There are places in the world with too many children.

ON WEDNESDAY, MARKET DAY, HUNDREDS OF Indian women were crouched along the sidewalks of Cochabamba, Bolivia, selling everything from shoestrings to Snickers bars. "Compreme! Compreme!" they barked. "Buy from me! Buy from me!" I knelt down and looked over a small mountain of apples a woman was selling. Behind her, lying in a small cardboard box, was a baby about 8 months old. Her eyelids lingered between open and shut, bits of fallen hair lay in tufts upon her shoulders -- malnutrition. I had seen scores just like her in the Bolivian hospital where I had recently started working.

The mother caught my eye and glanced back at the baby.

"She is sick," the woman said. "I have little milk in my chest."

"You could take her to Hospital Viedma," I said. "They can help her, and it does not cost much money."

The woman shrugged. "Apples," she said. "How many do you want? Four for a million pesos."

AS I WALKED DOWN THE PEDIATRIC HALL AT THE HOSPITAL, I PASSED UNDER the portrait of Alvina Patina, the wife of the wealthy Bolivian tin baron who had donated money to construct Hospital Viedma more than 70 years ago. She wore a pale green evening gown and silver slippers, her fan held flush against her chest, her head poised high. As I gazed up at her neck ringed with diamonds, I stumbled. A small boy had pulled down his pants and was urinating just below Alvina's silver slippers.

"Pssst! PSSSST!" A slight woman in a pink smock shooed the child away. This was Marina Arias, the Bolivian who prepared the food for the children. Her black cloth shoes slapped resolutely down the hall as she served trays of mashed bananas and eggs. She always wore a scarf over her graying hair -- the permanent she wanted would snip half her 40 million peso ($20) monthly salary. With four boys, a husband in and out of work, and her abandoned mother living with her in a two-room adobe home, she guarded every million-peso note.

I pulled my pink smock over the only fair hair and pale skin in the building, and we started down the hall. My eyes were wide open: I would be starting medical school in America in about a year, and daily volunteer work would be a chance to see how a hospital operated, especially one in a country that had so fascinated my husband and me on a previous one-week trip that we decided to live there for a year.

We came to a dark-eyed, pudgy-cheeked toddler in a wheeled cart. I reached in to pick her up, but stopped. Her diapers were soaked, and she had no legs. "What happened?" I asked Marina.

"Her mother left her on the railroad tracks," she said. "Someone said she already had too many children."

The next patient, a 6-year-old boy named Nasblin, was covered from neck to toes in bandages, except for the patch of skin where a tiny scorched penis emerged. Marina turned to me and clucked her tongue. "Que' barbaridad. What a barbarity. A drunk neighbor put him in a boiling pot of chicha {local corn-based liquor}. Some kids thought it was funny and kept dunking him back in."

She handed me a cup of bananas, and I moved the spoon timidly toward his mouth. His brown eyes rolled sideways. He began to cry. "Mama'! Donde esta mi mama'?" he sobbed.

"She is coming, she is coming," I told him in reassuring though awkward Spanish. "Do not worry."

"I hope she does come," whispered Marina.

In the next room, Jose', a 10-year-old, was sitting on the floor building a house of Legos. "This kid looks great," I said to Marina. "Why is he here?"

Another tongue cluck, another "que' barbaridad." "He has been here almost four months, and his mother has only visited him once. She says she has no money to take him home, but the janitors have seen her at a chicharia every Sunday getting drunk. Jose' is healthy, but he doesn't want to go home. He says she tried to kill him with a knife. He wants to live here in the hospital."

We continued walking, past the broken windows, leaky faucets, motorcycles parked in the hallway and a stray dog loping toward the burn room. I wanted to sit down for a few minutes, maybe a few days, however long it would take to cry it out. But already Marina's cloth shoes were slapping into the malnutrition room. It was a cool winter morning, and a large window was open. I shivered and closed it. There were no nurses in the room.

Many of the babies were partially bald, all had swollen bellies from malnutrition. In some parts of Bolivia, I would learn, five of every 10 children die before their fifth birthday, many from complications brought on by poor diet, others by lack of basic vaccinations. Their mothers live with death as ours did with colic. The windows of the funeral parlor I passed on the way to work each day displayed tiny white dresses with silver angel wings attached to the shoulders. Sometimes I looked at them and pictured the rows of thin children on the downtown sidewalks.

I started to feed a little boy whose face was wrinkled. He was about to burst into a wail. I sniffed and looked down. His diaper had come undone and he had diarrhea. I picked him up under his arms, propped him against the crib and placed my thumb and forefinger on the one dry square centimeter of the diaper. A doctor clicked past in high heels. "Don't change him," she said. "That's the nurses' job."

