A baby without a mother

How do you feed a baby with no maman?  To most of us, the answer to this question is not complicated: formula milk.  When I ask this question in Central African Republic(CAR);  peoples expressions become serious and dark; "impossible". I started asking this question, after I met “Souvenir“; a chubby, happy baby of 4 months.  His papa brought him to the hospital to get help with feeding.  Souvenir's mother had died shortly after childbirth. Normally, in these situations, women in the family or community offer help by breastfeeding the motherless baby.  But in this case there was no one to help.  No money, no family, no support. Formula milk: not available at the market. Baby bottles: impossible to find. Access to clean water: limited. Understanding the importance of drinking water hygiene: limited. Culturally: not accepted to feed babies by bottles. Knowing that all the strikes are against this situation, I was determined to help this baby. I dug out the last baby bottle from our medical depot.  I washed and sterilized the bottle. I hospitalized the baby to teach the papa about feeding, formula milk, water hygiene and caring for an infant.  Everyday I spent time with the dad, teaching how to take care of Souvenir.  Simple reminders.  Wash the bottle after each feeding.  Keep the bottle clean. Frequent feedings. Fresh milk.  Cuddle. I found a plastic bucket and helped him bathe Souvenir.  All the women in the hospital watched,  laughing.  I don't know if they thought it was funny that I was washing a baby or that the papa was washing the baby? Or maybe it was the combination! After a week, Souvenir was eating well, the papa seemed to understand the basics of hygiene and caring for the infant.  The papa asked to be discharged from hospital, as he had to go work in the fields to prepare for the coming planting season.  We agreed that he would come back to the hospital once a week for follow up and new formula milk prescriptions. The first two weeks as outpatient went smoothly.  Souvenir was gaining weight.  The women in the hospital always welcomed the papa and took care of Souvenir for a couple hours while the father visited and collected the milk.  He had found a community of support at the hospital. The third Friday, Souvenir had diarrhea.  He  looked severely dehydrated and tired.  We hospitalized the duo again.  The bottle did not look clean and the father seemed disinterested and unengaged.  We started from square one with the teaching, started treatment for baby and continued supporting the two. One day I walked into the room, Souvenir was lying on the bed alone, screaming and covered in diarrhea, head to toe.  The papa was nowhere to be found.  I was furious.  How could he just leave his sick baby unattended?  I collected a bucket, water, soap, and new piece of fabric.  I bathed Souvenir again.  I mixed  milk.  Washed the bottle.  Fed him and cuddled him until he fell asleep in my arms.  I found myself in a situation where I was now carrying a sleeping baby around, while trying to juggle the rest of my work. Luckily, Souvenir was happy to be held and slept in my arms while I continued on with my work. Eventually the papa came back and I had to explain to him that it was important not to leave the baby unattended. Everyday I continued to show the papa how to clean the bottle, to feed regularly, to give re-hydration fluids and to bathe Souvenir.  Despite all of our efforts Souvenir was not getting better; his diarrhea was getting worse, he continued to loose weight, he was spiking fevers throughout the day and night.  We started an intravenous line to help rehydrate him.  With the nutrition team we made a strict feeding schedule.  I urged the staff to be present during each feeding time, to wake the baby for feeding during the night and to support the papa.  It was imperative that the papa understood the gravity of his babies illness and to take some responsibility. I took the baby bottle home and sterilized several times a day.  The whole medical team got involved in feeding times and encouraged the papa. Souvenir was constantly hungry.  For every feed, the milk had to get prepared fresh; there is no fridge to preserve the freshness.  The team worked together and worked hard, everything was time consuming and challenging. Hygiene is one of the biggest obstacles here.  We are living and working in a world with no proper latrines or human waste disposal facilities, no diapers for babies, no boundaries for livestock, no shoes, untreated drinking water, no running water, crowded living arrangements, dirt floors, mud huts... the proliferation of bacteria is endless.  While I was spending time sterilizing baby bottles, preparing formula milk, it became abundantly clear to me the immense importance of having natural breast milk for babies; not only for the nutritional benefits, but for the immune system boost.  Without this.... feeding a baby without a mother is perhaps  "impossible" after all. Despite all of our efforts; Souvenir slipped away one night.  I was heart broken and at the same time furious.  How does this happen?  We put so much effort into supporting and teaching the papa to take responsibility for his baby.  But we failed.  We failed Souvenir.  His chance at life had too many strikes against him here.  Unfortunately Souvenir story is not an uncommon one; that is why we are here to support a community that struggles to provide even the most basic things in life; clean food and water.  The battle goes on.