Hassan's story

I work with an Afghan man who is very smart, in the "street-smart" sense of the word. He married a girl who was very young, and like a good Afghan wife, she soon became pregnant. She was 17 years old when she gave birth. The baby died of pneumonia at 6 months. I came into their lives about a year after their baby died, and met his wife for the first time when she was about 2 months pregnant with their second child. At this point, I guess that I should go back and explain how Afghan marriages work.
Most Afghans marry their cousin. Usually it is the groom's mother who negotiates the deal. Yes, it is a business transaction. The groom pays an amount according to what the woman can do. The standards are a bit different there than the west. For example, being able to read and write does not necessarily make you valuable. However, if you can cook and clean and sew and iron without complaining, you may fetch a very high price. When the wedding is over, the bride moves in with her husband and his parents, his brothers, their wives and any other unmarried siblings. There may even be grandparents if they are still alive. The poor girl, often a young teenager (though I have a friend that got married when she was 10) moves into a house with some very hostile in-laws. This was the case with Hassan's wife.
When her baby died, her mother-in-law blamed her, constantly berating her for the death of her baby. By the time the second one arrived, the poor girl was a nervous wreck. They came to me weekly with all sorts of imagined problems that the baby had. They were so afraid that something would go wrong and this one would die as well. No amount of assurance would calm their fears. They started to calm down a bit after the baby hit the 6 month mark, and survived, but they continued to worry.
One day, Hassan (his name is changed for his protection) came to me and said that the baby was very weak, and cried all of the time, and was very small. So, I went to see her. She was indeed very small and very weak. The temperature was over 100 F outside, but when I saw her, she was wrapped up in several layers of thick cloth. Her breathing was shallow and labored. I felt her little forehead and she was burning up. So I took off her clothes and cooled her down, then I asked to watch her eat. If you are in the medical field, you know how important it is to get an adequate history from a patient. I have found that very difficult with my Afghan patients. Sometimes you have to figure out what they mean. For example, when they say that someone is yellow, they don't mean jaundiced, they mean pale. Also, often they will say something different every time you ask, so I have to sort through, and sort-of take an average. Anyway, it took a while to sort through the complaints. Apparently Hassan's wife had stopped breastfeeding, because her mother-in-law told her her milk was bad and that is why her first baby died. Sigh...It wouldn't matter what I said, all those years of school and experience in maternity nursing mean nothing against the words of a mother-in-law.
They said that the baby ate formula well, but I knew from experience that I should observe and see what "eating well" meant to them. So they brought out a 4 ounce bottle and filled it with boiled water (water in Afghanistan is full of bacteria and parasites, so I was very proud of them for boiling it). They then put 1 scoop of powder in it. The baby sucked it down in and instant, then started crying. They said, see her stomach hurts. So, I picked up the can of formula and read the instructions. It was one scoop per ounce. She was getting mostly water. I explained to them that they needed to put 4 scoops into the bottle, but no matter what I did, they just wouldn't believe me. Also, in the meantime, they were convinced that the baby was going to die of pneumonia, because i had uncovered her, so they kept wrapping all of those hot layers back up around her. I realized at that point that I needed help. The next day, I asked my office mate (an Afghan man who translates my lessons into Dari) to help me explain the concept of concentration. Just because the baby was getting 4 ounces of liquid did not mean that she was getting 4 ounces of milk, and that she was crying, because she was hungry. I talked with him until I was blue in the face, and just couldn't get through. Suddenly, I realized that I was yelling at the poor man. I don't lose my temper often, but I just couldn't help myself, and the more I tried, the worse it got. So, I finally said (still yelling), "Hassan, I am not angry at you, and I am not yelling at you. I am just so angry with the pain and unfairness that made you first baby die, and is making you not able to see that you need to feed this baby better. I love your family, and I know that if you don't do what I say, she will die, and I don't want that to happen to you and your wife again!" I think that made him think. Then he told me that he couldn't afford to put 4 scoops into the bottle, because formula was so expensive. So, a generous man at our office anonymously donated a bunch of formula.
To address the issue of heat, I asked another American nurse to help me out. The Afghans respect "white hair", so since she is over 70, I though she could have a bit of an affect on them, and it worked. She was able to convince them that making the baby that hot all of the time was dehydrating her. The baby is now about a year and a half now. Though not completely out of danger, her chances of survival increase every day that she lives.