Warren

November, 2019. I have been in Nairobi for two days: it rains persistently, we are in the period of small rains (as opposed to that of the great rains in March) which, however, are not so small.

There is drumming on the roof of the Neema Hospital orthopedic surgery. Since yesterday morning I have been visiting patients operated on in previous years and those that I will take to the operating room from tomorrow. Around noon I am called to the pediatric clinic by Maria Vittoria, a young, tireless colleague: she asks me for an orthopedic opinion for a patient she is visiting. I enter and the colleague shows me a 12-year-old child lying on his left side on the bed, very thin, skeletal legs and arms with numerous sores, also extended to the chest and back. A clinical picture that, in addition to malnutrition, highlights neglect, in stark contrast to the flourishing appearance of the two younger brothers present with their mother. The child appears to me very suffering, he has an absent look, every attempt to move his arms and legs causes grimaces of pain, he answers with difficulty the simple questions I ask him. From his mother we know little about why he is in that condition of prostration, he remembers that he had been operated on his left thigh for no more than three years in a hospital outside Nairobi: the cause of hospitalization was a bone infection, osteomyelitis. The woman adds that perhaps some sore arms were already present before the operation.

In agreement with the pediatrician, we decide on hospitalization for immediate nutritional treatment and to undergo blood tests and x-rays. We need to have more elements to be able to initiate adequate therapy. The mother tells us that she does not have the money to pay for the hospital stay: she would like to take him home to treat him with our prescription medicines. He also has the two little ones to look after and cannot stop at the hospital to be with him.

I, Maria Vittoria, Gianfranco, the coordinating surgeon of the Health in the slums project of World Friends here at Neema, and Njogu Washington, the medical-internist Health Director, consult with each other. After so many years spent together, a double bond unites us: friendship and the pleasure of our work and, in cases like this, we never make decisions individually. We cannot let the woman take the baby home, she is a high risk patient. The woman leaves with the two children and the patient is taken to the ward to begin treatment. She seemed resigned to her child's fate, as if she had already given him up for lost, the most disconcerting thing was that the child seemed aware of the reason for abandonment.

In the early afternoon I go to the pediatric ward to see him, he is still turned on his side and is wearing a pajama that the head nurse put on him after having treated his sores; the painkillers are working, he has no fever.

He smiles at me, I ask him for the name I had forgotten after visiting a multitude of patients: “Warren”, he tells me with a faint smile. It is a request for attention and affection that has been lacking for who knows how long. With Henry, the physiotherapist, we try to move his elbows and knees bent for a long time from the pain and we decide for a physiotherapy treatment for the days to come. We will then try to put him on his feet to make him walk. When I pass by the next morning to greet him before entering the operating room, he is eating the porridge in a plastic bowl, as always lying on his side. I call Henry who is already at work in physiotherapy and I ask him to continue the gymnastics in bed with two sessions a day, morning and afternoon. I also suggest that he begin to sit him in bed carefully, propped up on pillows.

At the end of the surgeries I come to greet him. From the look I have the impression that he was waiting for me. She ate some rice and beans that I see left over on a plate on the bedside table, her mother has not yet been seen. Maria Vittoria started a protocol with blood tests and x-rays, she also started a drug treatment for the sores and joint pain, which are already decreasing compared to the previous day. In the late afternoon, passing through the control of the operated patients, I stop by him again to examine the x-rays taken recently. There are no obvious signs of bone infections, nor are there any signs of tuberculous disease in the chest, only small calcifications are seen in the areas that correspond to the skin sores, a sign that they are of long standing. A strange x-ray picture, but I am no longer surprised by these oddities that are encountered only here. At this point we decide to also start an anti-tuberculous therapy in the suspicion of extrapulmonary tuberculosis (the culture research of the bacterium will give us the result in at least two months, this wait could be fatal for Warren). For the rest, the boy is anemic while all other tests are negative, including the AIDS test.

The nurses tell me that in the afternoon the mother finally came, always accompanied by the two children. Has she realized that this child can heal with our help and her help? Perhaps at home, considering him incurable, he could have taken him to some charlatan healer who gave him concoctions based on various crap or drugs completely inappropriate to the case. There are many of these unscrupulous subjects, they have nothing to do with and are not to be confused with the traditional healers present in the villages, who have their own traditional and practical function. But I'll never know, she won't tell me.

Days go by, Warren improves visibly: the high-protein diet is working. Henry has put him on his feet and makes him walk, his mother regularly comes to visit him with his siblings. We are now three weeks after hospitalization, he has finally left the bed, I often see him sitting on the lawn in front of the pediatrics with his brothers. His smile returned. Today he entertains the two children in the room reserved for games in the ward. They are playing with wooden cubes: Warren stacks them each time in different shapes, after which the two little ones have fun making them collapse. They see me from the glass window overlooking the corridor and get up to meet me: just a hello with a high five. They keep playing, now it's the most effective medicine

May, 2020. I'm home, stuck in the pandemic. I should have been in Nairobi just these days. Maria Vittoria regularly updated me on Warren's condition, who is still on drug therapy. Every month he saw him at the check-up: overall he improved a lot even if some of the sores that still need to be treated persist. We knew it was going to be long… but now she walks and can go to school.

"You knew how happy you make me, Warren."

Antonio Melotto

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