Tuesday, January 30, 2007
Taken
Today during lunch a friend accompanied me to the headquarters of Chisomo Street Children’s Project. My intention was to talk to someone about Ganizani and friends/brothers who would be able to do a better job of researching their situation and background. Cosmas a nice Malawian in his late 20s greeted us and invited me to tell him what I knew about the boys. I told him about the boys in City Center and their house in Saint, about the conflicting stories of the whereabouts of their families, and the conflicting stories of their relationship to each other. When I finished Cosmas said, “Ganizani Nelson, both his parents are alive. He has been moving between relatives and may have finally left home due to the lack of freedom.” Apparently, he was in their system but preferred smoking marijuana to attending elementary school and was consequently kicked out. Cosmas struck me as a very patient and kind person with a strong no-nonsense streak. I was not really surprised by what I heard; it makes me laugh at myself and at Ganizani. I told Cosmas that next time I saw Ganizani I would let him know that we met – I’m sure he won’t be pleased by that fact. He’s 13. He deserves another chance and another but I need to be a little tougher. I think the new tactic will be the promise of food if and only if he goes back to the program. I am glad that there are social workers roaming the streets trying to get kids back into school and back into families.
Mostly Infruriating but Slightly Hilarous
Last August Clement submitted the paperwork and fees to apply for a passport. Our goal was to obtain it in time for him to travel to Zambia with my parents in October. In December he was told the passport should be ready soon. He went to Blantyre to collect it but after many phone calls and trips to various offices he reached his contact person who told him to go to Zomba. Dutifully he went to Zomba and was told that the person who had it was not around. They said they would bring it to Lilongwe. The guy came but there was no passport. A month later he went back to Blantyre and found out that his original contact left his job and the person who took over the position had been away but, “luckily just came back.” When Clement met that man he was told that his passport simply needed the signature of someone else, who was sick but “should be in tomorrow.” The following day he found the man of the highly desirable signature who then told him there was something wrong with his birth certificate. After some discussion he reconsidered, the birth certificate was fine but Clement needed a letter from the hospital requesting urgent processing of a passport (after 5 and ½ months!). (In my mind I was hearing something like, “How about $100” but Clement insisted that, he just really needed a letter.) While Clement stayed in Blantyre his friend Mavuto spent an entire day running around Lilongwe to different administrative offices trying to convince any other person in possession of an authoritative stamp and signature to sign the letter. The next morning I faxed the letter. This mollified the Blantyre signature man who then said the passport would be out within the week. The following Friday (the third or fourth day Clement called) he was told that the passport was out and that he could come pick it up. Clement called his father in Zomba who said he would go collect it Monday. Monday afternoon Clement’s father called and told him that the man who supposedly had the passport was in police custody. He was told that hopefully the man would be released on bail Tuesday and then would be able to hand over the passport. Clement says if the man is not released he will personally visit him in his cell and demand to be given his passport. (Apparently no one else at the office can find/give him the passport.)
As if that is not enough, another ridiculous drama is running concurrently. Clement - along with the other interns who have been assigned to Kamuzu Central Hospital - is fighting to receive a salary. After graduation, clinical officer interns must complete a year internship at a government hospital or clinic where they are posted by the Ministry of Health. The hospital or clinic in turn is supposed to provide them with housing and a small stipend. Now two months into their internship, those allocated to KCH have yet to receive anything . . . Okay, that’s not entirely true, they have been provided a small house (supposedly for 10-15 interns) located about 5 kilometers from the hospital. The house is furnished with a single twin bed and the interns have not been given any money for transportation, or even food.
Daily, a rotating group of interns visit the various administrative offices at the hospital and Ministry to beg. Of course the people they seek are often in meetings, and when they are caught in the office unaware they point the interns in the direction of someone else in another office across town who points them right back. “Come again at 5pm.” “Come back tomorrow.” “Get a letter from the hospital saying they can’t afford to give you anything,” etcetera.
Without pay or housing the interns are still expected to work 60-80hrs per week. Unlike residency programs in the States - where immediately after graduation you occupy the lowest rung of the medical hierarchy, with layers of experienced physicians above you, accessible for consultation and who ultimately remain responsible for the patients - these intern step into full wards alone. (Consultants are often not present at all or are completely overwhelmed by their own patient lists and responsibilities.) Interns have little to no informational resources, minimal medical resources, and little to no supervision; setting up a precarious situation for everyone involved. But, the alternative is wards full of patients without anyone to assess and treat them.
THE HOSPITAL DESPERATELY NEEDS CLINICIANS and the administration is essentially chasing them away. Several of Clement’s peers have already left KCH and those remaining are already becoming disenchanted by the government system. Hospital administrators should be grateful that they have enthusiastic clinicians willing to work in overcrowded hospitals for as little as $50/mo. I feel like screaming at the administrators, “HAVE YOU SEEN THE WARDS IN YOUR HOSPITAL?! WHAT ARE YOU THINKING?”
