WEBVTT - 105 Children 0:00:00.080 --> 0:00:02.360 What you hear in this podcast does not implicate any 0:00:02.400 --> 0:00:05.760 individual or entity in any criminal activity. The views and 0:00:05.800 --> 0:00:09.080 opinions are solely those of the individuals participating in the podcast. 0:00:09.920 --> 0:00:15.840 Previously on the missionary, they're providing nutrition services to combat 0:00:15.840 --> 0:00:19.320 a crisis that literally the hospitals and others were unable 0:00:19.360 --> 0:00:22.799 to handle just due to the volume. When I moved there, 0:00:22.840 --> 0:00:26.200 there was a mentality of you have two patients, which 0:00:26.200 --> 0:00:28.240 one has a better chance of life this one than 0:00:28.280 --> 0:00:30.520 this one? You pick in this one you leave. It's 0:00:30.560 --> 0:00:34.640 like you were color coding people on a war field. 0:00:34.920 --> 0:00:38.680 I was fit to like provide medical care and whatever 0:00:39.440 --> 0:00:43.080 were over my head, like this is serious, serious, make 0:00:43.240 --> 0:00:47.239 you take you care. So, based on the allegations you 0:00:47.280 --> 0:00:50.680 have heard that she was an unlicensed medical facility, that 0:00:50.760 --> 0:00:54.760 she was providing medical care without having medical qualifications, do 0:00:54.840 --> 0:00:58.560 these allegations surprise you, given you what you know about 0:00:58.920 --> 0:01:03.160 how and geos operated here, Of course they don't surprise me. 0:01:14.640 --> 0:01:17.600 Jim mc graham was twenty two years old when he 0:01:17.640 --> 0:01:21.800 found a pamphlet recruiting young healthy men to serve their country. 0:01:22.520 --> 0:01:27.120 It was November nineteen and millions of American men were 0:01:27.120 --> 0:01:30.760 going abroad to fight in World War Two, but Jim 0:01:30.840 --> 0:01:34.640 was a conscientious objector. Instead of taking up arms, he 0:01:34.720 --> 0:01:39.440 found other ways to help by planting trees fighting forest fires. 0:01:39.800 --> 0:01:42.840 But he wanted to do more. This call for volunteers 0:01:42.920 --> 0:01:46.800 sounded like an opportunity to provide a worthwhile service, not 0:01:46.959 --> 0:01:51.080 just to our country, but to all humanity. Jim volunteer 0:01:51.200 --> 0:01:54.000 to be a guinea pig in a study called the 0:01:54.080 --> 0:01:58.760 Minnesota Starvation Experiment run by Dr Ansel Keys of the 0:01:58.880 --> 0:02:02.440 University of Minnesota, DA. He was featured in a documentary 0:02:02.520 --> 0:02:06.000 by Colorado State University. We knew fairly well what a 0:02:06.040 --> 0:02:08.880 star of person looked like and what starvation did to 0:02:08.919 --> 0:02:11.560 the human body, but until this time, there had never 0:02:11.600 --> 0:02:15.680 been an opportunity to measure exactly what changes take place 0:02:15.720 --> 0:02:19.120 in the body under starvation conditions, Nor had there ever 0:02:19.200 --> 0:02:22.640 been any scientific tests to determine what best to feed 0:02:22.639 --> 0:02:25.040 a star of person to bring him or her back 0:02:25.080 --> 0:02:29.040 to health. The project's goal to learn how to treat 0:02:29.080 --> 0:02:33.959 starvation after the war ended. The experiment was fairly simple. 0:02:34.520 --> 0:02:38.880 Thirty six men were semi starved for six months. Their 0:02:38.919 --> 0:02:43.920 diet was modeled after famine diets of bread, potatoes, porridge, 0:02:43.919 --> 0:02:47.440 and turn ups. They continued walking at least twenty two 0:02:47.440 --> 0:02:51.280 miles a week, taking classes in the university and working 0:02:51.320 --> 0:02:54.600 at the lab. Jim was six ft two and he 0:02:54.680 --> 0:02:58.320 began the study at one hundred seventy five pounds, but 0:02:58.400 --> 0:03:01.560 it wasn't long before the famine diet took a toll. 0:03:01.919 --> 0:03:05.160 Most of us suffered from edema, the collecting of liquid 0:03:05.200 --> 0:03:08.280 in the body, some more than others. I always woke 0:03:08.360 --> 0:03:10.480 up in the morning with my face puffy on the 0:03:10.520 --> 0:03:13.680 side I was lying on. Sometimes my ankles and knees 0:03:13.680 --> 0:03:16.680 were puffy. I look in the mirror and see that 0:03:16.800 --> 0:03:19.799 my eyes looked hollow, my cheeks were only a thin 0:03:19.919 --> 0:03:23.119 covering for the bones in my face, and my hair 0:03:23.240 --> 0:03:26.440 was getting thinner. If I tried to smile, it was 0:03:26.520 --> 0:03:34.080 just a grimace, and I never laughed. As Jim and 0:03:34.080 --> 0:03:38.320 the other participants rapidly lost weight, some dropped to a 0:03:38.360 --> 0:03:46.040 mirror one hundred pounds, and the psychological changes mounted, fatigue, depression, paranoia, 0:03:46.640 --> 0:03:51.920 symptoms that previously hadn't been attributed to starvation. We became 0:03:52.160 --> 0:03:57.240 very irritable and intolerant. Little things seemed to annoyance. We 0:03:57.240 --> 0:04:00.400 were no longer polite with each other or with ssitors. 0:04:00.720 --> 0:04:03.960 It seemed as if the veneer of civilization had been removed, 0:04:04.600 --> 0:04:10.600 leaving bear the animal underneath. Years later, researchers would publish 0:04:10.720 --> 0:04:15.400 one thousand, three hundred pages on the scientific effects of starvation. 0:04:16.080 --> 0:04:18.640 The research remains key to a lot of what we 0:04:18.760 --> 0:04:23.160 know and still don't know about malnutrition. I have experienced 0:04:23.279 --> 0:04:26.120 hunger and the apathy and depression that goes with it, 0:04:27.760 --> 0:04:31.120 but we lived in sanitary quarters under the constant care 0:04:31.240 --> 0:04:35.919 of doctors. Furthermore, we knew that it would all be 0:04:36.000 --> 0:04:40.400 over on a certain date. I often think how horrible 0:04:40.440 --> 0:04:43.680 it would be to be starving and never know when 0:04:43.720 --> 0:04:48.760 it would end, if ever. In association with I Heart Media, 0:04:49.080 --> 0:04:53.159 I'm Halema ge Condy, Malcolm Burnley, I'm Roger Gola and 0:04:53.240 --> 0:04:58.839 this is the missionary episode six, one hundred five children. 0:05:08.080 --> 0:05:11.320 There are a few basic facts that everyone agrees on. 0:05:11.920 --> 0:05:15.599 Renee had run a health facility for malnourished children, It 0:05:15.680 --> 0:05:19.600 was unlicensed for years, and at least one hundred five 0:05:19.760 --> 0:05:24.280 children died, But those facts alone didn't support the worst 0:05:24.320 --> 0:05:30.960 of the allegations that Renee was a baby killer. We've 0:05:31.000 --> 0:05:35.200 passed through years worth of Renee's blogs, social media posts, 0:05:35.440 --> 0:05:39.280 talked to missionaries and activists, but there hasn't been much 0:05:39.400 --> 0:05:44.040 else to support these accusations and allegations. It was obvious 0:05:44.080 --> 0:05:47.280 to me that there were more perspectives out there, more 0:05:47.320 --> 0:05:50.960 people we needed to speak with, a completely different world 0:05:51.040 --> 0:05:54.760 that we hadn't tapped into yet. That was Uganda's health 0:05:54.760 --> 0:05:58.520 care system and the near dozen medical staff who worked 0:05:58.520 --> 0:06:01.720 with RENEE for years. I knew that I had to 0:06:01.760 --> 0:06:09.760 get into that world. The first time I traveled throughout 0:06:09.800 --> 0:06:14.760 eastern Uganda, passing by farms huge plantain and cassava plants, 0:06:14.880 --> 0:06:19.479 pineapples and sugarcane fields, I thought, how could there be 0:06:19.720 --> 0:06:24.520 severe malnutrition in a place like this? Um Dr Esther 0:06:26.160 --> 0:06:29.560 I am a pediatrician. I also have a PhD in 0:06:29.600 --> 0:06:32.679 a clean connutrition and I am the head of Manama 0:06:32.760 --> 0:06:38.120 Jimon Nutrician Unit, Malago National Referra Hospital. Dr Barby Rickare 0:06:38.320 --> 0:06:41.400 has been working on malnutrition for more than twenty years 0:06:41.880 --> 0:06:44.040 and then one of the GYMO Nutrition Unit is the 0:06:44.200 --> 0:06:49.000 top children's nutrition unit in the country. About one percent 0:06:49.320 --> 0:06:53.280 to two percent of children, especially in the five years 0:06:53.320 --> 0:06:59.440 of age, severely malnourished, so it is that big. On average, 0:06:59.480 --> 0:07:03.880 we admit about one hundred children per month with severe 0:07:03.960 --> 0:07:08.600 acute malnutrition just on one world that nutrition or unit, 0:07:09.279 --> 0:07:17.000 so that's is quite a big number. Malnutrition remains a complex, 0:07:17.080 --> 0:07:22.200 mysterious problem, especially for