Grit

I’m sitting in the Embassy, it’s 10pm, quiet, and dark. I am tired, not just from the day but from the week and the month and perhaps the year. I want a vacation and I will take one sometime soon but I find it hard to reconcile my feelings of exhaustion with the realities of life faced by my friends who are nurses. I have not mentioned them yet, Beatrice Namaleu and Simbili Msiska. I met sister Namaleu (remember sister is the title for nurses here, not just nuns) months ago when I brought Gabriel to the malnutrition ward (ward C) in Kamuzu Central Hospital. I hope she doesn’t mind my telling her story here and I hope you can see the light she emits through my words.

When we came that day Sister Namaleu was the one person who smiled. She saw the dying baby and his grandmother and me, acknowledged the urgency, and helped us without extra effort on our part to plead our case. Over the time that Gabriel stayed in ward C I hear her story bit by bit and we became friends. Sister Namaleu has been working in the government hospitals for over 20 years. That is a long time to work anywhere but even longer somewhere like KCH. Because of the shortage she often works 72 hour shifts. Of course the first time she told me this I was horrified and astounded. She simply said, with her usual smile, “We are three, if one is sick and one is at a funeral, that means I am the only one,” then pausing and looking around the noisy ward filled with at least a hundred children said, “and I cannot leave these children alone.” It is incredible that she does this regularly but the true miracle is that she smiles.

Sometimes, I visit her when she’s working and if I’m not in a rush she will take me around, show me the children she is most concerned about, introduce me to mothers who cannot breastfeed or to caretakers of infant orphans. She LOVES them. Even though there are hundreds she knows them, the ones with the swollen bellies and the tiny surgical patients, and they know her.

One day as we were walking out together I noticed a severely emaciated child sitting in a bed sobbing, while several women on the floor were eating and clearly laughing at the source of his tears. As we passed he called to Sister Namaleu and with a smile, she shooed the women away and negotiated with him until he dried his tears. When we left she told me his story. He was crying because he wanted to eat nsmia the “real” food his family members were eating but because he needed more calories he was only allowed to drink a calorie rich formula. She said his stays in the ward were becoming more and more frequent, he had been HIV positive since birth and now his body, after 15 hard years, was just wearing out. She told me she would ask the doctors if he could eat a little nsima. His story is sad, but what impressed me most, was not the image of his ribs or wrists but the compassion and respect Sister Namaleu had for both the boy and his family, and the joy she expressed in every act.

At home Sister Namaleu has six daughters, ranging in age from 9 to 18. Her husband, recently employed after 16 years of unemployment, moved to Mzuzu (four hours north) because that is where he found work and lives with the eldest daughter. Sister Namaleu jokingly calls their humble house in Lilongwe a girl’s dormitory. Her family has survived on her meager salary alone for many years and she has worked for every kwacha, in September this year she will retire; she wants to return to school to get a degree (now she only has a diploma in nursing). When I asked her who I will come to and who will take care of her little ones she says, “I will still come. I will have more time to see the ones who need me most.”

Msiska is my other beloved nurse friend. Msiska works with me in the labor ward. Frankly, when we first met, she scared me. She rarely smiled and I felt as though she was constantly assessing me. She is the charge nurse for the ward. Over the past year many things happened in life and in the ward and now her face is one of those I most look forward to seeing. (That experience of transformation provided an important personal lesson.) Msiska is a great midwife. She still often looks run down but there is no doubt that she always cares. There is so much about being a midwife (especially at Bottom) that is not glamorous, sometimes I have to laugh at how much and deeply I love it. Msiska shares this love.

Sometime last year DFID (the British development agency) decided to give money specifically to increase the salaries of nurses and clinicians, the thought being that this would help with retention of health workers. Unfortunately, the government decided that the new salaries bumped everyone into a higher tax bracket and in the end, nurses took home less money. In a similarly tragic turn of good news souring, earlier this year nurses were paid arrears (I’m still not clear what this was for) but two months ago the government decided they had over paid the arrears and would recover the money by deduct a fixed some from everyone’s pay check for the next 6 months. Last month Msiska tearfully showed me her pay check. Usually she earns 21,000MK (150MK:US$1), last month she brought home 8,000MK. This amount supports Msiska, her unemployed husband, their three children, two other orphans, and her mother.

So these are the women I work with, and I complain of being tired. I know some of it is choice and circumstance but it also determination and grit. I also know I will collapse if I work the way they do. I will take the vacation my friends and loved ones assure me I deserve, but part of me just feels weak as though I lack solidarity and strength.