9 p.m. Rainy season. Friday night. I was standing in the open air hallway when a mo-ped drove in with a bundle of cloth thrown over the driver’s lap. He jumped off the bike yelling, “Dogo toro” (doctor in the local language). Within the swaddle, lay a two-year-old girl drenched in sweat, barely breathing audibly. We placed her in a bed and I immediately examined her for severe malaria.

To diagnose malaria, we prick the finger and place a drop of blood on a microscope slide to stain and look for parasites. Lucky me, I am also equipped with a glucometer (to measure blood sugar) and a Hemocue (to evaluate hemoglobin levels for anemia), two appliances nonexistent at this hospital until I arrived with them in August. This child was severely hypoglycemic (blood glucose 18 mg/dL) and severely anemic (Hgb 2.2 g/mL).

Even without fancy gadgets, it is never a good sign when you prick a child’s finger and it does not bleed. It is also not a good sign when the blood that you can squeeze out is the not the deep red of a Saharan sunset, but rather a faint, watered-down rose. I left to search for a clean needle, IV fluids, quinine and the like, and by the time I returned, the mother was sobbing uncontrollably at the bedside. I ask the nurse if anything had happened fearing that the child had died in my three-minute absence. The nurse gave the mother a disapproving look and said, “Elle pense que l’enfant va partir” (She thinks the child will leave … die).

Some say that a mother’s intuition is never wrong.

Within minutes, before I could even get an IV started, I lost the heartbeat and began CPR. The problem with CPR here is two-fold: First, no one really believes it is going to work so they do not execute it properly; second, the deeply ingrained belief that death is a fate controlled by an omnipotent Dieu, and no mortal should interfere, prevents heroic life-saving efforts. The prevailing attitude is that any interference (CPR or otherwise) with this child’s destiny was bound to be transient. But listening to a heart slow when nothing can be done is a torturous predicament. The impatient-Western-medicine-demon in my American soul emerged and I left to find epinephrine in a resuscitation kit I had seen left over from Phase I malaria vaccine trials completed at this site in 2003. Normally, I would be running, however, because I needed someone to open the locked closet, I kept pace with the strolling nurse escort, prodding him to speed up.

In the closet, I was amazed to find a complete resuscitation kit, the size of a small suitcase, with anything my heart desired to run a code. I pulled out vials and looked at their expiration dates. Absolutely everything in the kit had expired two years ago. Despondent, I returned to the bedside and indulged in a few more rounds of CPR before pronouncing the tiny patient dead. As I stood aside while the mother’s bawling escalated, the nurse whispered what I’ve heard many times during this malaria season. “Ils sont venus trop tard” (They came too late).

This hospital is not New York Presbyterian’s Pedicatric ICU. Accepted. But the phrase “they came too late,” eats at me. When this frame of mind pervades patient care, it only cripples an already impoverished health care system, instead of searching for solutions. Why did they come too late? It’s easy to understand when families arrive last minute if they live 60 km away with no access to healthcare and no transportation. But this child lived three km away and had been sick several days. These are not questions I ask guilt-ridden parents minutes after their child has died, but I suspect the answer is money. Bednets are expensive. Quinine is expensive. Health is expensive.

Though the diseases I have treated these past few months seem exotic — malaria, typhoid, tuberculosis, cobra and viper bites — the prevailing patient profile is not very different from what you’d find in New York Presbyterian’s ER. What does an impoverished Dogon onion farmer with 14 children have in common with a homeless diabetic who lives under the Brooklyn Bridge? Neither of them can afford to be healthy. And their behaviors are equally predicable. They will wait until the very last minute to seek treatment, hoping, desperately, that their child’s cerebral malaria or their festering gangrene will resolve on its own. I came all the way out here to find the same obstacles. If the solution were as simple as spend more money, problems in global health would disappear as quickly as it’s taking our nation to decide on a national health plan.

David Werner who wrote the widely-translated 1970s village health care manual, Where There Is No Doctor, claimed that poverty is more powerful than knowledge: “No matter how many doctors tell a mother to feed her child, without the means, she cannot follow their advice.”

I watched the mother secure the small body to her back with a large piece of fabric. She left, dead baby in tow, back to her village. “Do we need to do anything?” I ask. At this hospital, the nurse tells me, we only do death certificates for those over 16 years of age. No death certificate. No autopsy. No time for any of that. At least the dead back home get better care.

Anastasia Grivoyannis ’06 is a student at Weill Cornell Medical College in the class of 2011. What’s Up, Doc?, a column featuring a rotating cast of medical students, appears alternate Fridays this semester. She may be reached at ag278@cornell.edu.