children in Uganda. They're quite a 0:07:22.280 --> 0:07:27.720 number of causes or predisposing factors to malnutrition. People are 0:07:27.760 --> 0:07:31.200 surprised why we have a lot of food and yet 0:07:31.320 --> 0:07:34.320 we have malnurised children. But these children may not be 0:07:34.480 --> 0:07:38.560 taken in adequate amounts. And also the quality of the 0:07:38.680 --> 0:07:42.840 food and how is this food prepared. In Uganda, the 0:07:42.880 --> 0:07:46.880 main stables of today are mostly starchry foods like cassava 0:07:47.040 --> 0:07:50.600 and maize that lack a lot of vitamins that babies need. 0:07:51.200 --> 0:07:54.360 A lot of other countries have addressed this by fortifying 0:07:54.520 --> 0:07:58.280 or enriching their stable foods. In the US, wheat flour 0:07:58.480 --> 0:08:02.280 is often enriched with iron and folic acid. Table salt 0:08:02.360 --> 0:08:09.600 has iodine, but that hasn't happened much in Uganda. Food 0:08:09.800 --> 0:08:14.000 isn't the only factor either. Also diseases. We find some 0:08:14.120 --> 0:08:19.520 chronic diseases like tibi or v or diarrhea, diseases predisposed 0:08:19.520 --> 0:08:24.720 that children getting malnutrition. These combined factors were deadly for 0:08:24.840 --> 0:08:30.040 malnourished children There's another oddity to malnutrition too. Instead of 0:08:30.080 --> 0:08:34.640 becoming skin and bones, some children's bodies swelled, especially around 0:08:34.679 --> 0:08:38.679 their stomachs. It's an image that many Americans are likely 0:08:38.760 --> 0:08:43.120 familiar with seeing on the news starving children with bloated bellies. 0:08:43.920 --> 0:08:46.680 The swelling is called edema, and it's similar to what 0:08:46.800 --> 0:08:51.319 happened to the adults under the Minnesota experiment. With some children, 0:08:51.640 --> 0:08:55.240 their faces can become so swollen as if they're having 0:08:55.280 --> 0:08:59.839 an allergic reaction, their eyes get puffy. In Ghana, this 0:09:00.080 --> 0:09:02.920 is called quash or car, meaning the disease of the 0:09:03.000 --> 0:09:07.080 displaced child. It mostly refers to when a baby is 0:09:07.120 --> 0:09:11.959 weaned prematurely after their mothers become pregnant again. Quash your 0:09:12.040 --> 0:09:15.640 car also has local names in Uganda of Bosi and 0:09:15.720 --> 0:09:21.199 Luganda and Lose and Lugisu. Experts like Dr Esther Barbera 0:09:21.320 --> 0:09:25.600 Care are still trying to research why certain children develop 0:09:25.679 --> 0:09:30.560 it and why others simply become incredibly skinny. Around the 0:09:30.559 --> 0:09:34.720 time that Renee had established serving his children, malnutrition was 0:09:34.760 --> 0:09:37.840 the direct cause of more than a third of deaths 0:09:37.960 --> 0:09:41.959 for children under five years old in Uganda, and malnourished 0:09:42.000 --> 0:09:45.920 children or nine times more likely to die than healthy ones. 0:09:46.840 --> 0:09:49.400 Even when children were able to get to hospitals like 0:09:49.440 --> 0:09:53.160 i Mlago and be seen by experts, there were still 0:09:53.200 --> 0:09:57.439 a high chance they would die. They'll take an example 0:09:57.480 --> 0:10:01.240 of ard that is them Lego and a demnutrition or 0:10:01.320 --> 0:10:04.800 unit they come verily to when they are critically ill 0:10:05.600 --> 0:10:09.120 with these complications and you try your best, but still 0:10:09.160 --> 0:10:19.880 about ten to may day. This is unacceptable and acceptably high. 0:10:20.520 --> 0:10:24.120 As grim as those numbers are, it's actually an improvement. 0:10:24.720 --> 0:10:28.000 Ten years ago, the mortality rate for children with severe 0:10:28.080 --> 0:10:33.160 malnourishment in Uganda was even higher. Sometimes between twenty and 0:10:34.679 --> 0:10:39.760 of severely malnourished children died in hospitals. That was the 0:10:39.840 --> 0:10:43.480 scale of the problem and that's why Uganda created a 0:10:43.520 --> 0:10:47.240 new system to build more health centers and clinics in 0:10:47.360 --> 0:10:52.600 hard hit areas. Testing testing, Okay, so could you just 0:10:52.679 --> 0:10:57.680 say your name, um and your profession. Okay. My name 0:10:57.760 --> 0:11:02.640 is r Dr Honey Forbach. I'm a retired medical practitioner 