November 12th

*Trigger Warning* Balukali, a Hope Foundation field clinic in the middle of a massive refugee camp home of the Rohingya. An expansive living, breathing camp that embodies the reality of what it means to flee from mass genocide and ethnic cleansing. It embodies grief and trauma, survival and adaptation, life and death. Yesterday I was in the middle of a flood of prenatal appointments when a woman walks into the tent and hands me a bundle of cloth. I open the cloth and see this tiny baby wrapped inside. The woman was worried about the baby’s feet, which were clubbed. I was worried about the size of this baby and the fact that it looked preterm, an estimated 32-34 weeks. I learn that she is a twin and her brother is in a tent somewhere in the middle of the camp with the mother. I request that the mother and second baby be brought in for evaluation. I examine the baby and begin the process of referral as this baby needs care that exceeds the capacity of the camp. Almost an hour later the woman returns with the second baby. She hands the baby to the Bengali midwives, who are cooing over how tiny he is and they nonchalantly hand me the second baby who is white-gray and cool to the touch. His heart was beating, but just barely. I hand the baby girl to a field worker, and the two of us take off running through the camp, while doing a full code/resuscitation including chest compressions and mouth-to-mouth as we ran almost a mile to the entrance where a small Tuk-Tuk ambulance is waiting for us. We were taken to a field hospital down the road where a team of doctors and I continued the resuscitation effort for another 15 minutes. His heart rate rose to the 140s, his color returned, and his oxygen sats were up to 70% at one point. But he was making no respiratory effort. Just a gasp here and there. And then you find yourself in that heavy space of knowing that even if this kid was to survive he would have no quality of life. You sit with the heaviness of it and the responsibility of what it means to make the call. The call to discontinue the resuscitation. I wrapped the baby boy in his linens and a clean hospital cloth. We reunited the baby with the woman who brought him to us, his aunt, while we tried to get the mom to the hospital as soon as possible so she could be with him. We sat quietly in a tent and we waited. The baby died before the mother arrived. The aunt knew the moment he passed. It was an intuitive moment. Sitting quietly in the tent, listening to his gasps, and then startled she reached out to me and pointed down to him. I looked down and could see the rest of the color leaving his lips, and I listened to a heart that was no longer beating. She knew. Without the need for confirmation, she knew. Hours later, after finding the mother in the camp and admitting her to the field hospital, I returned to the camp with the aunt and the baby. They were bringing the baby home to honor him and his short life according to their customs. It was an intensely humbling reminder that life and death are one in the same. In the world of birth, we dance with life and death on a daily basis, and we accept and honor both. *Photo taken and posted with permission of the family.*



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