Honorine: Part 3

Honorine: The Last Day

It is only fair to give you the end of the story. Honorine went home today. She was going to stay until Monday, but a family crisis caused her mother to leave today. The mother will walk down the mountain, carrying her belongings in one hand, and Honorine strapped to her back. It will not be an easy trek, for the mountain road is steep and treacherous. Moreover, Honorine is no longer a baby, and her mother is not a big woman. The mother will walk to a small town named Mugara: approximately two hours away on foot. She will then cram her and Honorine into one of the impossibly crowded bus-vans that serve as public transport here. She will then almost certainly have to transfer to another impossibly crowded bus to take her to her home near the Tanzania border. It is unlikely that the two of them will arrive home before tomorrow.

I cannot imagine what will go through the mother’s mind as she makes that arduous journey. Whatever it is, it cannot be good. She came here five days ago, because this clinic was her last hope. I was the symbol of that hope, for I was the embodiment of the “white doctor” that she had come to see. I was the embodiment of the western medicine that would save her daughter. Yet I was unable to make that last hope a reality.

The only good news that I can report is that we did see some improvement in Honorine during her five days at the clinic. I believe that the steroids did make a difference by reducing the swelling in her brain. The Honorine I saw those first two days was withdrawn and constantly crying. The Honorine at the end was often interactive and smiling. I know that this will be a temporary respite, but temporary is far better than nothing.

Her mother asked us before she left what she should do if Honorine’s condition worsened. Should she bring her back to the clinic, or go to a hospital closer to her? It may be true that our clinic is the first place that Honorine had any degree of relief. Yet, who is to say that we would similarly help her in the future? Moreover, the distance to travel is too far, the expense of making that trip too great. Therefore, we have seen the last of Honorine.

I cannot speculate on Honorine’s fate. It is too painful to do so. It is perhaps even more painful to contemplate the “what might have been” scenario. I take no consolation from the fact that I tried to save Honorine, for, in the end, I failed. But I know it was not so much my personal failure. The failure to save her is a failure on a far greater scale. It is an institutional failure; a societal failure; a failure of a world to provide equality of medical care to all its citizens. I am fully aware that such a thing is an impossible dream; that the Burundians will never have the same level of medical care that we Americans take for granted. But there is something inherently wrong in the fact that Honorine would have been saved had she been an American. But she is not. She is a Burundian, and that makes all the difference.

There are no words to describe what I felt today as I said my final farewell to both Honorine and her mother. It was all too sad, too heartbreaking; too much an abject exercise in futility. My only solace was to go back to my work: to the three year old asthmatic who had finally turned the corner after a frightening night of severe respiratory distress; to the four year old on the malnutrition ward who came into the hospital an apathetic, starving child, but who was now a smiling, fist-bumping adorable little girl; to the one month old who came in yesterday with a fever of 40 degrees (104 Fahrenheit), but who was now stable. We do what we can here. We have our successes and our failures. Honorine was among the worst of those failures. But, as one of my Burundian medical colleagues said to me today, this is Burundi. One has to accept the inherent limitations of life here. One does what one can, but one cannot do more than that.

I leave you with my last pictures of Honorine and her mother. The two are pictures of her mother being given honorary membership in the Short Tie Club. You can see a faint, but discernible smile on Honorine’s face, as she sits in her mother’s lap.