Recently, a rocket company went public on the Nasdaq, and by the time the bell closed, its founder had become the first person in history worth a trillion dollars. I read about it on a borrowed phone outside the pediatric ward at Al Sabah Children’s Hospital in Juba, South Sudan, waiting for the otoscope to free up.
I’m not writing this out of anger. I want to say that clearly. I just want to describe what was true on the same day, in the same world, on two sides of a number that doesn’t really mean anything to most people in either place.
By the end of my call that day I had seen just over two hundred patients. I started keeping count a while back, not to impress anyone, but because I think it’s useful for someone outside this country to know what an ordinary shift here actually looks like.
One of those patients was a boy with acute lymphoblastic leukemia. He needed normal saline for his line. We didn’t have any in stock that day, not unusual, and his family had nothing left to buy it with. I bought it myself. I do this more often than I’d like to admit. I am an intern doctor here, unsalaried, and I still find myself at the pharmacy counter paying for things that should never have been my responsibility to pay for, because the alternative is watching a child go without.
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That same boy will likely need chemotherapy at some point soon. South Sudan doesn’t have it. We don’t have radiotherapy either. If his family can somehow manage the logistics, and the cost, because nothing about crossing a border for treatment is free, we refer him to Uganda. Most families can’t. So “referral” often just means a piece of paper that names a hospital the child will never see.
I think about this boy and I think about my own situation too, because they’re connected in a way that’s hard to explain to people who haven’t lived inside a health system like this one. I want to specialize in pediatric oncology. That’s the plan, has been for a while. But South Sudan has no residency programs in oncology, really, very few residency programs in anything. To train as a specialist, I would have to leave the country, and the places that offer that training cost money I don’t have and have no way of getting. So the same gap that keeps saline out of a sick child’s IV line is also the gap that keeps me, the person who wants to treat children like him, from ever being properly trained to do it.
I’m not drawing a straight line from the trillion dollars to any of this. I know it’s more complicated than that. Capital moves in ways that have very little to do with where it’s needed most, and no single person’s fortune is the reason a hospital in Juba runs out of saline. But I keep thinking about the distance between those two numbers. A trillion dollars is a headline that traveled around the world in hours, with charts and historical comparisons.
A boy needing a bag of saline that his family doesn’t have is not a headline. It’s not even a sentence, most days. It’s just something that happens, quietly, in a building that most of the world will never think about.
Maybe that’s really the only thing I’m trying to do here, put those two facts in the same place, so that at least for the length of this page, they exist next to each other. A trillion on one side. Two hundred patients, one bag of saline, and a boy who doesn’t know yet that the medicine he needs doesn’t exist in his own country, on the other.
Tomorrow the count starts again at zero. The ward will still be there. So will I.
Buga Charles George Kenyi is a physician in South Sudan.
