CARACAS, Venezuela (AP) — "Papi, I fell!" said 3-year-old Ashley Pacheco, showing her father her scraped knee. Her parents cleaned the wound and thought nothing more of it.
Two weeks later, the little girl writhed screaming in a hospital bed, in a life-or-death crisis caused by Venezuela's shattered health care system.
It started with a fever. At the local clinic, doctors said Ashley would soon be on the mend, but her temperature kept rising.
So Ashley and her parents, Maykol and Oriana Pacheco, went to three other hospitals. None had the medicine or room to take Ashley in.
The next morning, her temperature had spiked to 103 degrees. Desperate, her parents took her to a fourth hospital. Doctors diagnosed her with a staph, whisked her into emergency care and gave her the last of the hospital's supply of the antibiotic vancomycin.
As night fell, she grew worse. An X-ray at a private clinic confirmed doctors' fears: The bacteria had spread from her scraped knee to her right lung. It had collapsed.
Doctors warned her parents that without a chest drainage machine and more antibiotic, she would die.
Racing through darkened, dangerous streets, they managed to find both. But in addition to medicine, Ashley now needed emergency surgery on her infected knee. Only two of the hospital's 27 operating rooms were fully functional, and 150 children were waiting for a spot.
The hospital was filthy. Stray dogs wandered the building, and the staff had run out of bleach to clean the floors. "It's gross here," Ashley said, watching cockroaches scuttle across the walls. "Papi, kill them!"
As she fought off pain, Ashley was also often hungry and thirsty; families have to bring in their own drinking water. "Can't you find me water?" she begged.
She eventually was booked into surgery. But the next week, the fever was inexplicably worse again, 102 degrees. Without enough antibiotics, the infection had quietly spread to her heart. Soon, it could reach her brain.
Her father spent August crisscrossing Caracas in his quest to find the drug. In the meantime, six children died on the pediatric surgery ward due to the lack of proper antibiotics.
Finally, nearly a month after she was hospitalized, Ashley's fever subsided. Her heart was scarred, and she would likely eventually need a valve replaced.
Suddenly, there was more bad news: She had picked up a fungal infection in her lungs, and needed a medicine no longer possible to find in Venezuela amid worsening shortages.
In the end, help came from the next room over. A mother donated the medicine to Ashley. Her son had died.
In late September, doctors declared Ashley infection-free.
"I'm going to see my baby sister, my brother, my grandma, my aunties. They've all been waiting for me," the little girl said as she limped off the pediatric ward.
Oriana sold the medicine the family had left over to other mothers to pay for Ashley's future treatment.
"We have nothing left," she said.
Hannah Dreier is on Twitter at https://twitter.com/hannahdreier. Her work can be found at http://bigstory.ap.org/content/hannah-dreier.