The sun is barely rising in rural Burundi when we begin our medical rounds in the pediatric ward. I am an American, doctoring in this central African nation, far away from my home in northern Ohio. An early start to our day is necessary since there are so many children here. They are all very sick—an inordinate amount of suffering crammed into their short lives. The mothers of these little ones sit sentry by their bedsides, some of them weeping, as we desperately try to save their babies from pneumonia, burns, and broken bones. Worst of all are the malnourished children, whose misery is caused by having so little to eat, their bodies shut down. Their swollen limbs, skeletal frames, and mewling cries of desperation are what keep me awake at night.
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Last week, I was struck by the hollowed eyes and scooped-out belly of a four-year-old boy. He weighs just 17 pounds. He was so weak, he could not hold his head up when I examined him. We are doing our best to care for this child, but before rounds started, the nurse on the ward pulled me aside to whisper that we were down to our last 20 packets of ready-to-use therapeutic food. Therapeutic food is an amped-up peanut butter that is given to put calories, protein, and vitamins into children who are starving to death. The average malnourished child will need three packs of this miracle spread a day, which means I only have enough to give 6 children for one day. There are many more children who need it on the ward right now. All the training in the world did not prepare me to figure out this math.
I picked up a pack of ready-to-use therapeutic food to see if we could split it somehow. Would that qualify as being efficient under these circumstances? The sachet I held in my hand was emblazoned with the USAID logo. In large red, white, and blue letters, it proclaimed that this life-saving packet the size of a candy bar is “from the American people.” When we had enough to go around, I felt proud of my country and the pragmatic solidarity donations such as this revealed. The generosity of the U.S. was a palpable presence in a place in the world where no American diplomat or leader would ever come. But as I ripped open the envelope and divided its contents into thirds, I felt nothing but a sense of shame. To my patients and their mothers, I offered apologies from the American people.
On the orders of the world’s richest man, USAID halted its operations seemingly overnight. It was the only supplier of ready-to-use therapeutic food in many countries like Burundi. In the wake of this startling termination, those of us working on the front lines are left with only what was already in our stores. Although feeding dying babies should surely qualify for the vague foreign aid waiver issued by Secretary of State Marco Rubio, the salaries of the staff and the cost of the fuel to get the therapeutic food to hospitals like mine are not. Without USAID employees, nobody can open the warehouses where the life-saving packets from the American people are stored. In Burundi, it will take us three months to get new supplies into the country. We might have planned for this had we known we would be cut off. But we were given no warning when the programs that support the care of sick and hungry children were sacrificed on the altar of “efficiency” in one harsh, abrupt stroke. Seeming indifference, from the American people.
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At the end of an exhausting day, as I climbed the hill from the hospital to my sleeping quarters, I looked across Lake Tanganyika to the Democratic Republic of Congo. There is a war going on there, with thousands dying so that powerful people can be enriched by the minerals that fuel our smartphones. The victims are mostly women and children, as always seems to be the case in the battles waged by men. The camps where such non-combatants would normally shelter are either closed or not able to function at capacity due, in part, to the withdrawal of U.S. foreign aid.
Once I am inside my room, I log onto the internet. I am bombarded by pictures of things happening outside of Burundi. In Washington D.C., a non-elected billionaire is answering questions in the Oval Office. He is well-fed, and the cost of his clothing alone could probably sustain the children in my hospital for a year. I read about the rising cost of eggs, and how people who sleep in dry, warm beds every night cannot afford to fill their cars with gas. I click through these headlines, and I wonder how we will feed the malnourished babies on the ward tomorrow. Images of glaring disparities, from the American people.
“Why are you doing this to us,” a harried doctor whose clinic has run out of tuberculosis medication asks me when I visit to see how he and his staff are doing. “You are leaving us with nothing, and people are going to die.” He is right, of course, and although death from tuberculosis in Burundi may seem far away to most people living in the United States, this airborne infectious disease cannot tell the difference between the lungs of an African and that of an American. Stopping USAID from providing the medications that keep tuberculosis at bay in places like Burundi is a risk to the lives and health of everyone back home. Infectious diseases know no boundaries, and by stopping the systems that treat and monitor them before they reach our shores, our borders have been made exceptionally insecure. As I exit this clinic onto the busy dirt road outside, one of the buses that passes me is emblazoned with a giant image of Vladimir Putin. Meanwhile, the U.S. flag that used to hang at a nearby secondary school supported by USAID has come down. A sense of abandonment, from the American people.
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The United States is a nation of plenty, even if we have forgotten this. More and more, when I return to my home country, however, I cannot help but notice a void. A spirit of compassion is absent. The joy of sharing with our neighbors, gone. Even in my Midwest—a region known for its hospitality—I feel people drawing in. “What is in this for me?” has become our mantra, our motto. When the answer does not sate us, we blame our perceived ills on people outside our country who face a starkness most Americans cannot even imagine.
But even in this climate, I have a hard time believing that most Americans would want this. The babies in Burundi did not cause inflation, but many will have to die because of it. When it comes to hope, they will have to look elsewhere. From the American people, they are likely to receive none.
