Precious Blood

Saturday at 5pm I found myself lying in the lab at Central Hospital listening to Mr Chabwera's life story while waiting for the blood, draining ever so slowly from my arm, to fill the one pint plastic bag lying on the stool. Mr Chabwera is a lovely man who does his job with such attention and care you might mistake it for passion, but he told me that his original dream was to be a lawyer. From the looks of it he is probably now in his mid-forties and although he has over ten years of experience working in the lab, has just recently been admitted into a bachelor's program of laboratory science. Off to a late start, he began school at the age of 10. When he was 12 he saw part of a court case and was swept away with awe and admiration for the judge. When he asked his father what he would need to do to become a judge, his poor uneducated father replied, "You keep studying and then you'll find out." At the end of high school his marks were not good enough to gain entrance into the university but he was offered a position in a certificate program for lab technology and that is what he did. He might have made a good lawyer but certainly the way he moves around the lab and the way he talks you can tell his work is infused with the knowledge that people's lives depend on his dedication.

Saturday morning I went to visit a few former patients in Lilongwe, including Doreen and Dalitso, whom I found well but hungry. Doreen depends completely on her 22 year old cousin who already supports herself and two children and whose sole source of income is the rent from three small rooms behind the house (I imagine a total sum of less than US$30/mo.) Dalitso now 4 months, is able to sit by himself and smiles a lot. He's beautiful and chubby, but I think every ounce of fat he gains comes off Doreen's bones. The last several times I visited Doreen told me that she has had nothing to eat. I wrestled with myself a bit over situation, wondering if I would be reinforcing a cycle of dependency if I support her and then silently yelling at myself, "Is there another reasonable option?!" I decided that Doreen is 18 and she is a dependent (both he parents are dead and her other adult guardian died, both her cousin's parents are also dead) and that's okay. She is doing really well with Dalitso, plus she is going to school, and like most people she wants a better life and wants to do better for her son and for herself. These moments make me aware of my own unhealthy maternalistic tendencies. We have to trust people, to believe that if given the resources, they will (in most cases) manage their lives appropriately. It's a problem that stretches from me to our international development policies.

After leaving Doreen, I met up with Deb, and together we went to visit a couple patients at Bottom . . . Ireen who came in the previous day with a Hemoglobin (Hb) of 1.7, and Emily whose eclampsia transformed her from a normal young girl into a shadow, no longer responding to family or voices, only to pain. Ireen had received 2 pints of blood on Friday but each pint only raises the Hb by about 1 point so she really needs 10 pints (spaced out over several days).

Ireen had delivered at Bottom on March 10th and was severely anemic then, to the point where I thought she would surely die soon. But, luckily she survived that crisis. Unfortunately, the cause of her anemia was never corrected so she returned to the village and the deterioration resumed; her milk also began to dry up and so her mother and grandmother supplemented the breastfeedings with water. When she reached the hospital Friday she was barely conscious, only muttering unintelligibly and screaming when I placed the IV. Tarek was not around for most of the day (busy at Central hospital) and I felt myself cursing his absence wanting him to be there to care for this incredibly sick woman (not me). Of course when he did arrive later in the afternoon, after she had received 1/2 a pint (and her Hb was probably 2), she sat up at the sight of him, began talking and joking in Chichewa - startling us and the guardians. If only our presence was enough for these patients.

Saturday, Irene was about the same as she was on Friday, conscious but white as death. Her guardians are both incredibly sweet and since I told them that I would like to visit them in the village and check in on the baby, every time they see Deb and me they ask us if we will come and tell us we must learn Chichewa.

Emily was also slightly improved. Her fever from the previous day resolved and although she still would not respond when I called her name, her guardians said that she responded to them and that she was able the eat the porridge they spoon fed her. Having received no nutrients for 4 days her milk was also drying up and the guardians were supplementing with formula from the nursery. I told them I would like to also visit them and see the baby over time.

Before we left Bottom we were told by the postnatal nurses that they had been waiting for blood for four patients all day, including Ireen, but had not yet received anything. So, Deb and I headed to Central and found Mr Chabwera. At the moment the blood bank at Central is a sad sight, just a few lonely pints in the fridge. Three of the patients who needed blood were A+ and one was O+. There were several pints of A+ so Mr Chabwera readily put those aside for us but there was only a single pint of O+ blood left for the entire hospital. The three of us stood over it, staring at it, debating whether to give it to the woman with an Hb of 4 or to save it for Pediatrics (if used for children it could save several lives). Finally we decided to do a swap, we would take the screened pint of O+ and I would leave a pint (I am also O+) which would be screened as soon as someone showed up with the keys to the cupboard that held the reagent needed to do the HIV test.

On the bright side, my goal to organize a blood drive at the Embassy, benefiting Bottom and KCH, is really going to happen. Flyers have been posted at Peace Corps, the Embassy, USAID, CDC, and the British High Commission. The date is set for April 11th. People I talked with have seemed enthusiastic so I hope the turn out will reflect their tone.

Ok, now if you can, wherever you are, go donate blood!