“I know, I know she was gift.”

“Love, then why do you not dress her? Why did you have trouble giving her your milk?”

“She was a gift, but I did not ask for this.”

Jeni sits across from me, eyes flicking from side to side, as though searching for an escape.

“This is the reason you’ve brought her in ill, though, my señorita – she must have a shirt, or jacket, of some sort.”

“It’s hard to take care of her. She is so little. I don’t know what she wants.”

I struggle for the right words, distracted by the already forming frown-lines on her small face. I feel like I could say the same thing about the too-young mother of the sick baby.

“How old are you?” I ask tentatively, my pen hovering above the chart.

“Sixteen,” she says, then her smile picks up and she adds coyly, “I’ll be 17 soon – in July.”

I smile back, trying to not look shocked, and tell her that my birthday is in July, too.

“Oh, when? So is my baby girl’s! We were born on the same day.”

“The twenty-sixth.”

“Ah, we were born on the first.”

A moment’s thought – her daughter’s precise date of birth, then, was her fifteenth birthday (here, affectionately called a quinceañera), an adolescent girl’s equivalent of an American sweet sixteen. While her classmates chose from pink confections of dresses and curled their hair, limbs livened by their first taste of champagne, the girl who now sat in front of me had lain alone on a cot in her own house, bleeding profusely, experiencing a much more painful introduction to womanhood.

I swallow, trying to moisten my dry mouth.

“Jeni. You’re so young, but this is – she is – so important, too,” I try, knowing it is not quite what I want to say.

“No, no, it’s not like you think.”

I sit forward, familiar with this feeling, because so much of my Ecuador has been living the unexpected.

“It isn’t my age. That I can change myself to understand.”

“What then, my love?”

“This – my most precious gift – she is a product of rape.”

Jeni’s face is calm, the words sounding heavy in her mouth. My muscles freeze. Even my eyes refuse to blink. I know she can feel me staring, and I want to look away, desperately. She raises her chin.

“She is… She is… I love her!” she says, defiantly, looking at some point on the wall above my head. “But I never asked for her.”

She looks down, and I manage to divert my eyes. Her child has thin limbs and a small belly, protruding in a way that undeniably indicates parasites. She has a dirty pair of too-big black toddler’s pants on, and no socks or shirt. Her hair is matted against her scalp and needs to be washed. Still, her mother clutches her close, like a sideways doll, as though she has momentarily forgotten the right way to hold a baby. The one-year-old adjusts, searching for purchase on her mother’s lap.

I breathe out through my nose, inwardly begging my tear ducts to settle down. It is better, if I must cry, to do it once her file is closed, the patient has left, and I have shut the office door.

My voice sounds far away to me. “She is the best of life, borne from the worst of it.”

Jeni looks at me. For the first time during her daughter’s consultation, I feel like she is really looking – seeing me, searching for something I do not know if she will find. A few minutes pass, in silence. Her scrutiny begins to weigh on me. Rare is it that a Kichwa woman will raise her head thus.

I am awed by the power she holds over me, from across the desk, without so much as touching me.

“Yes. I think so. I don’t really know how to do this, you know, but I think I can siga adelante. I think we will move away from that and we will make it,” she pauses, and her gaze drops to the little girl as her arms tighten around the tiny, rounded belly.

“We are growing up together.”