0:11:03.000 --> 0:11:07.240 and a nutritionist. I worked in the National Hospital Hospital 0:11:08.200 --> 0:11:15.280 from nine and then moved on to the National Nutrition 0:11:15.400 --> 0:11:19.760 Unit where I worked until two thousand and nine. Then 0:11:19.800 --> 0:11:25.920 I moved into programming and have recently retired Dr Hannover 0:11:26.040 --> 0:11:30.320 Pacho is another top child nutrition expert in Uganda. In 0:11:30.360 --> 0:11:33.559 two thousand nine, the year when they moved back to Uganda, 0:11:33.920 --> 0:11:37.080 Dr Pacho had turned her sights on working with the 0:11:37.160 --> 0:11:40.920 Ugandan Health Ministry to create policies to address the child 0:11:40.960 --> 0:11:46.560 malnutrition problem. She was instrumental in developing Uganda's new national 0:11:46.640 --> 0:11:51.400 guidelines on managing these cases, a step by step manual. 0:11:52.080 --> 0:11:55.679 Up until then, treatment of severe malnutrition had mostly been 0:11:55.679 --> 0:12:00.360 centered around hospitals. What was wrong with that approach? The 0:12:00.400 --> 0:12:05.880 approach was not wrong, except that there were challenges. One 0:12:06.000 --> 0:12:09.320 is that the care give us would stay for very 0:12:09.400 --> 0:12:14.120 long and in five distance away from their families because 0:12:14.160 --> 0:12:18.720 those facilities were few. And also in the course of 0:12:18.760 --> 0:12:23.960 staying in hospitals, they would get cross infections. Yes, the 0:12:24.040 --> 0:12:27.760 plan Doctor but Show helped create was to decentralize the 0:12:27.840 --> 0:12:32.400 care of severe and moderately malnourished children. The goal was 0:12:32.440 --> 0:12:36.640 to reach children who weren't accessing hospitals and to stop 0:12:36.720 --> 0:12:41.160 children from becoming severely malnourished in the first place. The 0:12:41.280 --> 0:12:47.080 community specifically is supposed to have a structure that identifies 0:12:47.480 --> 0:12:55.160 children with manetrition and refer them ali to the health facility. 0:12:55.800 --> 0:12:59.080 This model has been shown to reduce the mortality of 0:12:59.240 --> 0:13:02.839 child malned Chrisian. The idea was to move them up 0:13:02.880 --> 0:13:06.960 the pyramid of care as the cases got more complex. 0:13:07.679 --> 0:13:11.640 Children with moderate malnutrition could be treated out patient, as 0:13:11.679 --> 0:13:14.679 in they go to rural health clinics for checkups and 0:13:14.840 --> 0:13:18.880 get nutritional formulas, but they stay at home. On the 0:13:18.920 --> 0:13:24.360 other end were severe cases of malnutrition, especially those with complications. 0:13:24.400 --> 0:13:27.760 These children were supposed to be enrolled in full time 0:13:27.920 --> 0:13:31.440 in patient care, but this was also a last resort 0:13:31.520 --> 0:13:35.680 for only the most intractable cases. Once a child's health 0:13:35.880 --> 0:13:39.200 was stabilized, they could be transferred back home for the 0:13:39.240 --> 0:13:43.440 rest of their treatment. If this sounds familiar, it's because 0:13:43.480 --> 0:13:46.600 these are the guidelines. Renee says. She modeled serving his 0:13:46.720 --> 0:13:51.040 children after sending out social workers to teach about nutrition 0:13:51.280 --> 0:13:54.679 and screen for children with severe malnutrition in the villages, 0:13:55.240 --> 0:13:58.719 and then taking those sickest children back to their facility 0:13:58.800 --> 0:14:02.760 in Jina. I asked Dr Bachou which region was the 0:14:02.840 --> 0:14:06.000 worst in two thousand nine, the year Renee sat up 0:14:06.000 --> 0:14:09.960 serving his children. I it was an eastern region, Eastan 0:14:10.040 --> 0:14:14.480 region Lamutumba. It was a real case of severeli Malarui. 0:14:14.679 --> 0:14:18.360 It was really an emergency that the country had to 0:14:18.480 --> 0:14:22.400 move in to ensure that a nutrition in it was established. 