Dree worked harder and longer hours in each village they rode into. She was kind to everyone and smiled gently at them, tended to their needs quietly, and cried when she thought no one was looking.
But Maxence was always looking.
The child sitting on his legs was terribly light, much too light for his age, and profoundly unhealthy. Not to put too fine a point on it, but this childsmelled.His breath was sulfurous, and foul body odor wafted from his clothes every time he moved.
The odd thing was that he didn’t appear dirty or oily at all. He looked recently bathed, and yet hereeked.
The child’s mother was young, maybe still a teenager, and thin but not as sickly as the child. Three other women and one man surrounded the mother, petting her and discussing the child and the doctor with her. Batsa had said they were cousins, a sister, and her mother-in-law.
Again, Maxence considered the effect on this tight-knit community of outsiders walking in, announcing they would build a thing that the community could not understand, and then leaving them without the information and skills to use or maintain it. This project was so ill-planned, and he needed to bring it to a halt.
The mother and other family members had been struggling to hold the child, who was a willful little guy, so Max had stepped in. The child watched him from under his drooping eyelids, a baleful and suffering stare. Much of the child’s petulance was probably because he was sick, but kids always behave better for people who aren’t their parents.
Dree glanced up at Max, her blue eyes worried, and turned the child’s head to look in his ears. Evidently, the child’s ears were normal because she rapidly returned to holding the child’s hand and gently rotating the boy’s arms to inspect his skin.
Purplish bruises blossomed under the child’s mahogany skin, concentrated near the joints. The child flinched when Dree barely prodded him, and a thin film of blood smeared the fingertip of her protective glove. Her bright blue eyes became more worried.
She asked Batsa, who was sitting in a chair beside the table, “How’s his appetite?”
Batsa relayed the question to the mother and then came back with the answer, “He is very pious and will not eat milk or yogurt because it comes from a cow, which is sacred, and he will not eat yak yogurt or milk because they are too much like a cow’s. The family is vegetarian, and he eats all the subjis, which are cooked vegetables. His mother believes he will be a holy man.”
“Eating both lentil and bread or rice?”
Quick chat. “Yes.”
“So, he’s getting all the amino acids, at least in theory.” Dree asked, “Does he eat eggs?”
A quick chat in the Nepali language, and Batsa said, “She feeds him three eggs a week for strength, but he will not grow stronger.”
“It’s definitely not protein deficiency,” Dree muttered under her breath. And louder, “Does he eat the egg yolks?”
Batsa conferred. “Yes, he eats the yellow parts very much. She gives hers to him.”
“Probably not fats or cobalamin.” Dree looked up at Max. “I thought it was going to be a lack of vitamin B12, but if he’s eating eggs, then it’s probably not. Any ideas?”
Maxence shook his head. “Absorption? Maybe celiac disease?”
“His stomach isn’t distended, though.” Dree asked Batsa, “How about diarrhea?”
Batsa conferred and replied, “She says yes, for a month now.”
Dree blinked and nodded. “Okay, then. Maybe it’s celiac or some other malabsorption problem.” She turned to Batsa. “Tell the mother not to feed him any wheat, wheat flour, rye, or barley. No more bread for him. Get him rice, and make sure she doesn’t put flour in anything that he eats. I don’t know if that’s it, but at least it’s something.”
Batsa relayed the information to the child’s family, who seemed very upset at first that their child would not be able to eat rotis or naan and other bread. After a few more minutes of explanation, the family seemed to get it.
The family thanked Dree and the two guys profusely, of course, as always. The male cousin who had arrived with them gathered the fussing, very ill child in his arms and carried him out of the house.
Dree shook her head. “The pinpoint bleeding around his hair follicles, the bruising, and the joint swelling just doesn’t look like celiac disease, but I don’t know what it is. Celiac disease can look like almost anything, though.”
Max agreed with her. “It doesn’t look like other vitamin deficiency diseases like beriberi or pellagra, which I’ve seen in children when working in remote villages in Western Africa. His hair was brittle. It was uneven and didn’t look like it had been cut, just broken.”
Dree sighed. “I’m not a doctor. I’m just doing my best. I’ve got thirty more patients to see, and the sun goes down in three hours. I’ll have to put him in the back of my mind while I try to help these other people.”
Maxence watched Dree and helped where he could as she whipped through the next couple dozen cases. Many of them were easy. Some needed a few sutures. Others needed reassurance that it wasn’t anything serious. A man needed one of Dree’s precious tetanus vaccines that she slept with to keep them from freezing, which would inactivate them.
Dree was fluttering around her last few patients, dressing a wound on a little boy and explaining to a different young mother through Batsa that cradle cap is not life-threatening and just to scrub it off. She passed by Maxence and whispered, “I still can’t figure out what that boy had.”
He shrugged. “I haven’t seen anything like it.”