"But . . ." I started. I knew there was no nurse around, but I was the outsider and she was the doctor. I set the mashed bananas by his bed. Maybe I should stay out of this, I decided. I moved on, feeling the holes bored through my back by the toddler's eyes.

A doctor in the next room was taping a gauze patch over the eye of 10-year-old Martin. He used scissors from a rusted Mackintosh Quality Chocolates box, and hydrogen peroxide from a Finesse shampoo bottle. "What's wrong with his eye?" I asked.

"He does not have one," the doctor said. He turned aside and in half-English, half-Spanish said, "He have tumor. Cancer. Only have a few months to live. The parents wait too long -- they do not see any problem, no blood, no vomiting, no broken bone. Very sad."

In Bolivia, ignorance is often fatal. Three-fourths of Viedma's patients come from the countryside, where amulets are trusted more than doctors (of which there are few) and where sheep-tending is valued more than studying. Because of poor mountain roads, people make do with what they have: inflated gall bladders of dead cows suffice as soccer balls, insecticide kills lice in children's hair (though the children are sometimes exterminated, too). Many of the mothers who brought their children to Viedma slept on the bare floor next to their children's beds, unable to understand the ailment, the cost or the language the Spaniards had brought.

But beyond ignorance came cruelty that no one even attempted to explain. A nurse and I stood over the bed of Roberto, an 8-month-old boy who had only a bloody bone where a leg and foot used to be. His drunk mother, the nurse was saying, set him on fire with cooking oil and left him on the floor of her adobe house. A dog entered, smelled cooked flesh, chewed off his right foot and was starting on the left when neighbors arrived. Now in his crib, his eyes wide with terror, he thrashed from side to side against the strips of cloth that bound him.

The nurse shook her head. I looked at the bedpost. The pain I was feeling wasn't the kind that made me want to cry, it was the kind that made me want to shut my eyes and not look at human beings for a while. I lifted my head and saw the other tiny bodies swallowed by bandages, gulping at the thought of more horror stories wrapped inside. I had just started at Viedma but already I wondered: How long would you ache before numbness set in?

I watched the nurses. Their eyes never made contact with a child's, their hands were a whirlwind of motion, snapping up sheets, spooning out medications, swinging open the screen door to disappear. If you were going to work at Viedma every day, maybe this was the only way to survive. Maybe, like Alvina in her silver slippers, I'd have to tilt my head up a little just to get by.

The nurse by Roberto's bed turned and grabbed a patient's straw, rinsed it under tap water and put it in another boy's milk cup. I watched in amazement. The water in Cochabamba was so parasite-ridden that I showered with my lips zip-locked. I boiled the water for 20 minutes before even thinking about drinking it, and still my husband would have parasites or amoebas every few months. Just one drop . . .

I looked around for boiled water to rinse another straw. There was none. I saw only a colored-pencil sign on the wall showing a nurse and the words "Follow the norms." I bit my lip and did the same thing that the nurse had.

AS THE DAYS GOT WARMER, MY JOB GOT HARDER. Flies pouring in through torn screens and open doors would alight on the handle of my plastic spoon as it made its final approach into a child's mouth; to shake off the flies without shaking off the mashed bananas was no easy task. I was sitting next to a 9-month-old malnourished girl who wasn't making things simpler. She had no idea what this procedure -- eating -- was all about. Only when she opened her mouth to scream could I whisk in the bananas.

I started to leave and then looked back at her. Wasn't this the same girl I had seen in the cardboard box a few weeks ago on the sidewalk? Had her mother taken the suggestion? I glanced at the chart above her bed. She had third-degree malnutrition, diarrhea, anemia and insufficient vaccinations. Her name was Gabriela.

"Do you know where her mother is?" I asked a nurse.

"Pfftt," she spat. "Who knows where any of these mothers are?"

I walked down to the burn area, where I was going to watch a doctor change bandages and scrape the dead skin off several burned children. The seven-bed room buzzed with flies. Ten yards down the hall, the double-door back entrance to the pediatric ward remained wide open. Flies enjoyed unlimited visiting hours, including the ones that had been crawling on dead rats in the trash 20 feet away and on the corpses in the open-air morgue around the corner. I asked someone why the doors couldn't be closed. "Oh, the odor in here!" he said, pointing to the burn area.

