This week on the ward we were faced with the depth of the effects of present day poverty in South Africa on a family. This child had been admitted with severe malnutrition which her parents knew was related to the fact that they could not afford to feed this their third child. They had told us as much when we admitted her. They had recently come to Cape Town from a northern province of South Africa to look for employment. We instituted the WHO 10 Steps treatment regimen and engaged with our Social Worker who contacted local services. We were gratified to see the child respond well to the treatment which included a staphylococcal septicaemia. But we soon met with disappointment when she developed a new chest infection, pretty certainly acquired in hospital. Three days later though very weak, she  was definitely responding to the strong antibiotic therapy. Her mother had been at the bedside most of the time, but had asked for leave to attend to the other two children at home. She clearly regretted having to leave her daughter and was soon back at her post, quietly seated with her child but clearly anxious.

As recovery (for the second time) appeared to be taking hold, her father visited, very concerned and passionate – he wished to take his daughter out of hospital. When we gave him time to work through his arguments and concerns (nearly two hours including interpreting from the Xhosa), it became clear that this was not about different cultural world views of health and healing (an assumption often made in these situations by Western-trained health professionals) but about a wonderful father who has nowhere to turn: three children, no money and little prospect of any beyond government Child Support grants. His daughter being in hospital was a major catastrophe for the family as he had to look after the other two children and was not able to look for work. They could not coutenance NOT having a parent with their sick baby.

An added stress for them was the hospital policy not to feed parents of children in hospital unless they are breast feeding. I am pleased to say that this is under review at provincial level, and that we have been able to procure food for her.

Why is this case ‘hard to handle’? Because it is so humbling, and because it shows how much is stacked against children living in severe poverty. And I am part of the history that produced this child’s situation and this family’s situation. We can treat malnutrition; preventing it is much harder to do.