She was an aged woman, in the dusk of her life. She lived all her life in a small village, away from the bustle and hustle of the major city, though the city was only half an hour away from the village center. She took pride in her livelihood, having raised her children with almost no income, and grown her own food and tendered to the livestock she had.
Being away from the city or village center also meant being away from health care. She first noticed a blister on her right hand, which she cleaned whenever she remembered. She went on with her daily chores, and the issues of life that consumed her. But the area of blistering did not go away. In fact, over weeks, it grew ferociously and her hand was becoming non-functional. There were fields to be tended to, children to be fed, clothes to be washed, goats to be milked; and on went the list of things to be done.
Until one day she realized that she was in grave danger of losing the hand that had fed her family. She made the journey to the small village clinic. The nurse took one look at the hand, and told her that it was too far gone- the hand would be amputated. Her right hand.
But being in the city center did not mean that adequate medical care was available to you, as a young mother found out at the country’s premier medical center. Her child had been born without event, and he had been growing well until he was a few months old. Suddenly, he seemed not to be able to feed well, and he would turn a dark shade whenever he exerted himself. She brought him to the hospital, only to be told her beloved son had a heart malformation that would need open heart surgery, the kind that could not be performed in the country. He would have to get to a neighboring country with that capability so she applied for a passport for him to travel. As she walked into the pediatric ward from the immigration department, she noted that the bed her son had laid in was empty; and instantly she knew. He was gone. The weight of her loss hit her as she slumped to the floor. Children were not supposed to die.
But she was not the only mother that was covered in sorrow. There was wailing from a mother who had lost her child to Cryptococcal meningitis and full blown AIDS. Yet another child lost their life to tuberculosis. It seemed that death resided here, and life did not peek its face in that ward often enough.
While preserving life is a task essential to the medical staff’s purpose. Success at this task however, seemed elusive, for various reasons. To begin with, the facility they worked in lacked so much. There was very little for monitoring patients. The patient in heart or respiratory failure could deteriorate over hours, and seem to die suddenly because predicting catastrophic events was challenging. There are no isolation rooms. Patients with tuberculosis and cancer were on the same ward, and infectious diseases roamed rampant, passed on freely from child to child. Equipment was lacking (no positive pressure ventilation bags at every bedside) and very few oxygen sources in the ward.
As a trainee in Pediatric Critical Care, caring for the sick and dying child became my area of expertise. Children here in America are not allowed to die without a fight for their lives- no matter what the disease process or their prognosis. The lives of children are preserved with the help of accessible monitoring, machinery, medications, resources and trained personnel. Even the most dire of circumstances is addressed with a flurry of medical attempts in the face of futility. There is no life too insignificant. It is a system that is constantly seeking new and innovative ways to predict changes in the medical status of patients, and improve ways to manage disease. There is a wealth of medical therapy, progressive research and evidence-based medicine by which we base our medical practice on. Our patients get the privilege of para-medical services such as Child Life Specialists, Physiotherapists, Nutritionists, and Social Workers… And so on the list goes.
When compared to the affluence of Western Medicine, the paucity of such services in the Developing World is alarming, even discouraging. Many commodities that we take fore granted as standard of care in the Western World, are yet to be instated in the Developing World. Education is perhaps the first step in moving towards improving outcomes for acutely ill children, addressing cultural biases that diminish the the value of children, and then on to assessment, treatment and management of the sick child. Basic and Pediatric Advanced Life Support strategies are vital to optimal survival in the management of pediatric conditions, and with increased awareness of these strategies, great strides can be made towards improving pediatric health care in the Developing World. Lastly, by incorporating adaptable technologies to sustain the advancement of medical care. 
However the myriad of complex and exorbitant machinery available to the West are not what is necessary, but sturdy and indispensable accessories to sound professional medical judgment that aid in accurate diagnosis and patient treatment. There is no substitute for access to medical care; patients need to be able to get to where they can receive advanced care for any effective improvement in outcomes. We have much to learn from pediatric medical practice in the developing world, and vice versa. Only the sharing of knowledge and a partnership of minds and technology between our worlds can do wonders to improve the lives of children.
Unami Mulale, M.D. is a Pediatric Intensivist in the Greater New York Area who is passionate about seeing the lives of children changed for the better both through improved medical care and social justice.
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