The Children of Kakuma

In the spring of 2001, not long after food rations supplied to refugees were cut by the WFP, UNICEF sponsored a fairly extensive nutritional survey that involved all of the children in the camp. The results, showing lower-than-expected rates of acute, as well as chronic, malnutrition (based on body weight to height ratios) seemed a contradiction to everything we were seeing at Kakuma.

Despite the optimistic results of the nutritional survey, and the relatively easy access to nutritional programs, the hospital was admitting more malnourished, dehydrated, and sickly babies. They were thin as a whisper; so frail you could see their hearts beating through the paperlike skin on their fragile little bodies. You could see, too, when those delicate pulses ceased, as one after another slipped from this world gently and without a fight. I’d been lulled into complacency by the presence of a nutritional program and access to food for the refugees here. I’d believed that I’d see no more starving babies, but I was wrong.

One of the babies was Sunday John—so named because he was born on a Sunday. Tiny, shriveled, malnourished, and about eight months old, he was born in South Sudan during the worst of the fighting there. It had taken his mother months to get across the border and into Kakuma, and only another day to have Sunday admitted to the pediatric ward for nutritional support. An intravenous line delivering hydration was taped to his tiny arm. A feeding tube snaked through his nose to his stomach, delivering the special nutrition he needed to recover and grow. He had large, soulful eyes that tracked my every move when I approached him. Fearful of another needle stick or exam, he let out a weak cry when I touched him. When I wrapped the tape measure around his arm to see how he was progressing, he moaned and tried to push me away. When his foot was pricked for a small sample of blood, he let out a weak cry and wrinkled his brow, watching me again until I whispered that we were done, then moved far enough away that he could be sure of that. He was afraid of everyone but his mother, who, when I was done, wrapped her arms around him and kissed his little cheek. I watched as the corners of his cracked lips lifted into a smile, and his eyes seemed to sparkle.

Weeks later, he was discharged to the little hut where he would live with his mother, and I knew that, at least for Sunday John, there was hope.

The children of Kakuma, who had no toys and few breaks from the monotony of their lives, were resilient and resourceful and filled with laughter at even the smallest chance for play. They fashioned toys from objects they scrounged from the piles of garbage that dotted the camp or simply found unclaimed in the road. From rocks and sticks they created trucks, and on larger sticks of wood they painted doll’s faces. The ingeniousness of their strategy was admirable, but still, from my Western perspective, I wished I’d brought toys—balls and bubbles and books—but I was as empty-handed as the children here.

One day I noticed a cluster of children crowded around one small boy who held a shiny yellow marble in his outstretched hand. It glistened in the sun, seeming to throw off a brilliant light of its own. The children leaned closer, clearly wanting to hold it for themselves, to feel the glossy, cool smoothness in their own dirt-streaked little hands. They milled about, watching, waiting, and hoping for a chance to just touch it. That shiny yellow marble was the center of the universe for those children on that day. That simple glass ball held a special kind of magic in that desolate place until the young boy curled his hand over it and slipped it back into his pocket. The magic was gone and the children who’d gathered to watch groaned in unison, their little shoulders sagging as the boy who owned it stepped back into the road, kicking stones and dirt as he went. And as I watched, I wished for all those children a life filled with the magic of shiny yellow marbles.

I especially wished that for Agnes. She was ten years old when I first saw her in the pediatric ward of the hospital. She had been admitted with nephrotic syndrome (kidney failure), likely resulting from tuberculosis. Her body was swollen to twice its normal size; her heart always raced, and she took her breaths in small, shallow gasps. For Agnes, that effort to breathe required all of her strength and prevented all other movement, including the small bit of energy needed to smile. She could not even lie flat to sleep; her efforts to breathe meant that she had to sit, and even sleep, upright.

In this late stage of her disease, treatment was minimally effective; our best hope was to make her comfortable. But comfort was relative here. Agnes had to share her hospital bed with another patient—always, it seemed, a squealing baby.

Agnes’s lone dress looked like an old sack that had been sewn together at the shoulders. It was the dull, lifeless gray of the ration sacks and likely had been just that not so long ago. She wore and even slept in it every day, and it added to her weary appearance. Her close-cropped, dull, and dusty hair further added to the impression that she was old, if not in years, then in suffering.

Her family had too many responsibilities to stay with her in the hospital, but her mother and toddler brother visited frequently. The only piece of clothing her tiny brother had was a ragged old sweater. He didn’t even have pants. He strutted about wearing only the frayed sweater; it never deterred him from laughing and playing. He was lucky; at least he had some covering. Many children didn’t even have that, and they ran about bare-skinned and without any protection or covering for their little bodies.

Even in camp, there were degrees of poverty, and Agnes and her family were destitute, with nothing but hope to call their own. For Agnes, even hope was elusive. Her childhood had been stolen; she had the sad, bloated, and burdened face of an old woman. Still, even through the long days and nights of sharing her bed with another patient (I always thought of it as her bed since she lived in the hospital), she never complained, though she never really spoke either. Words sapped her energy, and to speak with her, I had to learn to read her eyes, for it was there I could see a sparkle of joy or the unmistakable flat reflection of her melancholy.

One day, in one of many efforts to induce a small moment of joy, I let her listen to the sound of her own heartbeat with my stethoscope. For the first and only time that I knew her, Agnes looked straight at me and, her eyes shimmering, drew her lips into an unexpected and rare smile.

A few days later, on an especially warm morning with the sun beating down hard already, I stopped at the pediatric ward to see Agnes. I poked my head in, my eyes scanning the ward, but she was nowhere to be found, either in her bed, or elsewhere in the large tent. I headed outside to continue my search.

“Where is she?” I asked everyone I saw.

The only replies were shoulder shrugs or head shakes. No one had seen her, and no one seemed worried. My heart pounded as I raced along the tent’s perimeter, and then, with blissful relief, spied her there. Someone had moved her outside to the rear of the tent for a bit of fresh air, and there she sat on a stiff wooden chair. Because of her chronic difficulty breathing, she sat perfectly upright, her back straight as a ruler, her dress spread out covering her knees—a princess of sorts overlooking her kingdom. I gave her an especially warm greeting that morning. She raised a brow, likely confused about my joy at seeing her, but it was absolute joy I felt. I stopped daily to see Agnes, to say hello, to share a smile, to tell her funny stories; she sometimes offered a thin smile, but she never spoke.

When I went to say good-bye to her to let her know I was going home, she barely acknowledged me, and it occurred to me that I was only one of many aid workers who’d passed briefly through her short life and then just disappeared. My chest tightened at the thought. I was deserting her just as everyone before me had. I leaned down to give her one final hug. I was going home. Agnes was already there.

I have tried in the last months, now years, to get word of Agnes, but sadly, there is no news. I suspect that her child’s spirit, entombed in an old and battered body, simply gave up the struggle. Agnes was possessed of a rare courage and an almost angel-like serenity. She is surely an angel now, freed from her struggles and pain. She will always be an inspiration to me for her unfailing goodness in the face of so many unfair burdens.