President Trump, meet this comatose two-year-old

Atwo-year-old boy named Sunday Dahn lies in a coma in a rural health centre in Rivercess, Liberia, with cerebral malaria. Even if Sunday survives, he may suffer permanent brain damage.

In Washington, we’ll see debates about US President Donald Trump’s proposal to slash humanitarian aid, and politicians will emerge as winners or losers depending on the outcome. But the real winners and losers are kids like Sunday.

I’m on my annual win-a-trip journey with a university student — this year it’s Aneri Pattani of Northeastern University — and Aneri and I find that most people in rural Liberia have never even heard of Donald Trump. Yet he will profoundly shape their lives, and deaths, for American health assistance benefits half the Liberian population.

It’s not, of course, that Mr Trump is responsible for Sunday’s coma. And our Liberia journey underscores that saving lives is often harder than we think.

Pregnant women in Liberia receive free mosquito nets to prevent malaria, and almost every household has received one — including Sunday’s. The problem is that families often don’t use the nets.

“Sleeping under the net makes one hot,” Sayee Dahn, Sunday’s father, explained as he stood anxiously by the boy’s bedside. He loves his son and didn’t intend to risk his life any more than an American who sends a text while driving is deliberately risking the life of the child in the back seat. In each case, we get lulled by routines and do stupid things.

Mosquito nets are often misused; I’ve seen them turned into wedding dresses, fishing nets, sponges and chicken fencing. Yet there’s overwhelming evidence that net distributions do save lives; they’re one reason the number of people dying globally from malaria has dropped 60% since 2000.

When Sunday developed a fever, his father spent US$8 (270 baht) — a considerable sum for him — for medicine from a street vendor. Unfortunately, it was apparently counterfeit or ineffective.

This is a huge problem: One large study found that 32% of antimalarial drugs sold in poor countries were fake. Predatory Chinese companies export these counterfeit drugs to poor countries with weak regulation.

So Sunday’s malaria worsened. By the time his father brought him to the clinic, he was at the edge of death.

There is no doctor for many miles around, and no lab or blood bank, but the clinic has a physician assistant, the Rev Carl Hanson, who immediately gave the boy an antimalarial suppository. “He’s still in danger,” Rev Hanson told me hours later, looking at the tiny figure.

Yet if humanitarian aid is complex and imperfect, the evidence is overwhelming that it helps; it has helped save more than 100 million children’s lives around the world since 1990. With US financial support, Liberia is experimenting with rural health workers who encourage families to use bed nets, administer rapid malaria tests, hand out reliable medicine and refer cases to clinics.

Rural health workers promote contraception, which is free in Liberia through support from US aid and the UN Population Fund. Mr Trump proposes to cut off both family planning assistance and money for the Population Fund.

Dr Ami Waters, co-medical director of Last Mile Health, which established the network of rural health workers, offered a glimpse of the consequences if contraception becomes less available. She described treating a 14-year-old girl who lost a baby and suffered complications, and a 19-year-old student who, in trying to self-abort with a stick, perforated her uterus and suffered sepsis.

“A lot happens when you don’t have family planning,” Dr Waters noted dryly.

She treated those patients here in Rivercess, where the hospital has no working X-ray machine, the operating theatre lacks running water and oxygen and the pharmacy has mostly bare shelves. There is no aspirin, no gauze, no anaesthetic and, most seriously, no antimalarials. Aneri noted that she had a better supply of medicine in her bag than this entire county hospital did.

Some people say: Let Africans look after African problems. And, indeed, they do. In the Rivercess hospital, we met Betty Tarr, who had four children of her own but adopted her nephew, God Power, after the boy’s mother died. Her husband was furious and abandoned her when she took in God Power.

Now God Power is severely malnourished and fighting for his life, but not because Ms Tarr neglected him: When we met her, she hadn’t eaten for three days.

We can’t save every child. But America and other wealthy countries have always tried to provide modest sums — less than 0.5% of GDP — to fight disease and illiteracy, as a sign of global leadership and of our common humanity.

Mr Trump proposes that we turn our back on that bipartisan tradition, and on children like Sunday and God Power. I hope Congress and the American people understand that what’s at stake isn’t numbers in a budget, but children’s lives.

Mosquito nets are often misused; I’ve seen them turned into wedding dresses, fishing nets and sponges.