This is a 2-week old baby girl who was brought into my exam room during OPD (clinic) today. My first impression was the same as yours might be, that this baby is severely malnourished. It became quickly obvious however that something more serious was wrong, as the baby was breathing very fast and was very lethargic. I quickly send her to the pediatrics ward where she would be able to receive antibiotics, IV fluids, and nutrition assistance, however in just a few hours one of the pediatric residents who is volunteering here this month let me know the baby had died. The mom lives in a village 20 miles away, so it was mostly likely quite a feat for her to reach the hospital today. Most people who live that far out walk or ride bicycles everywhere, and the only way they might get a ride on a vehicle is if someone with a pickup is kind enough to stop and let them ride in the back. It's not uncommon for them to walk six hours to reach the hospital to be seen, something I didn't believe until I took a ride out in the back of a truck myself three years ago, and saw the people walking or riding three to a bicycle. Incidentally, our driver was very compassionate, stopping to give rides to everyone he could on the way back to the village. By the time our small Toyota pickup reach home it had approx. seven in the crew cab and no less then 16 people (one being me) and a baby in the bed. But, who would opt out of that when the alternative is walking 20 miles on foot?