0:14:24.680 --> 0:14:28.800 The name Nama Tumba sounded familiar. Later I went through 0:14:28.840 --> 0:14:32.680 my notes again and there it was. One of the 0:14:32.800 --> 0:14:38.920 children in the court case against Renee. His name Tolala Kifabi, 0:14:39.560 --> 0:14:56.360 his village Namatumba. We began this podcast and reporting this 0:14:56.520 --> 0:15:00.680 story with the court case against Renee. The fact that 0:15:00.800 --> 0:15:05.440 two Ugandan women were suing an American missionary over the 0:15:05.520 --> 0:15:09.440 deaths of their children. That to me was the most 0:15:09.480 --> 0:15:13.240 important part of this story because it seemed like this 0:15:13.320 --> 0:15:17.560 was a rare opportunity for Ugandan's to get justice. We 0:15:17.600 --> 0:15:22.040 had heard so many allegations, but these were the actual victims. 0:15:22.560 --> 0:15:26.560 Their stories were essential and piecing together what went wrong. 0:15:29.520 --> 0:15:32.560 Starting with the court documents that Renee submitted, I thought 0:15:32.600 --> 0:15:36.000 I could find material evidence that Renee was running this 0:15:36.160 --> 0:15:40.720 quack facility. Now to Lale is one of two children 0:15:40.760 --> 0:15:44.440 whose mothers are suing Renee Bach. He died after being 0:15:44.480 --> 0:15:48.840 treated at serving his children for seven days. His mother, Gimbo, 0:15:49.080 --> 0:15:53.480 was given fifty thousand Ugandan shillings less than fifteen dollars 0:15:53.480 --> 0:15:57.480 for her loss and a bag of beans. We mentioned 0:15:57.480 --> 0:16:03.120 his story in episode one. In the court documents, Kimbo says, quote, 0:16:03.480 --> 0:16:07.320 the women from Serving his children were not doctors and 0:16:07.440 --> 0:16:10.960 may have done something unprofessional that led to the death 0:16:11.000 --> 0:16:15.360 of my child. Essentially, she thinks something went wrong, but 0:16:15.640 --> 0:16:20.040 doesn't know exactly what now. The lawyers say Serving his 0:16:20.160 --> 0:16:24.040 children violated to Lally's right to life because the facility 0:16:24.360 --> 0:16:28.400 wasn't licensed at the time. The case also states that 0:16:28.440 --> 0:16:32.400 they violated his right to privacy because to Lali's photo 0:16:32.520 --> 0:16:41.600 was posted on Serving his Children's social media account. I 0:16:41.680 --> 0:16:45.640 managed to track down the health workers who oversaw Tolali's case. 0:16:46.360 --> 0:16:49.600 It was early two thousand thirteen when to Lali first 0:16:49.680 --> 0:16:54.840 became sick in his village of Namutumba. Namatumba is about 0:16:54.880 --> 0:17:00.720 an hour away from two major hospitals. The local health 0:17:00.720 --> 0:17:04.919 center diagnosed to Alale with malnutrition and directed Gimbo to 0:17:05.000 --> 0:17:08.560 buy nutrition supplements. This should have been a sign that 0:17:08.640 --> 0:17:12.800 the system was working, but according to Gimbo, she couldn't 0:17:12.880 --> 0:17:17.240 afford the medicine, so she returned to the village empty handed. 0:17:18.640 --> 0:17:22.000 Sophie said, those are the children. Renee and her employees 0:17:22.040 --> 0:17:24.720 were trying to help. She didn't get children who were 0:17:24.760 --> 0:17:28.520 fine from the villages. She was getting children from the 0:17:28.680 --> 0:17:32.679 ridges who are desperate to bring them and how at 0:17:32.760 --> 0:17:38.119 least for them to reford Esmail. That's Sophie Mutessi, a 0:17:38.200 --> 0:17:41.360 midwife who worked at serving his children from around two 0:17:41.359 --> 0:17:44.760 thousand twelve to two thousand fifteen. She has a lot 0:17:44.800 --> 0:17:48.960 of experience bridging the gap between villages and hospitals. To 0:17:49.160 --> 0:17:52.840 Lally was a prime example of those gaps. Even when 0:17:52.880 --> 0:17:57.800 services are nearby, many Ugandans, especially the poor, faced too 0:17:57.840 --> 0:18:01.679 many barriers to accessing them. Patients have to pay for 0:18:01.720 --> 0:18:07.119 basic supplies like gloves, gaus, bedsheets, medicines, even mats to 0:18:07.160 --> 0:18:10.520 sleep on, and they have to pay for that upfront. 