AUDIE CORNISH, HOST:
One-hundred-and-five children died at an unlicensed treatment center for malnourished kids in Uganda. It happened between 2010 and 2015. Now the American missionary who founded and ran the center is being sued over those deaths. NPR's Nurith Aizenman has the story of Renee Bach.
NURITH AIZENMAN, BYLINE: When Renee Bach was 18, she left her home in Virginia for the Ugandan city of Jinja to volunteer at a missionary-run orphanage. A year later, Bach made a life-changing decision. She would move to Jinja full-time, start her own charity. She says it felt like a calling from God.
RENEE BACH: It's kind of hard to even describe in words. Like, there was something that I was supposed to do, and I wasn't sure what that was.
AIZENMAN: But a few months in, she thought she'd hit on it after coming across several children with severe acute malnutrition - impossibly thin arms, ribs poking out, sunken eyes. They were in a hospital, but Bach says the nutrition coordinator there told her that medically, these kids have been stabilized. They just needed to be fed back to health.
Soon, Bach was raising funds to set up a center that would offer malnourished children and their moms a free place to stay while they recuperated, complete with the special foods and medicines they'd need and lessons for the moms on nutrition and the Bible.
(SOUNDBITE OF MUSIC)
AIZENMAN: That's a promo video. Bach set up shop in a large house...
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON #1: And you can help a child.
AIZENMAN: ...Came up with a name.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON #1: Help now at servinghischildren.org.
AIZENMAN: Jackie Kramlich was one of many young Americans drawn to volunteer at Serving His Children.
JACKIE KRAMLICH: I went in with a lot of admiration.
AIZENMAN: It was the summer of 2011. Bach had hired three Ugandan nurses. She'd stocked up on oxygen tanks, IV catheters, monitoring equipment. More than a dozen kids at a time were being cared for. But Kramlich, who'd just become a registered nurse, was taken aback to find that a lot of these kids weren't just severely malnourished. They had complicated illnesses.
KRAMLICH: Pneumonia, intestinal parasites, tuberculosis - many were in stage 4 HIV.
AIZENMAN: Almost every week, a child would die. Also, it seemed to Jackie Kramlich that Bach, now 22 years old, was handling a lot of their medical care herself. It all came to a head over a baby girl named Patricia. Bach kept a blog about her experiences, including the day Patricia's parents brought her to the center wrapped up in a blanket. This blog has come to haunt Bach. She's since taken it down, which is why NPR is having someone else read what Bach wrote.
UNIDENTIFIED PERSON #2: Under the blanket lay a small but very, very swollen, pale baby girl. Her breaths were frighteningly slow. I hooked the baby up to oxygen and got to work - took her temperature, started an IV, checked her blood sugar, tested for malaria and looked at her HB count. I was attempting to diagnose the many problems that could potentially be at hand. Got it - Malaria, positive. HB, 3.2 - a big problem, most likely fatal. She needed a blood transfusion and fast.
AIZENMAN: But after a blood transfusion was started, Bach wrote, Patricia seemed to take a turn.
UNIDENTIFIED PERSON #2: Her neck and face started swelling a lot. Her breathing went from bad to worse. Her throat was beginning to close.
AIZENMAN: That's about the moment Bach called Kramlich on the phone to ask if Kramlich could swing by the center.
KRAMLICH: So I walk in, and there's this child - swollen, wheezing, blood's running. And she goes, you know, I think she might be having a reaction. But I don't know because Google says that if they're having a reaction that they'll have a rash, and I don't see a rash.
AIZENMAN: Bach says she would sometimes run the tubing into a child for a blood transfusion, insert IV's, and sometimes...
BACH: Without a medical professional standing right next to me, yes.
AIZENMAN: But, she says, always...
BACH: Under the request and the direction of a medical professional.
AIZENMAN: As for her blog posts...
BACH: I was just writing to tell a story to my friends and family. And the mistake that I made was I very much wrote in first-person, which, looking back, sounded very prideful as if I was, you know, doing all of those things myself. But the reality was is that there was medical professionals present doing those things.
AIZENMAN: In the case of Patricia, Bach remembers a staff nurse doing the blood transfusion. And when Patricia seemed to have a reaction, she says, this nurse phoned a private doctor who recommended rushing the girl to a hospital. Bach then did just that, and Patricia lived. But for Kramlich, this was too close a call.
KRAMLICH: I was just beside myself, furious.
AIZENMAN: Soon after, she quit and sent a letter of concern to the charity's board of directors back in the U.S. because under international guidelines and Ugandan law, if a severely malnourished child has the kind of extra complications Bach's center was taking on, this child must be treated in, ideally, a hospital but, at the very least, a high-level health facility that's been specially approved by Ugandan authorities. At this point, Bach's nutrition center didn't have any kind of health license or even a doctor on staff.
Saul Guerrero specializes in childhood severe acute malnutrition at UNICEF. He says malnourished kids with these extra complications are so fragile, if you don't know what you're doing, it's actually safer to do nothing.
SAUL GUERRERO: Their metabolism is not working. Their immune system is not working. So once you initiate any kind of treatment, that will have, very often, knock-on effect.
AIZENMAN: Just putting them on an IV can trigger a heart attack.
GUERRERO: The chances that child will die are very, very high.
AIZENMAN: In 2011, 20% of the children Bach says she took in died. The next year, the death rate was 18%. By 2013, Bach had hired two doctors, and the death rate was down to 10% But Guerrero from UNICEF says even that's high by international standards.
Bach says she took in these complicated cases...
BACH: Not because we felt like it was fine...
AIZENMAN: ...But because there didn't seem to be a better place for them.
BACH: I can tell you time and time again taking kids to hospital after hospital and them being, like, sorry, we don't really deal with malnutrition. Like, the best bet is to take them back to your nutrition center.
AIZENMAN: Dr. Hanifa Bachou is a Ugandan expert on malnutrition. When I reach her on her cell phone, she says she doesn't accept Bach's explanation.
HANIFA BACHOU: I don't accept that.
AIZENMAN: Bachou is working with the government to set up inpatient care for severely malnourished children across the country. And she says by that point, Jinja's regional referral hospital had a fully-fledged malnutrition unit to care for complicated cases. But even if there was a need for more inpatient facilities, Bach's critics say it was not appropriate for her to try to provide it.
LAWRENCE GOSTIN: Just think of the arrogance.
AIZENMAN: Lawrence Gostin heads a center for global health law at Georgetown University. He sees Bach's actions as a particularly extreme result of an attitude a lot of Americans bring to poor nations, from college kids to credentialed doctors.
GOSTIN: The American cultural narrative is that these countries are basket cases.
AIZENMAN: So, he says, Americans assume whatever their own qualifications, they're sure to be of help.
Ultimately, in February of 2015, Jackie Kramlich filed a report with Ugandan police. A month later, Jinja's district health officer shut Bach's center down. By then, Bach had gotten the place licensed as a health clinic. But in his report, the officer noted that the license had expired, and he'd found at the center, quote, "very sick children who need referral to higher centers."
PRIMAH KWAGALA: It is what shocked most of us.
AIZENMAN: Primah Kwagala is a Ugandan civil rights attorney.
KWAGALA: We couldn't imagine a human being without skill taking in people that were almost on their death beds.
AIZENMAN: A few years later, Bach opened a new center in partnership with a government health center and with Bach no longer involved in medical care. But early this year, Kwagala, the Ugandan attorney, filed a civil lawsuit on behalf of the mothers of two of the children who died. She says she wants Bach held to account. These families, Kwagala says, deserve justice.
Nurith Aizenman, NPR News.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.