Certainly the people who attend KCH need these interns. Just a small illustration of that. . . Clement told me that he had a patient yesterday with pleural effusion who had been pushed from one person to anther without any investigation or treatment. By the time he reached Clement he was breathing with great difficulty. Clement drained the fluid, drew labs, and ordered a chest x-ray. Even without the results, the man was so grateful to be helped that he insisted on having Clement's phone number. Telling Clement that the next time he had a problem he would contact him directly. Clement told him that he might not be at KCH the next time but the man persisted, he said he would come to Clement regardless if he had to travel across the country. He also told Clement that he wanted to visit him at his house to which Clement responded that he didn't have a house. The man unwilling to be put off and still holding out his hand said dismissively, "I'll find you and we'll chat."
Last night when Clement narrated the most recent episodes of these ongoing sagas all I could do was laugh. Clement is applying for medical school in a few other African countries moving closer to his dream of becoming a pediatrician and serving those who have the most difficulty accessing care, but not surprisingly he is also looking forward to a few years outside Malawi.
As if that is not enough, another ridiculous drama is running concurrently. Clement - along with the other interns who have been assigned to Kamuzu Central Hospital - is fighting to receive a salary. After graduation, clinical officer interns must complete a year internship at a government hospital or clinic where they are posted by the Ministry of Health. The hospital or clinic in turn is supposed to provide them with housing and a small stipend. Now two months into their internship, those allocated to KCH have yet to receive anything . . . Okay, that’s not entirely true, they have been provided a small house (supposedly for 10-15 interns) located about 5 kilometers from the hospital. The house is furnished with a single twin bed and the interns have not been given any money for transportation, or even food.
Daily, a rotating group of interns visit the various administrative offices at the hospital and Ministry to beg. Of course the people they seek are often in meetings, and when they are caught in the office unaware they point the interns in the direction of someone else in another office across town who points them right back. “Come again at 5pm.” “Come back tomorrow.” “Get a letter from the hospital saying they can’t afford to give you anything,” etcetera.
Without pay or housing the interns are still expected to work 60-80hrs per week. Unlike residency programs in the States - where immediately after graduation you occupy the lowest rung of the medical hierarchy, with layers of experienced physicians above you, accessible for consultation and who ultimately remain responsible for the patients - these intern step into full wards alone. (Consultants are often not present at all or are completely overwhelmed by their own patient lists and responsibilities.) Interns have little to no informational resources, minimal medical resources, and little to no supervision; setting up a precarious situation for everyone involved. But, the alternative is wards full of patients without anyone to assess and treat them.
THE HOSPITAL DESPERATELY NEEDS CLINICIANS and the administration is essentially chasing them away. Several of Clement’s peers have already left KCH and those remaining are already becoming disenchanted by the government system. Hospital administrators should be grateful that they have enthusiastic clinicians willing to work in overcrowded hospitals for as little as $50/mo. I feel like screaming at the administrators, “HAVE YOU SEEN THE WARDS IN YOUR HOSPITAL?! WHAT ARE YOU THINKING?”
Certainly the people who attend KCH need these interns. Just a small illustration of that. . . Clement told me that he had a patient yesterday with pleural effusion who had been pushed from one person to anther without any investigation or treatment. By the time he reached Clement he was breathing with great difficulty. Clement drained the fluid, drew labs, and ordered a chest x-ray. Even without the results, the man was so grateful to be helped that he insisted on having Clement's phone number. Telling Clement that the next time he had a problem he would contact him directly. Clement told him that he might not be at KCH the next time but the man persisted, he said he would come to Clement regardless if he had to travel across the country. He also told Clement that he wanted to visit him at his house to which Clement responded that he didn't have a house. The man unwilling to be put off and still holding out his hand said dismissively, "I'll find you and we'll chat."
Last night when Clement narrated the most recent episodes of these ongoing sagas all I could do was laugh. Clement is applying for medical school in a few other African countries moving closer to his dream of becoming a pediatrician and serving those who have the most difficulty accessing care, but not surprisingly he is also looking forward to a few years outside Malawi.
Tuesday, January 09, 2007
Pictures
Many people have asked for pictures. Unfortunately, although I have hundreds, I don't have the time it takes to upload them. However, my dad has posted the pictures from their trip on his realestate website www.mikejorissen.com They are not of the best quality, but you can get an idea and if you've been following the stories, you can probably guess the identities of the people featured in the snapshots.
