Babies

I am being frightened, inspired, confused, and enlightened by the first year of life.

This chapter begins in risk and tragedy. The first pregnancy outcomes I saw were a 6-month-old miscarried fetus and a ruptured ectopic pregnancy. I was left to ponder the commonness of early death and the fragility of life—that is, if you even make it that far.

Thankfully, I soon scrubbed into an emergency C-section procedure with a happier ending. It began with the taut mountainous belly of a tiny village woman, opened a red wet hole in her middle, and basically just pulled out a baby...full of pink chub and beautiful screaming life. As I watched this new person breathe her first air and make her first sounds in this world, she looked like a miracle to me.

(Check out some REMEDY supplies in the surgeon's hands!)

At the same time, last week I was knee-deep in infant mortality data. I had analyzed the first 5,000 household records from a survey of the VMH patient population, and found five-times higher infant mortality rates among the tribal versus non-tribal communities. My mentor suggested that we investigate the causes of these deaths and disparity. So, in one week I wrote a proposal and designed a verbal autopsy questionnaire, got approval from the swift-working SVYM IRB committee, and started interviews.

For the past few days now, I’ve been visiting homes to learn about the events leading to infant deaths. The families we meet are generous with their lives—sharing stories, medical records, theories about illness and death, and opinions of the healthcare services available to them. There’s a lot of rich information to record and process. While I can’t follow 99% of the Kannada interviews (will have to use a translator later), I can tell that the mothers are incredibly

stoic. The average mom has accepted her child’s death (most do not think it was preventable; many report a sudden death without symptoms). This allows her to move past the tragedy. Sadly, this can also undermine the infant’s chance of survival, negate health system efforts to reduce mortality, and make cause of death determination really difficult. Looking at so many mystery deaths, it’s clear that we can’t yet understand all causes of local infant mortality. This study is, however, shaping up to be a valuable test of the door-to-door verbal autopsy method, and hopefully helping to build a bridge between the neonatal/post-neonatal period in homes and SVYM in the community. One other major finding is that infant mortality is not as high as we had thought, since many of the so-called infant deaths are actually stillbirths and miscarriages. I know it’s not great news, but it is important to know.

Down the hallway in the NICU—a tiny bed surrounded by heat lamps and stuffed with copious layers of blankets—a pair of babies is sleeping today. These twins were born here four days ago, weighing in at 1 kg and 800 g. They lie side-by-side with arms outstretched, and still don’t even touch in their bed for one newborn. Both have under-formed extremities, female genitalia, and faces. Watching over them, I imagine partial organs and branching vessels, arrested mid-process—a fatally premature system inside. And yet, I definitely see little lips pursing, symmetric lungs inflating, wide eyes opening and closing to the light—a living being outside in the world. Not a miscarriage, not a stillbirth, not an infant death…good G-d, these babies are alive! It is scary, but still there’s a lot of hope.

A baby’s future depends on so many things, a lot of which we can’t control. But the key is that we CAN optimize a lot more than we do—and seizing those opportunities in the fragile first year of life is enough to keep me busy, fulfilled, and inspired in my work these days.