Floods

It is pouring outside. Not a drop all day and then, just now, a small breeze and a distant grumble heralded the amazing power of water roaring down from thousands of feet above. Gullies instantly formed and rush around the base of the house. The vision and the deafening sound demand attention, silence, and awe. I am sitting at the table in my apartment feeling peaceful. It’s nice to feel small and insignificant when the provocative force also has a similar effect on your problems and preoccupations (as opposed to feeling small in the face of seemingly insurmountable problems and preoccupations – a more common experience for me.) Life. Today I’m quietly observing a deluge and yesterday I was struggling with my internal floodgates, trying to keep the choking waters at bay.

So much has happened since my last entry. I have an apartment, as of last week. It’s a simple boxy structure - one big square for the kitchen and sitting area, two smaller adjoining squares for bedrooms, and a small square bathroom Not very inventive but there are nice big windows in the front that let in plenty of light, there are covered patios in the front and the back, the ceilings are high, and I painted the walls nice soothing colors. There are three identical flats on one plot. The first flat is empty, the middle one is rented by a nice Malawian family, and the last one is mine. There is room and hope for both a flower and vegetable garden. I have my home.

I was able to rent the flat because I have a new paying job, which also started last week. My job with the Italian NGO finished in December and around that time I saw an ad for a part-time RN position at the US Embassy. So, I applied and, after a panel interview, got the job. I will be working at the Embassy 20 hours a week and at Bottom 24 hours a week. I must say it is a bit surreal to work for the US government; I actually had to raise my right hand and swear to some pretty patriot language. Being in the clinic itself is also surreal. The clinic serves only about 100 people (only American Embassy, CDC, and USAID staff and their families). Local hires (myself included) are not supposed to be seen at the clinic. So far it seems the clinic averages about two patients a day with fairly innocuous complaints (of course there is the rare car crash or heart attack, but thankfully those are rare events). To care for these patients there is a well-stocked pharmacy, a lab that runs 24/7 with an experienced and friendly lab tec, and I was told today that the Embassy even has its own blood bank. Meanwhile Bottom exists, not more than two miles away, at the other end of the spectrum. It’s as though we have a little America right here serving as patch test. We can hold it up close to Malawi and really see the disparities. I haven’t done very much in my few days at the Embassy but I have made the rounds and overall the Embassy staff is incredibly warm, welcoming, and interested in my work at Bottom. My fantasy now is to find small ways for the Embassy to serve the people who seek care at Bottom and KCH. My first idea is blood. How beautifully metaphoric. I’d like to organize a blood drive. I’m sure bureaucracy will pose a significant hurdle but I have hope, we’ll see how it goes.

As for other updates, I did go and deliver formula to the baby of the 17-year-old who died in labor ward. I was quite proud of myself. I found my way to the rural health center alone (well with some help from police at a roadblock). When I arrived at the health center the grandmother was waiting for me with the baby and her other daughter. I drove them back to their home in the “nearby” village, which was a good five miles away, with the grandmother giving directions in Chichewa and gestures. The terrain was mostly four-wheel drive worthy roads but my little Toyota Sedan did a great job. When we did reach a muddy impasse, I stopped the car and we walked the rest of the way to the house through the stares of all the neighbors and neighbors of neighboring villages. Finally we arrived at a neat brick and mud home with mud floors and a tin roof. Inside there was one small room with a couple goats and one bare large room, with a large straw mat and one chair. The grandmother offered me the chair and the mat quickly filled with women. I felt honored, content, and uncomfortable. After a few minutes she escorted me back to my car and I promised to return again with more formula. That was two weeks ago.

Doreen started school. I visited her two weeks before she started but have not returned since. She called me to tell me that classes began and said that Dalitso is a big problem. I can imagine . . . trying to express enough milk by hand to keep him satisfied for the day, every day. I am due for another visit. I hope when I see them next that she is still breastfeeding, attending classes, and that Dalitso is gaining weight.

Last week at Bottom was a bit rough. On Wednesday I delivered two babies, one needed resuscitation and one, although it was a vacuum birth, was doing great when the mom left labor ward. When I went to visit the one in the nursery on Thursday I found her with an axial temperature of 105.8F!!! Which means her core body temperature was about 106.8! (normal is 98.6) Of course at any one time there are close to 30 babies in the nursery and one nurse so it wasn’t surprising that no one had noticed her amazing fever but I was still horrified. I gave her a bath in tepid water and then we started her on antibiotics for sepsis. At the same time I also found out that the baby from the vacuum birth had been admitted due to sepsis as well. The nurse said that if the babies did not improve in a few days she would call Peds (otherwise a Pediatrician only occasionally visits Bottom). Thursday, Deb and I also picked up the resuscitation of a baby from a delivery we did not attend. After over two hours of bag and mask we told the 18-year-old mom that her baby would not survive and we stayed and watched the baby die and the mother wail. Friday, a woman walked into the hospital six months pregnant, with her first baby, with a hemoglobin of 2.9 (normal is 12-14). We (nurses, clinical officers, and myself) put her on oxygen and started a transfusion. Apparently she had bled a lot the previous week but only came in on Friday because she thought she had malaria. Hemorrhage plus malaria, not good for maintaining a decent blood count.

Saturday and Sunday passed in a blur, my intention was to go and do my visiting - check on the babies at Bottom, see Doreen and the orphan - but in the end I just wanted to be still, so I did none of that. I cried some. I visited my friend Dawn. I had brunch with Deb and Zack. And, then watched a movie with friends.

Today I was back at the Embassy, good but slow. I sent a message to Deb asking her to check on my babies. She sent a message back saying that one had a temperature of 106.1 axial and that the nurse said the room was hot and many babies were having fevers (?!). Deb asked her to call Peds. I hope the baby will survive the night.

Several people responded to my entry about the mother who died I have now also offered to help two more babies whose young mothers died at Bottom in the last week. Formula here costs about $10 a can. There is a famine here and I can promise none of these families have the resources to buy formula many cannot even buy maize. If you would like to contribute to help these babies let me know.