Sunday, January 07, 2007
An Ending
Thursday afternoon when I answered my phone in the middle of the labor ward my hello was met by hysterical sobbing. After a few seconds the sobbing receded and an unfamiliar voice said, "Boston is no more." Immediately I left Bottom and headed to the Pediatrics ward at Central. As I turned the corner nearing the ward I found Boston's mother, accompanied by a few friends, silently seated on a bench, eyes red and swollen from 30 minutes of devastation.
That afternoon I waited with them there, then drove behind the ambulance that carried mother and child home for their final goodbyes. The next morning Frank called just as they were beginning the burial ceremony. I arrived in time to join and small procession of women carrying wild flowers into the house. While the men sat quietly along the fence outside, the women overfilled the small room with their bodies and songs, Boston's small coffin the centerpiece on a grass mat.
I cried. But this time my tears were not for Boston. His time here was an eternity of suffering; anyone could see an old man staring out from his eyes. I cried for his mother. At 31 she has already buried two husbands and now she is burying her last born child. I cried thinking of the lightness on her hips; the sudden absence of this child who was always on her hip or back, or in her arms with his head pressed against her chest. I cried for the emptiness of her arms and for the other women at Bottom who arrive with expectations and large bellies, and return home with a small bundle to place in the ground. I cried for the women in the room many of whom surely had lost their own children and who were expected to go back to life, to drawing water, cooking, and cleaning.
Sometimes in the hospital when I am resuscitating a severely asphyxiated baby - one who is hovering between worlds - I talk to them and try to convince them to stay. It is a moment, I believe requiring absolute honesty. I cannot tell them life will be a pleasant journey. Being born to a poor woman in one of the world’s poorest countries (and perhaps to an HIV positive mother), the only enticement I can offer is the promise of their mother’s love. And, I plead that they will stay so her heart may grow with the experience of that love.
After an hour or so in the house, with the women singing hymns, we moved outside. The coffin was placed in the center of the road and encircled by the separate but now closer groups of men and women. A minister and a few other male members of the community stood to speak before the walk began to the burial site. As we walked I realized we were easily two hundred people and this sight led me to think about the differences between Malawi and the US in the ways we mark life and death, and in the ways we cherish life. Here life’s fragility presents itself bluntly nakedly and yet the end of each life remains a significant event. In the States many of us still believe we are invincible, we do everything to sustain life and yet how many deceased adults would draw such a crowd to their funeral on a Friday afternoon?
At the graveyard the minister spoke again, a few family members lay flowers on the coffin lid and then three men lowered it into the Earth. After topping the coffin with rows of sticks and a grass mat, the men took turns with shovels to fill the hole. Sitting in the tall grass to my right Boston’s mother was silent. The baby on his mother’s lap to my left pulled at my hair. In the dirt at the head of the small mound someone placed crude black metal cross, scrawled letters in white paint read “Boston Kauda 11/2005-1/2007.” The grave next to Boston’s had no little cross only three sticks and a stone, which was at that moment being traversed by a large elegant snail.
From there we returned to the house. People branching off along the way until only a small gathering of family remained. I too said goodbye to Boston’s mother, shook hands with Frank, and returned home.
That afternoon I waited with them there, then drove behind the ambulance that carried mother and child home for their final goodbyes. The next morning Frank called just as they were beginning the burial ceremony. I arrived in time to join and small procession of women carrying wild flowers into the house. While the men sat quietly along the fence outside, the women overfilled the small room with their bodies and songs, Boston's small coffin the centerpiece on a grass mat.
I cried. But this time my tears were not for Boston. His time here was an eternity of suffering; anyone could see an old man staring out from his eyes. I cried for his mother. At 31 she has already buried two husbands and now she is burying her last born child. I cried thinking of the lightness on her hips; the sudden absence of this child who was always on her hip or back, or in her arms with his head pressed against her chest. I cried for the emptiness of her arms and for the other women at Bottom who arrive with expectations and large bellies, and return home with a small bundle to place in the ground. I cried for the women in the room many of whom surely had lost their own children and who were expected to go back to life, to drawing water, cooking, and cleaning.
Sometimes in the hospital when I am resuscitating a severely asphyxiated baby - one who is hovering between worlds - I talk to them and try to convince them to stay. It is a moment, I believe requiring absolute honesty. I cannot tell them life will be a pleasant journey. Being born to a poor woman in one of the world’s poorest countries (and perhaps to an HIV positive mother), the only enticement I can offer is the promise of their mother’s love. And, I plead that they will stay so her heart may grow with the experience of that love.
After an hour or so in the house, with the women singing hymns, we moved outside. The coffin was placed in the center of the road and encircled by the separate but now closer groups of men and women. A minister and a few other male members of the community stood to speak before the walk began to the burial site. As we walked I realized we were easily two hundred people and this sight led me to think about the differences between Malawi and the US in the ways we mark life and death, and in the ways we cherish life. Here life’s fragility presents itself bluntly nakedly and yet the end of each life remains a significant event. In the States many of us still believe we are invincible, we do everything to sustain life and yet how many deceased adults would draw such a crowd to their funeral on a Friday afternoon?
