant assailed me. The nurses had a habit of flipping a dirty mattress for a new patient rather than washing it. Humidity intensified the smells and I was grateful for the gentle breeze blowing through a broken window. Beds lined either side of the room. Most of them had mattresses and most of them were surrounded on every side with people. In Vanuatu going to the hospital was a family affair; aunts, uncles, cousins and grandparents surrounded beds by day and at night they could be seen lying in various places on the hospital floor and grounds.
At the back wall of the ward sitting on a rusty table was an incubator with a small, naked figure inside. A tiny brown baby lay in the middle, taking up only a fraction of the available space. His skin was slightly jaundiced, it looked thinly draped over his tiny bones, each one of us his ribs were distinctly visible. He looked small enough to fit comfortably in a shoebox. Brown fuzz on his arms, shoulders and chest, indicated his prematurity. There were still little smears of blood in various places on his body. His thick curly locks were plastered to his head with remains of the waxy vernix. The nurses had not washed him well after birth, afraid that his fragile body would not be able to handle the exposure of cleaning. He looked weak and helpless.
To his left was his mother, a young woman in her twenties. She sat staring over the beds of mothers nursing their new born babies. When I asked the baby's name, she did not respond but kept looking blankly forward. A shirtless little boy with a round pot-belly reached up and tugged at the woman's skirt. Another woman, who I later learned was the newborn's grandma, picked the toddler up quickly and turned to me. “Hemi no gat nam,” (He doesn't have a name) she said and looked down sadly.
I later learned that the little boy in her arms, who was about two years old, was unnamed as well.
My Dad showed my sister and I how to feed the baby through a syringe. Each time we fed him we had to fill the syringe with glucose water, turn it upwards and tap out the bubbles of air, then remove the cap from the tube that went through his nose into his stomach and put the syringe in. Ever so slowly we had to squeeze the liquid through the tube. In any first world country he would have been hooked up to an IV and had the glucose water dripping constantly. Unfortunately the hospital on Tanna Island was not equipped with IV's small enough for a baby his size.
The next few days ran together. Shaina and I must have slept-walked between the feedings every two hours day and night. It had been about five days since the baby's birth and he had not shown any signs of digesting food. What went in either came out his mouth or had to be removed with a syringe through the tube to his stomach. And he kept loosing weight. He was down to 2.2lb's.
We laid down in our beds early one night. “Will you feed baby next?” I asked my sister.
“Uhuh, but we have to think of something to call him besides baby...”
“How about Jacob,” I said.
“That sounds good.”
One night Shaina asked the nurse if she would mind doing the 2AM feeding that night, since she would be on duty anyways. The nurse replied, “If you don't feed him, no one does.” She treated us like children guarding a robin's egg that had fallen from the nest. Could we not see the life was as good as gone from this small, speckled egg? Were we not aware of the hopelessness of baby Jacobs situation? As an adult leaves the fallen egg to a child, so the nurses left him to us, smiling at our intentions, but inwardly knowing the inevitable ending.
I entered the hospital, picked up his chart and wrote 'Baby Jacob' on the line for his name. I walked down the rows of beds to the very end. He was whimpering softly, his mother lay on the bed asleep. On the wall above her head was a huge cockroach. I grimaced and looked away. As I opened the small door on the side he began to calm down. I started to feed him, his fingers wrapped tightly around mine and I sang softly, “Baby mine, don't you cry...” He drifted off to sleep peacefully. Despite the time I could not bring myself to pull my hand away from him. I stood there long after I was done feeding him.
My dad diagnosed him with duodenal atresia, which is when the small intestine coming out of the stomach has not formed properly or is too small and will not allow food to pass through. Because of this he was unable to digest anything we fed him. It also prevented him from being able to absorb the nutrients his body needed for survival. If we could have afforded to send him to a hospital in Australia then he could have been given reconstructive bowel surgery and would have had a high chance of survival. But the type of surgery needed was very dangerous and expensive. It would have needed highly trained professionals and advanced equipment, all of which were unavailable in Vanuatu. Instead we decided to send him to Port Vila, located on the main island of Vanuatu. There they could do an X-ray to find out for sure what was wrong and if there was anything to be done.
Recently we had been taking Jacob out of the incubator twice a day and holding and rocking him for fifteen minutes or so. He seemed to crave human touch and his face would change from that of deep pain, to peace and contentment at the touch of a human hand. He seemed to know that his time was short. If given someone's finger to hold, he would grab with surprising strength, as if grasping life itself. I would sometimes offer him to his mother to hold, but she would refuse and look away.
At the airport Baby Jacob's mother was upset. She did not want to get on the plane, apparently thinking there was no hope for her son anyway. Her mother scolded her sternly in their native tongue until her head hung low with shame. She submissively took the baby in her arms.
As she walked slowly towards the plane with Baby Jacob in her arms I wept; I wept for the love that Jacob had been denied by the one who gave him life. I wept for the helplessness of this child. I wept for a life that would be cut short, a life that could have been saved in a different part of the world. I wept for the mother. How many children had she seen die? What kind of pain had caused her to have to completely disconnect from her own child? And where was this child's father? I wept for the knowledge that this was no special case – she was one in hundreds of women on our island who had lost children soon after birth. He was one in hundreds of babies who had remained unnamed due to his fragile health. I wept as I watched her board the plane. Wept with my face pressed up against the chain link fence that surrounded the air field.
Later in Port Vila they confirmed Jacob's condition. The only way to save him was through a very difficult kind of surgery. Feeding him the glucose water would keep him alive for only a few more days. The mother asked if she could take him out of the hospital. They gave her leave and we never heard of him or her again. I imagine he died quietly and peacefully in his mother's arms in some small bamboo hut out in the bush. I like to imagine that he left this life as peacefully as he entered it.