THE NEWYORKER, APRIL 13, 2020 55A stool sample, sent to a private hos-
pital for analysis, indicated infectious
gastroenteritis.
After Twalali was admitted, a night
nurse examined him, and made a note
to discuss antibiotic treatment with a
doctor. The nurse inserted a plastic can-
nula into Twalali’s vein to infuse anti-
malarial medication, and a nasogastric
tube to supply nutrients and fluid. He
was placed on oxygen, and his vital signs
were monitored hourly. In the morning,
he was examined by a doctor, who
confirmed the nurse’s decisions and coun-
tersigned the medication doses; in the
six days Twalali stayed at S.H.C., that
doctor visited him three times.
Following initial treatment, Twalali’s
malaria cleared, and he was less lethar-
gic, happier. But his diarrhea got worse,
and his temperature spiked. On July 15th,
he started refusing food, and by the early
hours of the next morning he was
semi-comatose, struggling to breathe.
On doctor’s orders, nurses attempted to
resuscitate him with intravenous fluids.
He died at eleven o’clock.
After reviewing the records, the Har-
vard instructor told me, “My over-all con-
clusion is that there is no question this
child was regularly attended and in gen-
eral closely monitored.” She added, how-
ever, that “the child likely needed higher-
level and more frequent review by a
physician or child-health expert, and there
were a few deviations from standard man-
agement of malnutrition.” Her greatest
concern was that Twalali had received
“far more I.V. fluid far quicker than is
typical.” The World Health Organiza-
tion advises a conservative regime for
malnourished children, out of fear that
excessive fluid can lead to heart failure.
But, the Kenyan researcher noted,
“this has generally been expert opinion
with hardly any reliable research evi-
dence.” The W.H.O.’s restrictive ap-
proach has been a subject of debate for
decades, with some recent studies show-
ing that larger volumes of fluid pro-
duced better outcomes. So the doctor
treating Twalali had a quandary: too lit-
tle fluid and the boy could die of dehy-
dration; too much and his system could
be overwhelmed. The researcher said
that it was a judgment call, difficult to
evaluate without seeing the patient in
the moment. “The discretion of the treat-
ing clinicians at the bedside is the sin-
gle most important factor in matters of
life and death,” he told me.
Twalali’s grandmother remembers see-
ing Bach personally treat the baby. But,
when Twalali was admitted, Bach was on
her way to the United States, and she re-
mained there for the duration of his stay;
her passport is exit-stamped July 10, 2013.
Kwagala told me that this meant noth-
ing to her: “You could have that stamp
created on the street. ”
The case of Kakai’s son Elijah is no
more conclusive. The court filings con-
tain no medical records for him, because
according to S.H.C. he was never admit-
ted. Kakai says in her affidavit that in
July, 2018, Elijah received a diagnosis of
tuberculosis at a hospital. An S.H.C.
driver brought her and her son to a health
center called Kigandalo, where S.H.C.
was running a malnutrition program in
partnership with the Ugandan govern-
ment. But the nurses there wouldn’t admit
him, because they didn’t have an isolated
ward for T.B. patients. They did offer
some fortified milk, which Kakai ac-
cepted, because her son was “small-bod-
ied,” and they gave her money for trans-
portation home. Elijah got sicker, though,
and the next day Kakai took him to a
government hospital in her own district.
He died there three days later. “I strongly
believe,” Kakai attests, that S.H.C.’s em-
ployees “did something to my child that
led to his death.” It is possible that Eli-
jah received tainted milk at S.H.C., which
killed him several days after he ingested
it. But it is more likely that he died as a
result of his tuberculosis and malnutrition.O
nly one American medical practi-
tioner provided an affidavit: Jac-
queline Kramlich, a nurse who volun-
teered at S.H.C. in 2011. As the suit
points out, S.H.C. was not licensed as
a health facility during her time there;
it did not issue official death certificates,
just summaries of treatment and of the
circumstances of death. Bach and her
family maintain that these were bureau-
cratic oversights. Kramlich argues that
the clinic’s management showed a lack
of supervision and professionalism. Bach
“did not follow orders of any medical
professional, but, rather, she gave orders
to her nursing staff,” she writes.
Kramlich arrived at Serving His Chil-
dren a few months after finishing a B.A.
in nursing. “I went in holding Renée inreally high esteem, with the impression
that she’d gotten in over her head, and
there was no help to be found, because
it’s Africa—which is obviously not true,”
she told me. “What raised my flags is
she didn’t really seem to want my help
once I was there. If I asked basic nurs-
ing questions—‘Are there any contrain-
dications for this medicine?’—she’d be,
like, ‘Don’t worry.’”
Kramlich left S.H.C. after less than
four months. In her resignation letter,
she told the board, “Although Renee is
very intelligent, quick to catch on, and
unquestionably dedicated and moti-
vated, the fact remains that she has no
formal training in the medical practice
with which she works every day.” Kram-
lich added that it seemed “unreason-
able, and even dangerous, that an un-
trained person like Renee should be in
a supervisory position.” Nonetheless,
she wrote, she was grateful for the ex-
perience: “There were so many parts of
Serving His Children that were such a
blessing to be a part of.”
Kramlich moved back to the United
States in 2015. Her concerns might have
been forgotten if not for a friend of hers:
Kelsey Nielsen, an American social
worker who was part of the same insu-
lar missionary world in Jinja. In 2018,
Nielsen began an influential social-me-
dia campaign, called No White Saviors,
that took aim at the failings of Western
aid in Africa. Bach became her primary
target. “Kelsey, she got it in her mind
that it had not been dealt with,” Kram-
lich told me. “She starts up this whole
No White Saviors page, and she was
going after Renée. I was, like, Oh, boy—
buckle up. She’s a very passionate per-
son, even when she’s completely stable.”“
Ifeel like this is happening at the
right time in my life,” Kelsey Niel-
sen said at a café in Philadelphia, when
she was in town visiting her mother,
who lives in nearby Collegeville. If she
were younger, the success of No White
Saviors might have gone to her head,
but Nielsen was about to turn thirty,
and, after a decade of intermittent work
in Uganda, she felt ready to lead a
movement that was about issues, not
egos. “People come up to us and treat
us like we’re celebrities,” she said. “Peo-
ple online, too.” In a year and a half,
the campaign has attracted more than