0:18:11.119 --> 0:18:14.320 Those who can visit the hospital can't always stay long. 0:18:15.119 --> 0:18:18.439 That's what made serving his children different. They paid for 0:18:18.480 --> 0:18:22.800 everything by time they reached hospital. Then need is not 0:18:23.000 --> 0:18:27.800 only treatment. The mother is stressed, that's taken three days 0:18:27.800 --> 0:18:32.280 without eating, no, so not everything blessed sickness. Don't you 0:18:32.320 --> 0:18:37.440 reach at Rene's place, the treat her psychological and give 0:18:37.480 --> 0:18:41.680 her class time for resting. In July two thou thirteen, 0:18:42.000 --> 0:18:46.200 Gimbo was pregnant with another child by now months had 0:18:46.200 --> 0:18:49.399 passed since they visited the health center, so to a, 0:18:49.480 --> 0:18:56.959 Lali's condition had likely gotten worse. Serving his children passed 0:18:56.960 --> 0:19:00.800 by Gimbo's village during one of their outreaches, the staff 0:19:00.840 --> 0:19:04.120 asked her to take to Lale to the facility in Ginger, 0:19:04.600 --> 0:19:07.240 So Gimbo sent her mother to go with tolal A. 0:19:08.440 --> 0:19:10.919 But this didn't seem to be the same serving his 0:19:11.080 --> 0:19:16.160 children that Jackie Kramlck, the American nurse and volunteer, had criticized. 0:19:16.920 --> 0:19:20.760 By now, the organization had heated her warnings and hired 0:19:20.880 --> 0:19:27.240 trained nurses to join the staff. When Tolally arrived at 0:19:27.280 --> 0:19:31.199 serving his children, he was in really bad shape. He 0:19:31.320 --> 0:19:36.440 was severely dehydrated, his body was swollen, his skin was peeling, 0:19:36.880 --> 0:19:41.720 and his condition would only continue to worsen. Sophie Mutessi 0:19:41.960 --> 0:19:44.879 took care of tolal A on at least two shifts. 0:19:45.240 --> 0:19:48.359 According to her notes, Tolally was no longer able to 0:19:48.400 --> 0:19:52.640 eat the special formulas made for severely malnourished children, which 0:19:52.680 --> 0:19:56.600 is a bad sign. He also had diarrhea and was vomiting. 0:19:57.280 --> 0:19:59.919 Looking at her own notes, Sophie said that there was 0:20:00.040 --> 0:20:02.840 no difference between the food they were feeding him and 0:20:02.880 --> 0:20:07.359 what was coming out of Tol's body. That was a comment, 0:20:09.880 --> 0:20:12.000 why is that serious for the rest of us. They 0:20:12.080 --> 0:20:15.960 weren't medical like you are putting milk here. It was 0:20:16.040 --> 0:20:20.399 the milk coming down, which means no digestion was taking place. 0:20:20.680 --> 0:20:24.280 Does that mean the digestive system just isn't working down? 0:20:24.400 --> 0:20:32.639 Not working hm, urinating one or four times, dehydrated, Continue 0:20:32.680 --> 0:20:38.200 with plants, rehydrate your got you chosen. He spent, So 0:20:38.280 --> 0:20:44.240 that was the end of your shift. One of the 0:20:44.280 --> 0:20:48.000 early lessons of the Minnesota starvation experiment was that you 0:20:48.119 --> 0:20:51.840 have to be very careful about how you refeed or 0:20:52.040 --> 0:20:57.000 rehabilitate patients. Dr Barbara Carey told me about something called 0:20:57.040 --> 0:21:02.200 refeeding syndrome. Refitting syndrome is a phenomenon or a condition 0:21:02.280 --> 0:21:06.600 that occurs to manorite children when you're beginning to feed them. 0:21:07.119 --> 0:21:12.240 They have had electrolytes that imbalanced, that are not in 0:21:12.440 --> 0:21:15.880 right order, so when you begin to feed them, then 0:21:15.920 --> 0:21:20.200 that may worsen the condition. This causes a rapid crossing 0:21:20.440 --> 0:21:24.520 of some electrolytes into the cells, others out of the cells, 0:21:24.600 --> 0:21:28.000 and then that causes derangement in the body function and 0:21:28.040 --> 0:21:32.560 then they may Die. Here's Dr Barbara carry talking about 0:21:32.640 --> 0:21:36.360 the therapeutic milk products they use that Lago and how 0:21:36.400 --> 0:21:39.280 they monitor at the way we manage this or we 0:21:39.440 --> 0:21:43.159 prevent it is we use a feed usually we call 0:21:43.200 --> 0:21:46.480 it therapeutic feed, or it is like a medicine, but 0:21:46.600 --> 0:21:51.080 in form of food. It has the right balance of 0:21:51.119 --> 0:21:55.320 these nutrients and we give it cautiously slowly until the 0:21:55.400 --> 0:22:00.840 body is learning or beginning to learn to use these nutrients. 0:22:00.920 --> 0:22:04.119 Then always tip up the nutrient of value, especially the 0:22:04.240 --> 0:22:07.760 protein and the energy, so that now this baby or 0:22:07.760 --> 0:22:11.119 this toad begins to gain weight again. So it is 0:22:11.160 --> 0:22:14.960 actually a serious killer if you're not using the rate 0:22:15.119 --> 0:22:19.480 feeds in the beginning before the body function returns to them. 0:22:20.400 --> 0:22:23.760 The special formula she's talking about our f SEM five 0:22:23.880 --> 0:22:27.280 and F one two powders you can mix with water, 0:22:27.560 --> 0:22:31.720 developed in the nineties as an emergency treatment for child malnutrition. 