Diagnosis - Bad Spirits

 I am standing toe to toe with the family and friends of a mother who had just died as the rain beats down on the tin roof and the yard begins to flood  There are two rooms in the house with only one window in each room.  One room contains the male domino players while most of the women and children and older men are squeezed together in the other empty room.   Small children peer down from an upstairs loft.

Children of the Lakou- always ready to greet us and offer a chair after a walk up the trail to do home visits Their mother is expecting a baby in January a the new birth center

The translator is busy negotiating the adoption of the baby.

I am wondering what type of diarrhea  she had and if it could spread to all these people living so closely together.  I try to remember what her husband had said.

No fever.
No blood.
Vomiting.
Her mother had the same thing and died too
She had it for one week

"Does anyone think it might be cholera?" I try to say.

"Bad spirits.  She had bad spirits and they could not get rid of them."

Cholera or dysentary or something else?   They are both caused by crowded conditions and poor sanitation.   Our own country had many serious outbreaks with both diseases.  Cholera was the main cause of death on the Oregon Trail and dystentary killed more soldiers in the US Civil War, than battle.  It killed thousands of babies who were given cow's milk so their mothers could work in the sweat shops of New York City.

We all  remembered the cholera outbreak in Haiti; the one that was traced back to the United Nations Security Forces.  For many years, there were piles of rehydration salts with directions on how to mix it everywhere.   Soap and rehydration salts.

I gave her soap and rehydration fluids.  If we had beds that morning perhaps I might have let her lie down and given her an IV.  But we had just opened and we had no beds.  Later we would blow up an air mattress but that morning we had not yet gotten that far.   We did not yet have IV fluids.  
These things would come but not that day.

I ask the translator to take me to the supervisor for PIH's agent sane program and say again, Maybe cholera?" and he says no, "She had bad spirits."   I figure they should know what cholera looks like as so many people died from it but I am still unsettled and there is the issue of the baby and what he will eat.  I am also there to set up a new birth center.

But I worry that the "spirits" that killed this Mom would impact maternal and infant health.  I began to see those "spirits " as all those things that lead to death and disability hat are not necessarily see under a microscope or can be tested for.   I began to see the "spirits" that killed her while keeping my eyes open for outbreaks or other people with similar symptoms.

As I walked back to the birth center, after my visit, with the agent sante, I began to notice the large number of children not in school.  I  began to see the "spirits" as those things in any society that
any society that deny a mother the ability to feed or educate or get health care for her children.

They had called the "Leaf Doctor" after the woman had come to see me.  He could not save her either.  Dis he turn to him because she could not afford the moto ride to the hospital or because she believed it was spirits he could cast out.

I could have kept her lying in the grass and watched her ads I unpacked.  I could have given her an antibiotic or gently held her head and gave her fluids.  I tell myself I did not know then she would not go to the hospital and that she was going home to die.

The baby is given a container of formula and it is agreed that the baby will go which translator on the week-end.  There are conversations about potential visits and the birth certificate.   Its pins around me and I beignet think that at least the baby will be cared for and live but the spirits were at wow