At the graveyard the minister spoke again, a few family members lay flowers on the coffin lid and then three men lowered it into the Earth. After topping the coffin with rows of sticks and a grass mat, the men took turns with shovels to fill the hole. Sitting in the tall grass to my right Boston’s mother was silent. The baby on his mother’s lap to my left pulled at my hair. In the dirt at the head of the small mound someone placed crude black metal cross, scrawled letters in white paint read “Boston Kauda 11/2005-1/2007.” The grave next to Boston’s had no little cross only three sticks and a stone, which was at that moment being traversed by a large elegant snail.
From there we returned to the house. People branching off along the way until only a small gathering of family remained. I too said goodbye to Boston’s mother, shook hands with Frank, and returned home.
Wednesday, January 03, 2007
Boston
Boston is 14 months old. He is not walking or talking and weighs just over 6kgs. Boston’s mother brought him regularly to the feeding program at the house of Frank’s mother-in-law. When I visited her at home with Boston several weeks ago, I held him in my arms and could feel the reverberations of illness in his lungs against my chest with every breath he took. I don’t know if he has ever been healthy; I have never seen him well. His father died last year. His mother is unemployed and lives with her parents and her two older children (ages 4 and 6). She is thin although not sickly in appearance, but the image of Boston in her arms portents an ominous fate. Most likely this mother will lose her child, her children will lose their mother, her parents will lose their daughter and their support. Death is inevitable but the order here is wrong.
During that visit Sister Namaleu and I convinced Boston’s mother to take him to the pediatric ward; he has been there ever since. Last week I visited and he looked better. I held him in my arms resting his head against my chest emitting a weak cry of complaint only occasionally. Boston has a soft brown stuffed triceratops. It lives by his side. When I passed Boston to another friend I took his little dinosaur and with exaggerated sounds made it give him big kisses on the cheek. In response, Boston smiled faintly. I imagined that inside he was laughing convulsively like a healthy little boy, squealing with glee as I did it again and again. I’m sure that’s what he would have done. I was thrilled to see even his little smile.
Yesterday I returned to the hospital and found Boston with an IV line. His mom sat him up to feed him and managed to get a spoonful of milk in his mouth. He cried and coughed until both the milk and phlegm came up. I tried to support him in a seated position but after several minutes of his moaning let him lie back. Sister Namaleu inserted a nasogastric feeding tube. In the crib next to Boston another mother held her baby of perhaps two years also feeding her through a NG tube. Beautiful unbelievably long eyelashes framed her half open eyes, now set deeply in a face that was little more than skin pulled tight over bone. Where is the justice? What do we pray for? For these children to recover from their current illness, only to face another and another? For them to die in peace and let their parents suffer their loss? Without understanding how it might be possible I pray for an end to suffering.
I stopped in Pediatrics today to visit Boston. The girl with the beautiful lashes died last night. Boston continues to deteriorate. He was propped up against folded cloths, awake but still, using all his energy to take in air.
During that visit Sister Namaleu and I convinced Boston’s mother to take him to the pediatric ward; he has been there ever since. Last week I visited and he looked better. I held him in my arms resting his head against my chest emitting a weak cry of complaint only occasionally. Boston has a soft brown stuffed triceratops. It lives by his side. When I passed Boston to another friend I took his little dinosaur and with exaggerated sounds made it give him big kisses on the cheek. In response, Boston smiled faintly. I imagined that inside he was laughing convulsively like a healthy little boy, squealing with glee as I did it again and again. I’m sure that’s what he would have done. I was thrilled to see even his little smile.
Yesterday I returned to the hospital and found Boston with an IV line. His mom sat him up to feed him and managed to get a spoonful of milk in his mouth. He cried and coughed until both the milk and phlegm came up. I tried to support him in a seated position but after several minutes of his moaning let him lie back. Sister Namaleu inserted a nasogastric feeding tube. In the crib next to Boston another mother held her baby of perhaps two years also feeding her through a NG tube. Beautiful unbelievably long eyelashes framed her half open eyes, now set deeply in a face that was little more than skin pulled tight over bone. Where is the justice? What do we pray for? For these children to recover from their current illness, only to face another and another? For them to die in peace and let their parents suffer their loss? Without understanding how it might be possible I pray for an end to suffering.
I stopped in Pediatrics today to visit Boston. The girl with the beautiful lashes died last night. Boston continues to deteriorate. He was propped up against folded cloths, awake but still, using all his energy to take in air.
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