0:22:32.800 --> 0:22:36.440 Refeeding syndrome is something that critics like Jackie said Renee 0:22:36.560 --> 0:22:39.880 was clueless about. But if you feed a child too 0:22:39.960 --> 0:22:43.280 much or the wrong type of substance too early, it 0:22:43.359 --> 0:22:47.240 can kill them. Even though Renee had access to these 0:22:47.240 --> 0:22:51.159 feeding formulas, which are normally distributed by units f or 0:22:51.200 --> 0:22:54.119 the Ministry of Health. If a child is in danger 0:22:54.200 --> 0:22:57.399 of refeeding syndrome, they should be around specialists who can 0:22:57.440 --> 0:23:01.360 recognize it. In that case, I thought maybe Renee had 0:23:01.400 --> 0:23:04.560 failed to refer to Lally to a hospital when he 0:23:04.600 --> 0:23:07.160 should have been, which would have been a clear sign 0:23:07.200 --> 0:23:10.919 of negligence. But in the court case, Renee says she 0:23:11.119 --> 0:23:15.120 left the country the day to Lally arrived at the facility, 0:23:15.160 --> 0:23:19.240 and she submitted her passport pages as proof, which means 0:23:19.280 --> 0:23:22.280 in theory, she wasn't there to make the hour. By 0:23:22.320 --> 0:23:27.280 our calls about to Lally, that decision would have fallen 0:23:27.280 --> 0:23:31.960 on the most senior person there. Mudasi causa as first 0:23:31.960 --> 0:23:37.600 professionalism msconsin she was employing professionals, qualified people. That's what 0:23:38.040 --> 0:23:41.239 I knew. Oh, I know she was employing professionally. They 0:23:41.280 --> 0:23:45.680 didn't have quacks there, okay. Mudosie is a clinical officer 0:23:45.800 --> 0:23:48.920 who works at the now Lifenia Children's Hospital in Ginger. 0:23:49.440 --> 0:23:53.480 They're kind of in between nurses and doctors. They play 0:23:53.560 --> 0:23:57.280 a big role in filling the healthcare gaps because they 0:23:57.280 --> 0:24:02.240 can practice medicine, diagnosed cases, performed surgeries, but they don't 0:24:02.320 --> 0:24:06.760 spend as many years studying medicine as doctors. We Darcie 0:24:06.840 --> 0:24:09.399 would come into serving his children a few times a 0:24:09.440 --> 0:24:13.280 week to check on the children, write prescriptions and sometimes 0:24:13.280 --> 0:24:17.160 refer them to the hospital. Actually, when I found him, 0:24:17.240 --> 0:24:20.720 he was working at the hospital. As these are doctors notes. 0:24:20.760 --> 0:24:27.040 Do you recognize these? Yeah, I suppose my handwriting. I 0:24:27.119 --> 0:24:30.360 had him read over the notes on Tolally's case. Then 0:24:30.400 --> 0:24:32.520 I asked him if there was any sign that he 0:24:32.560 --> 0:24:37.360 had requested that Tolally be referred to the children's hospital. 0:24:38.320 --> 0:24:43.000 He didn't. He thought serving his children was managing the case. Fine, 0:24:43.320 --> 0:24:47.000 this one, this one was it was story. But you 0:24:47.040 --> 0:24:50.800 would do, you'd manage. That's why when you look at 0:24:50.800 --> 0:24:54.960 to these records, I was saying, well, there's some improvement. 0:24:56.200 --> 0:25:01.280 The new complaints were not there. Yeah, so cooking and stable. 0:25:03.440 --> 0:25:09.159 Days later, on July sixteen, two thousand thirteen, Totally died 0:25:09.320 --> 0:25:16.000 of severe malnutrition. I asked Dr Patow to read over 0:25:16.080 --> 0:25:20.160 Tollly's medical documents as a second opinion, to see if 0:25:20.160 --> 0:25:25.119 there were any irregularities, any sign of misconduct, anything that 0:25:25.200 --> 0:25:29.760 went wrong reading water, you know, how He examined the patient, 0:25:30.400 --> 0:25:34.600 came up with the tentative diagnosis, and then returned that 0:25:34.760 --> 0:25:37.920 the treatment protocol, I think he must have had some 0:25:38.240 --> 0:25:43.520 you know background, yeah, or for managing this kiss? Is 0:25:43.560 --> 0:25:45.879 there any point so far where this child should have 0:25:45.920 --> 0:25:49.080 been in a hospital? Do you think? I don't know, 0:25:49.119 --> 0:25:52.560 I don't know to commit. But then it's this jealous 0:25:52.600 --> 0:25:55.760 put on oxygen, this child was put on ivy. This 0:25:55.920 --> 0:26:01.760 child was you know, put on antibiotics, the antibiotics and 0:26:01.960 --> 0:26:08.600 was being monitored. So not knowing this situation A then 0:26:09.119 --> 0:26:12.440 I would assume that this is a health facility with 0:26:12.560 --> 0:26:16.480 the trained health focus. What if it's me She has 0:26:16.560 --> 0:26:23.760 all this sophisticated a medical equipment and she is not trained. 