Dressed in huge cloth boots, jackets and surgical masks, a doctor, two residents, a nurse and I shuffled into the small operating room next to the burn area. The first child was carried in and a gas mask was placed over his face. The doctor put my hand on the boy's big toe and told me to hold it straight up in the air. I watched him wash his hands and pull on secondhand plastic gloves. I realized I had done neither. The doctor unrolled the leg bandage, exposing a cylinder of bloody flesh.

"Do you know how much I make a month for coming here every morning?" he said. "Thirty-five dollars.

"And look," he said, pointing to the used gauze with which he had to rebandage the wounds. "Sometimes we can't operate because we don't have drugs or gas or instruments. Sometimes the supplies are stolen."

I held up one big toe again, and a resident held up the other while the doctor rewrapped. Our heads jerked up simultaneously: A fly was circling near the leg, preparing to land on raw flesh. One touch of a fly's dirty leg could lead to infection, possibly death.

"Kill it! KILL IT!" screamed the doctor, dropping the gauze and wildly snapping a towel at the fly. With my free hand I tried to trap it -- a ridiculous pantomime. The fly circled again and buzzed over to a windowpane. Five sets of eyes glared at it for the rest of the operation.

Later, I looked back in on Gabriela. Something kept pulling me back to her, to lean over the crib or hand her a tiny toy, even though she never smiled or uttered a sound. She was lying on her back, passing her third week alone at Viedma. A fly was wading across her mustache of milk, another inching along her lower lip. Never did she flinch. Her sheets smelled of urine, her diapers of diarrhea. I looked around for a nurse. As I spooned mashed eggs into Gabriela's mouth, a heavyset nurse burst into the room, brandishing a can of insecticide as if it were the cure for cancer. She marched over to Gabriela's corner and sprayed the fly-covered window, the baby, the spoon, the egg and me. "Stop! Please!" I yelled, but she had dashed to the opposite corner to spray where a blind woman was breast-feeding her sick baby.

My eyes were stinging, my throat choking. I later learned the spray was so toxic it had been banned in West Germany. "Couldn't you wait until after they eat?" I shouted. She looked at me for a second and then walked out mumbling, "We have to kill the flies."

"Does she have to kill the kids, too?" I demanded.

"They don't care," a Bolivian volunteer in the room said. "You see the way they are with the children, yelling at them or just ignoring them. And this -- que' barbaridad!"

"Que' barbaridad," I repeated quietly.

I SAT ON A HALL BENCH WITH ONE OF THE FEW nurses who each day looked at me when she said good morning. She was rubbing a swollen foot. I asked her how many days a week she worked.

"Six," she said.

"How much is the pay?"

"Forty million pesos a month," she said.

Twenty dollars. My mind was calculating. I had only been in Bolivia four months, but I had a good handle on what life here cost. The chicken I had bought the day before was $4. One chicken a week would be $16 a month. That left $4 a month for vegetables, housing, clothes, electricity, transportation and her children's education.

"My husband left me a year ago," she sighed, "for a teen-ager."

I walked home with my head down, berating myself. How could I have snapped at the heavyset nurse? If my life were as miserable as the average Bolivian's, how much sympathy would I spare? How could I, from a tidy suburb in America where fate was something I could forge, judge people in a land where fate had wrung the hope from them again and again? Viedma was not a fancy private hospital; it was one of the few state-run hospitals in Bolivia, all critically short of resources. I resolved to have more patience.

A few days later, the strike began. Suddenly there was no one to have patience with. Virtually everyone connected with the hospital -- administrators, nurses and janitors -- abandoned Viedma, hoping to pressure the government into raising salaries. The front doors were locked, as well as the doors to the emergency room -- the only one at that time available to the poor in Cochabamba. A few emergency-duty nurses took turns monitoring the pediatric hall. Parents who could afford to pay the bill had taken their children home; many adult patients had simply unhooked their IVs and hobbled away. The kids who remained were huddled into a bunker of three rooms on one wing of a ward. As Marina and I neared them, we heard a noise down the hall. I followed it and the cheers rose as if I were a ship sighted by castaways. "What disease do you have?" I leaned over and asked one boy.

"Tuberculosis and meningitis," he answered.

"A-ha!" I said, and began backpedaling from his bed.

This, it turned out, was the room into which the children with infectious diseases had been shifted during the strike. No sign had been posted. I pulled a healthy 5-year-old girl, still in the hospital because she had been abandoned, from the bed of a contagious friend. I found myself again cursing the ones too bludgeoned to care -- the nurses and a few toy-stealing janitors to whom I had sworn to show more empathy.

Back in the bunker, Jose' was standing in one corner, feet together, surveying the room for a possible exit. The floor was flooded with liquid from the broken toilets and faucets in the bathroom next door. A nurse was sitting across the hall, head down, knitting. I started to say something but caught myself.

