KHANDSARI, Nepal -- On the 16th day of her life, the baby awoke with a choking cry in the pre-dawn darkness of her family's mud hut.
Bhikhari Pasman fumbled to light an oil lamp and saw foam on his daughter's lips. His wife, Rampati, clutched the baby to her breast but found her too weak to nurse.
So the father ran across the sleeping village to wake the shaman, who listened to his panicky words and chanted some magic over a jar of mustard oil. He rushed home and, as instructed, dripped the oil in the ears of the now-unconscious baby.
By the time the sky began to lighten, she was dead. The sixth child born into the Pasman family, she was the third to die. She died without a name, a common occurrence in Third World villages where parents fear that naming a newborn can be an unwise challenge to fate.
But on this morning, a week after the baby was buried on the bank of the Soti River, she has acquired an identity of sorts. Her brief life and sudden death have become data, the precious, impersonal currency of public health research.
The facts of her ephemeral existence, recited by her despondent parents, are inscribed on a form by a soft-spoken interviewer. That form will be compiled with others detailing the first weeks of life for thousands of babies born this year and last in the plains of Nepal.
Stacks of forms will be trucked eight hours on perilous mountain roads to a small office next to a crumbling Hindu temple in Kathmandu, Nepal's capital. The data will be typed into desktop computers and accumulated on computer tapes. The tapes will be flown to Baltimore, where researchers at the Johns Hopkins School of Public Health will extract lessons for lands decimated by disease.
And the unnamed baby from Khandsari will take her small place in the history of public health. It is a discipline that has transformed human life in wealthy countries over the past century by greatly reducing the risk of early death.
Despite the devastating setbacks of AIDS, war and natural disaster, the same profound change is coming to the Third World.
The achievements of public health are rarely recognized and little understood, partly because of the mesmerizing power of modern medicine. With its dazzling trauma centers and daring surgeons, medicine is defined by the drama of snatching a life back from the precipice of death.
Public health could not be more different. Instead of scrambling to heal the sick, its practitioners plot ways to prevent illness. Rather than embrace the latest technology, they seek remedies so simple and inexpensive as to be practical in even the most destitute places.
Yet the low-tech solutions of public health save lives on a scale incomparably greater than cutting-edge medicine. The most skilled doctor can fight illness only one patient at a time; public-health measures protect whole populations. The $250,000 that a heart transplant in Baltimore would cost could buy enough of the mundane arsenal of prevention -- vaccinations, mosquito nets, latrines -- to save thousands of children in the Third World.
Here in Sarlahi District, a patch of cleared jungle crisscrossed by rivers that drain the Himalayas, Hopkins researchers and their Nepalese collaborators have conducted a series of nutrition experiments that are changing the calculus of death in the developing world.
Paid for by U.S. taxpayers, the experiments are directed from the East Baltimore campus of the nation's oldest and largest school of public health. They are built around that most ordinary accouterment of American childhood: the vitamin pill.
Though Westerners may think of Nepal as an exotic land of mountain treks and Everest expeditions, it is one of the world's poorest countries. Most of Sarlahi's half-million people are subsistence farmers like the Pasmans, inhabiting a world of creaking oxcarts and smoky cooking fires that has barely been touched by the past century. For scientists who study illness and death and how to prevent them, it is a human laboratory of unparalleled opportunity and a spectacle of inexpressible suffering.
Rampati Devi Pasman lies in the shade outside her home with a brown blanket wrapped around her yellow sari -- a crumpled figure with only her despairing eyes visible. A goat is tied at the gate. A twig broom leans beside a stone stained red with ground spices. Slices of yellow squash, spread to dry in the sun, are rotting after the previous day's rain.
The grieving mother holds her head between her palms, answering monosyllabically in her native language, Maithili, as the project worker completes the Infant Verbal Autopsy form. Since the death of her daughter, she has been racked not only by grief but by incapacitating headaches. When she struggles to sit up, her head teeters as if she might lose consciousness. Sometimes she moans and is unable to answer.
