In the hospital in maradi

Activity 1

Read the text.

IT’S LATE JULY 2005. In a makeshift hospital in Maradi, Niger, dozens of mothers sit with their children, waiting to see if they are malnourished enough to be saved. The hospital is run by Médecins Sans Frontières (Doctors Without Borders), a French relief group that won the Nobel Peace Prize in 1999. They are one of my favorite relief organizations because they fearlessly go to the worst places, and they seem far more efficient than the lumbering UN.

The hospital is a few blocks off Maradi’s main drag. This is the third largest city in Niger, but that’s not saying much. Even the capital, Niamey, is a backwater, and it’s a ten-hour drive away.

To get into the hospital the mothers pass through a small metal gate guarded by two unarmed men. By dawn there’s already a long line to enter. The women are wrapped in impossibly bright fabrics, a collage of color shocking against their desert black skin.

Weeks later, when I return to New York, an elegant lady stops me on the street and puts her hand on my arm. “Oh, Anderson, those women in Niger.” She sighs, pausing to gather her emotions. “I mean, the fabrics. Where do they find them? Those colors. They must put so much thought into it.”

The morning I arrive at the hospital, there are about a dozen mothers waiting with their kids outside the gate. A naked little boy with skin like an elephant’s squats in front of his mother and shits. She wipes his wrinkled butt with a piece of cardboard from a box of medicine.

The mothers watch you enter, watch you come and go as you please, the color of your skin, the camera on your shoulder, the only entry pass you need. In the twitch of an eye, they’ve scanned your clothes, your eyes, read your intentions, your ability to help them. They don’t beg; they know you’re not here for that. They see the camera, the notepad; you can do nothing for them right away. Maybe in the long term you can help, they think, so they’ll let you take pictures; but, really, they don’t care. Their needs are immediate. Liquid. Food. Nutrients. Now.

Inside the compound, just beyond the gates, in the admissions tent, Dr. Milton Tectonidis examines a two-year-old boy clinging to his mother’s breast.

“He’s quite dehydrated,” he says about the boy, gently pinching the skin of the child’s left arm. The boy’s name is Rashidu. His eyes are wide, and he looks right at Dr. Tectonidis.

“Usually in a kid you look for sunken eyes, and skin that doesn’t come back, skin that stays folded,” he says, barely pausing long enough to glance up. “In a malnourished kid, however, it’s not a very useful sign. Because they’re so scrawny, the skin always stays like that.”

In his native Canada, Dr. Tectonidis might be mistaken for a drifter. His long hair is unkempt; his tall, thin body swims in the white T-shirts he always wears. He has worked with Doctors Without Borders for more than a dozen years, and in as many countries. He’s treated tens of thousands of children, perhaps hundreds of thousands. He’s lost count of how many he’s saved.

“The very bad ones are in such shock, they don’t look at you like that,” Dr. Tectonidis says, smiling at Rashidu’s unblinking gaze. “But he’s weak, so I’ll keep him here.”

The tent is crowded. About forty mothers with children sit on wooden benches waiting to have their children measured and weighed on a giant scale that hangs from a bar. The mothers say nothing. Only the children make sounds – coughing and crying, crying and coughing. A constant cacophony.

Dr. Tectonidis doesn’t wait for Rashidu to get weighed. There’s not enough time. Cradling the child in his arms, he takes him straight to the intensive care ward.

The UN had been warning about food shortages in Niger for months, but who pays attention to press releases? In this television age, nothing is real without pictures: starving kids, bloated bellies, sunken eyes – Sally Struthers stuff. Warnings don’t get headlines, crises do. Malnutrition sounds so bland. Famine? Now that’s a showstopper. The problem is, Niger isn’t suffering from famine – not yet. Adults aren’t dying, just thousands of kids. It’s a food shortage, a hunger crisis, severe malnutrition – none of which will get you a spot on prime-time TV. The BBC was the first TV crew here; we came second. Most American networks don’t even bother to show up.

“We saw it coming in February,” Dr. Tectonidis tells me later. “We sent out a press release saying, ‘Watch out! We need free food and free health care.’” February. Now it’s July. Help is just starting to arrive.

“Maybe it was the tsunami,” I say. “People unable to focus on more than one crisis at a time.”

Dr. Tectionidis shakes his head. “It’s always like this,” he says. “The less politically important a country is, the longer the delay.”

According to Dr. Tectonidis, the UN wants to raise a billion dollars for a reserve fund. That way, every time there’s an emergency they don’t have to go around begging, and exaggerating the scope of the problem. That’s basically what they do now. The figure they’ve been using, the one I heard on the BBC – “3.5 million Nigeriens at risk of starvation” – is carefully crafted and somewhat misleading. You’ve got to read the fine print. “At risk” – that’s the key phrase. What exactly does it mean? We are all at risk in some way, aren’t we? If no aid arrives, if no attention is paid, 3.5 million Nigeriens could starve. True. But it doesn’t work like that. Kids start dying, then some reporters pay attention – usually freelancers, men and women looking to make a name for themselves. They arrive first. Their pictures motivate someone from a network to come and do the story. Then more aid arrives. It’s not a perfect system, but it’s what the market will bear. The problem for Niger is that not enough people are dying. A few thousand children isn’t enough.

RASHIDU IS LAID out on a plastic mattress. In the intensive care ward, there are no sheets on the beds. It’s too messy for that. The room is actually a tent several hundred feet long, with a single row of beds on either side. The mothers share the mattresses with their children.

When a child is severely malnourished, his body breaks down, devouring itself. The fat goes first, then the muscles, then the organs: the liver, intestines, kidneys. The heart shrinks, the pulse slows, blood pressure drops. Diarrhea dehydrates, the immune system collapses. Starvation doesn’t kill the child; infections and disease do. No layer of fat between flesh and bone, nothing to pad the pain. His little heart simply gives up.