Marina and I headed upstairs to the vacant maternity ward, listening to the squeak of my sneakers and the slap of her cloth shoes. The striking nurses now had my understanding, but Marina, the cook who refused to strike, had my admiration. We peeked around the corner of one room and saw an Indian woman sitting on her bed, her feet curled under her wide skirts and her eyes staring at a tree outside the window.

"Where's your baby?" I asked. A mistake.

"She was about to deliver it, but had been told she could not enter the hospital because of the strike," Marina said. "And when she turned to leave, she lost her balance and fell down. Baby died."

The woman still stared at the tree. "Why is she here now?" I whispered.

Marina spoke to the woman in Quechua, the local Indian language. "She says her money was stolen while she slept here, and her husband is in Santa Cruz trying to find work. She cannot leave without paying her bill."

I headed toward Gabriela's room, shaking my head and stopping to pull a 3-year-old from a shower of ceiling plaster chips knocked loose by a construction worker. Gabriela was alone in an eight-bed room, with bits of feces dried on her tiny fingernails. Someone had stripped her bed of sheets. She had cried and cried until she had keeled over in a three-point landing -- one of the points being her nose. I stood over her, gripping the wobbly bar of her crib to stop my hands from shaking. If a tree falls in a forest, or a child cries in an empty hospital, and no one hears -- does it make a sound? I wished only one thing: that Gabriela could sleep, for a long, long time.

I drew in a breath, then spun around and kicked an empty plastic bathtub. It wasn't empty. Dirty water ran across the floor. I couldn't laugh. I couldn't cry. I couldn't understand: How could the $5-a-month raise the nurses and janitors might get justify the neglect of a baby? Every time I walked into this decaying building, no matter which mental approach I took, my own moral beams and floorboards were shaken. How could I survive Viedma?

I slowly walked back to the kitchen and sagged onto a toy chest. I half-listened as Carmen, another volunteer, was telling Marina that her neighbor's maid had nearly died of appendicitis the day before because several hospitals refused to admit her -- either in support of Viedma's workers or because Carmen couldn't pay $500 in advance. I shut my eyes. It was difficult enough inside Viedma's walls without imagining what was happening in the poor neighborhoods outside them.

We heard shouts in the hall. In one corner stood a young female janitor, crying. Near her, the emergency nurse was pacing. Then we turned and saw 7-year-old burn patient Juan, his head drooping, shuffling into his room. His eyes were red, and he was mumbling, "He made me go! He picked me up like a doll."

I turned to Marina.

"Last night Juan's father snuck into the hospital and tried to take him home. The father was drunk. He does not live with the family anymore. Juan held onto the headboard bars, but the father pried his hands loose and threw him over his shoulder and took off."

"Why did the father do it?" I asked.

"He could not pay the bill."

"Why is the janitor crying?"

"Someone said she was going to get part of her pay docked if Juan did not come back. She is supposed to guard the children so they can't escape, but the social worker went to his house and got him back."

"And why is the nurse upset?"

"Oh, somebody accused her of trying to help the father take Juan. Maybe she felt sorry for him. Or maybe she wanted less work."

Marina raised her eyebrows as if to say, "Which do you think?" I couldn't think. In a daze, I stumbled out of the ward, head down, and ran into a red-eyed man hawking dried peas. I stepped around him, then came to the men's ward and peered around the entrance. Now I knew to peer before entering a ward.

Five men were lying in beds in a long, silent hall. One was smoking a cigarette, another was staring at toes sticking out of his cast. The nurse's desk was scattered with open patient charts, as if she had gone on strike in a hurry.

"How are you doing?" I asked a startled man.

"Eh, all right," he said, drawing back his sheet to show me the full length of the cast. "I have not seen a nurse in a week or so."

"Have you been getting food?"

"Most days they come by with soup," he said. Then he waved his hand as if to say nothing mattered. "I have no faith in countries or people. All my faith is up there."

He looked up. I looked up. His vision was better than mine -- all I could see was the ceiling and the peeling paint.

AFTER 24 DAYS, THE STRIKE WAS ABANDONED. THE government had promised to increase wages at the start of the coming year. The hospital was buzzing with new patients, with workers cleaning out closets, sweeping floors and attacking toilet bowls unflushed for nearly a month. Even Gabriela, now 13 months old, stood up in her crib to soak in the activity. For the first time in more than three weeks, she had a roommate.

