American With No Medical Training Ran Center For Malnourished Ugandan Kids. 105 Died
SPECIAL REPORT
August 9, 20195:44 PM ET
NURITH AIZENMAN
MALAKA GHARIB
Renee Bach, 30, has left Uganda and is now back where she grew up in Bedford County, Va.
Julia Rendleman for NPR
Ten years ago, Renee Bach left her home in Virginia to set up a charity to help children in Uganda. One of her first moves was to start a blog chronicling her experiences.
Among the most momentous: On a Sunday morning in October 2011, a couple from a village some distance away showed up at Bach's center carrying a small bundle.
"When I pulled the covering back my eyes widened," Bach wrote in the blog. "For under the blanket lay a small, but very, very swollen, pale baby girl. Her breaths were frighteningly slow. ... The baby's name is Patricia. She is 9 months old."
Bach went on to write that Patricia had fallen sick three weeks earlier. But her parents had been unable to find anyone closer to home who could cure her.
Then, wrote Bach, "One of their relatives told them about a 'hospital' ... with a 'White Doctor.'"
Except Bach was not a doctor. She was a 20-year-old high school graduate with no medical training. And not only was her center not a hospital ? at the time it didn't employ a single doctor.
Yet from 2010 through 2015, Bach says, she took in 940 severely malnourished children. And 105 of them died.
Now Bach is being sued in Ugandan civil court.
"Something that I was supposed to do"
How could a young American with no medical training even contemplate caring for critically ill children in a foreign country? To understand, it helps to know that the place where Bach set up her operation ? the city of Jinja ? had already become a hub of American volunteerism by the time she arrived.
A sprawling city of tens of thousands of people on the shores of Lake Victoria, Jinja is surrounded by rural villages of considerable poverty. U.S. missionaries had set up a host of charities there. And soon American teens raised in mostly evangelical churches were streaming in to volunteer at them.
Bach was one of these teens. On her first trip, in 2007, she worked at a missionary-run orphanage ? staying on for nine months.
Once back home in Virginia, Bach ? now 19 years old ? came to a life-changing conclusion: She should move to Jinja full time and set up her own charity.
In an interview with NPR, Bach says it felt like a calling from God.
"It was a very, very profound feeling and experience. It's kind of hard to even describe in words," she says. "Like there was something that I was supposed to do."
At first Bach wasn't sure what that was, beyond a sense that it should address some need that wasn't already being met by existing charities.
Funded by money raised through church circles back home, Bach rented a large house in one of Jinja's poorer districts, called Masese, and began testing out options, including starting a program to serve a free hot meal to neighborhood children. Twice a week about 1,000 of them would line up by Bach's house to receive a bowl of food. Bach named her charity "Serving His Children."
According to Bach, word of her feeding program spread through Jinja. In the fall of 2009, she says, she got a call from a staffer at the local children's hospital asking if she could help out with several severely malnourished children.
Bach says the staffer told her that from a medical standpoint, these kids had been stabilized. They just needed to be fed back to health. Could Bach take them in?
Bach says seeing a child in this state ? impossibly thin arms, ribs poking out, sunken eyes ? "was almost an out-of-body experience. And a sense of, 'Oh my goodness, this isn't right. This needs to stop.' "
She says she agreed to help the children. And before long she came to feel that this was God's plan for her: turn the house into a center where malnourished children and their mothers could live while the youngsters recuperated ? complete with free rations of the special foods they would need, the medicines doctors had prescribed and lessons for the mothers on nutrition ... and the Bible.
In early 2010 Bach posted a blog entry titled "Here we go!" Her nutrition center was up and running.
A disillusioned volunteer
Jackie Kramlich was one of many American volunteers drawn to the center.
"I went in with a lot of admiration," Kramlich recalls.
It was the summer of 2011.
By this point Bach had hired three Ugandan nurses to help out during the day and stocked a room she dubbed "the clinic" with medical gear such as oxygen tanks, IV catheters and monitoring equipment.
The center was caring for as many as a dozen children at a time.
But Kramlich ? who had just been certified as a registered nurse in North Dakota ? was taken aback to realize just how sick these children were. They weren't just malnourished. They had complicated illnesses.
"Pneumonia, intestinal parasites, tuberculosis, many were in stage 4 HIV," Kramlich says.
Almost every week a child would die.
Also, it seemed to Kramlich that Bach, now 22 years old, was handling a lot of the medical care herself.
A court filing by Ugandan attorney Primah Kwagala includes excerpts from Renee Bach's blog as well as from a blog posted by a supporter of her charity who had visited and taken photos. This page above includes a photograph of Bach inserting an IV catheter into the vein of a severely malnourished child.
Jan. 21, 2019, court filing by complainants suing Renee Bach in the High Court of Uganda in Jinja
Which brings us back to that baby Bach wrote about in her blog: 9-month-old Patricia.
In her blog, Bach wrote that she immediately ushered Patricia and her parents into "the clinic."
"I hooked the baby up to oxygen and got to work," she wrote. "Took her temperature, started an IV, checked her blood sugar, tested for malaria, and looked at her HB count." (That's a measure of hemoglobin in the blood.)
"I was attempting to diagnose the many problems that could potentially be at hand. Got it: Malaria: positive. H.B. 3.2. ... a big problem ... most likely fatal. ... She needed a blood transfusion. And fast."
Next, Bach wrote, "we" ? it's not specified who is meant by "we" ? started a blood transfusion for Patricia.
But about 30 minutes later, Patricia seemed to take a turn.
"Her neck and face started swelling. A lot," she wrote. "[Her] breathing went from bad to worse. Her throat was beginning to close."
That's about the moment Bach called Kramlich on the phone to ask if Kramlich could swing by the center.
"So I walk in," Kramlich recalls, "and there's this child, swollen, wheezing." Kramlich could see the blood still being transfused into Patricia's vein. "And [Bach] goes, 'You know, I think she might be having a reaction. But I don't know. Because, you know, Google says that if they're having a reaction, they'll have a rash. And I don't see a rash."
Kramlich says that as was often the case, it was clear to her that Bach was the one making the medical decisions. And in this instance, she says, none of the staff nurses were even at the center.
"It's just horrifying," says Kramlich. In Uganda, just as in the U.S., only a medical professional is permitted to perform invasive procedures like a blood transfusion. She says her thought at that moment was, "This isn't a game. You have no business running blood ? at all."
Bach says it's true she would sometimes perform medical procedures such as running the tubing into a child for a blood transfusion or inserting an IV.
And sometimes, Bach says, "without a medical professional standing right next to me, yes. But it was always under the request and direction of a medical professional."
As for her blog posts, Bach tells NPR, "I was just writing to tell a story to my friends and family.
"And a mistake that I made that I wish I wouldn't have is, I very much wrote in first person ? which looking back sounded very prideful as if I wanted to allude to the fact that I was, you know, doing all of those things myself. But the reality was that there were medical professionals present doing those things."
In the case of baby Patricia, Bach's memory is that one of the staff nurses at her nutrition center did the blood transfusion. And she says when Patricia seemed to have a reaction, this nurse called up a private doctor, who ? over the phone ? recommended that Patricia be rushed to a hospital.
Bach and Kramlich do agree that ultimately, Bach drove Patricia to a hospital. And Patricia lived.
But for Kramlich this was too close a call.
"I was just beside myself. I mean furious."
Soon after, Kramlich quit ? four months into what she had originally intended to be a yearlong volunteering stint. Kramlich also sent a letter of concern to the charity's board of directors back in the U.S.
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