0:26:26.359 --> 0:26:30.320 Who who decides to when to take action or not action? 0:26:32.320 --> 0:26:37.159 I was just as baffled as Dr Pato. Initially, I 0:26:37.200 --> 0:26:40.600 thought by tracking down for Lolly's journey, I would find 0:26:40.720 --> 0:26:45.080 the prime example of Renee's medical misconduct, whether she had 0:26:45.119 --> 0:26:48.760 done medicine herself or made decisions that had led to 0:26:48.760 --> 0:26:53.240 to Allalay's death, But to Alway's case, hadn't done that. 0:26:53.840 --> 0:26:58.320 In fact, it showed the opposite that Renee had hired 0:26:58.440 --> 0:27:03.280 qualified Uganda ners in medical professionals at least by two 0:27:03.280 --> 0:27:07.000 thousand thirteen. It showed that they were the ones who 0:27:07.000 --> 0:27:10.679 had treated to Lala and didn't bring him to the 0:27:10.760 --> 0:27:16.320 local hospital. Ultimately, it showed that Tolally had died despite 0:27:16.359 --> 0:27:21.399 their best efforts because severe malnutrition is so hard to 0:27:21.440 --> 0:27:26.880 treat at that stage. That makes Tolal a one about 0:27:27.000 --> 0:27:31.440 least one hundred five children who died at Serving His Children, 0:27:32.119 --> 0:27:35.160 And I keep thinking back to that number. We've talked 0:27:35.200 --> 0:27:40.119 about it throughout this podcast. One hundred five children died. 0:27:41.200 --> 0:27:44.280 I mean, it's shocking every time I hear it. And 0:27:44.320 --> 0:27:47.840 remember those are just the numbers that Serving his Children 0:27:47.880 --> 0:27:51.160 admits to, and they provided them a couple of years ago, 0:27:52.000 --> 0:27:56.320 and given the inaccuracies in their documentation, that number could 0:27:56.320 --> 0:28:00.280 be way higher. We don't have the medical docum mints 0:28:00.359 --> 0:28:03.080 of the other children who died at Serving His Children. 0:28:03.960 --> 0:28:07.359 That said, the number one hundred five still seems like 0:28:07.400 --> 0:28:11.879 a lot to me. Here's the math. Between two thousand 0:28:11.920 --> 0:28:16.639 and ten and two thousand fifteen, one hundred five children 0:28:16.640 --> 0:28:20.240 out of nine hundred forty who were treated in patient 0:28:20.359 --> 0:28:24.560 at Serving His Children died. That's a mortality rate of 0:28:24.640 --> 0:28:29.359 eleven percent. But that's nearly half the mortality rate in 0:28:29.520 --> 0:28:35.439 Uganda's top hospital after learning about how hard it is 0:28:35.480 --> 0:28:40.640 to treat severe child malnutrition. That number doesn't look as 0:28:40.680 --> 0:28:44.360 bad as it did in the beginning. Based on that 0:28:44.440 --> 0:28:47.720 number alone, it could be tempting to say that serving 0:28:47.760 --> 0:28:52.600 his children helped save more children from malnutrition than had died. 0:28:54.720 --> 0:28:59.480 But there's one obvious caveat that we can't forget. Even 0:28:59.520 --> 0:29:03.880 though to Lolly had gotten quality care from quality Ugandan 0:29:03.960 --> 0:29:09.200 medical professionals when he died, serving his children was still 0:29:09.600 --> 0:29:28.800 an unlicensed facility. Wake up, Africa, you're trying to come 0:29:29.560 --> 0:29:36.560 open up your pie gone Helen. Welcome to Africa. Watch 0:29:36.560 --> 0:29:38.800 on the Dr Mombi Show. My name is Dr mombys Iraki. 0:29:38.880 --> 0:29:41.360 How you're doing. How's everything going? I pray you well 0:29:41.520 --> 0:29:45.200 in everything earthing. I just hope everything is going absolutely 0:29:45.200 --> 0:29:47.480 fantastically for you and you're living your best life. Now. 0:29:47.520 --> 0:29:50.200 I've got a story that got me just I even 0:29:50.200 --> 0:29:52.920