The baby boy lay wide-eyed in his crib, his mother sitting on a stool next to him. She was dressed in the traditional five layers of skirts, an apron and a straw hat. Her smile was wide, her teeth perfect and her dark eyes radiated warmth -- all rarities among the Indians of the Andes. She showed me a swelling the size of a tennis ball above the baby's genitals. The doctors were going to operate the next day, she told me.

"That's great, I hope they do," I said, catching Viedma cynicism in my voice.

Outside the door, a man was leaning against the wall. Marina waved me over. "This is Gabriela's father," she said excitedly. "He doesn't have enough money, but he wants to take her home."

My jaw dropped. I long ago had assumed no one would ever come for her. In five months, I had never seen a visitor by her bed. "Do not leave!" I told him. "There is a German doctor here who wants to help you pay her bill. She has been healthy for months. Where is her mother?"

"She left with another man," he said. "She took the money I had sent her for the baby's hospital bill."

"Is there any place you can take her? Relatives?"

"Maybe I will ask my sister in Tarija."

"Great. She really needs to be out of this hospital," I said. "She could catch anything here." He left to find the doctor and promised to return in a few days.

I went back into the room, swooped up Gabriela and pushed her above my head like a barbell. She giggled. It was the first time I had heard any sound but a cry. Tomorrow, I thought, we will practice walking -- maybe she could toddle out Viedma's door. I bounced down the hall and into Jose''s room. He was working on math exercises in a secondhand book I had bought for him at the market. I leaned over and watched him multiply 3 times 4 and 3 times 5. "Finish these three pages for tomorrow, and then we'll correct them," I told him. He nodded and dropped back into the book.

Next door, a 6-year-old boy with burned legs, a new patient, was fitting triangles and squares into openings in a plastic can. He wedged the last one in and looked up. We dumped the can, and he started over. When a nurse came to take him in to have his bandages changed, I promised to bring the toy back the next day. I caught myself humming. It was the little things. They were all I could do, a small source of sunlight for the kids and for me.

The next morning, I was leaning over the toy chest when Marina tapped me on the shoulder. "You know the new boy in Bed No. 1 in the burn room?" she asked.

"Yes, I played with him yesterday."

"He is dead."

"What? What happened? He was fine, and I was going to . . ."

"He went in for curacio'n, and he never woke up. The nurses whisper that someone left the anesthesia on too long. The doctor was not there, only the residents."

A few minutes later, I saw the resident who had been in the curacio'n room with me several weeks before. I asked her what had happened.

"He was going to die anyway," she said curtly and looked back at her charts.

I dropped my head and turned down the hall. His burns weren't that bad, I mumbled. In the malnutrition room, the pretty Indian woman was leaning over Gabriela's bed. The baby was lying flat on her back; she tried but failed to lift her head.

"A fever," said the woman. "Feel her body."

Gabriela's legs were burning. My eyes were welling. "She shouldn't be here," I whispered in English. "She could die too, and who the hell would care?"

I blinked to hold back the tears. "Your, your baby's operation is today?" I finally asked the woman.

"No," she said and smiled weakly. "They say tomorrow."

Three days later, the doctors went on a strike of their own. On the fifth day of the strike, I saw the Indian woman eating dirt from her apron pocket. On the sixth, she and the baby disappeared.

Why hadn't I given her money? Why hadn't I talked to a private doctor? Was it really enough here to make a kid giggle or teach him 3 times 4 or show him where to insert a plastic triangle? Could I just do the little things and walk away without guilt? Would I ever find a way to deal with Viedma?

Gabriela's father returned three weeks later. He told the social worker he couldn't give the child a home. He never came back.

A month passed. Four couples were supposed to come to adopt Gabriela, but no one did. One day I was watching a nurse give Gabriela a bath, wishing she would use soap to clear up the sores covering her bottom, cringing when she yelled at the child for eating her excrement. As the nurse looked around for a sheet to dry her, she put the wet, swollen body in my arms.

"Why don't you take her?" she asked and smiled.

Me? In a few months I would return to America and a frantic freshman med student course load. Hadn't my husband and I postponed having our own children because of school?

I looked down at her wide eyes, her Buddha belly and tiny brown feet. Wouldn't an hour a day in my arms and a packet of instant oatmeal be better for her than this? If she actually were the child I had seen on the street six months before, would she even be here if it weren't for me?

I laid her back in the crib. A few minutes later, I walked slowly down the hall, running my hand along the old wall, and looked inside the social worker's office.

"Senåora," I said. "You know that little girl Gabriela? What would happen if I wanted to adopt her . . . ?" ::

Sally Wilson and her husband now live in the United States, where she is attending medical school. Two months ago she gave birth to a daughter, Saviana. Their daughter Gabriela is now 2 years old.