A Name Change

Several weeks ago I received another unwanted phone call. Just before 7am Mrs. Manga called to tell me that 8-month-old Memory had died. Instantly I felt devastated, exhausted, and furious with myself. Eight months previously Memory’s mother had died hours after the premature birth. Mrs. Manga - the employer of Memory’s mother - kindly took it upon herself to help as much as she could. She gave the grandmother a room, money for food, blankets and clothes for the baby but was still unable to afford the necessary formula. So, I bought the formula, they cared for the baby, and in my periodic visits I watched Memory transform from a delicate baby of 1kg into a healthy infant.

The day Memory was admitted into the hospital, Mrs Manga called me. I visited several days later and found her hot, listless, and breathing quickly. The clinicians had her on a regimen of anti-malarials and antibiotics. I felt satisfied with her care, handed her grandmother more formula and left. A week or so later Mrs Manga called to let me know that Memory had been discharged but that the fever continued. She wanted to take Memory to another hospital. I never followed up. That was one week before I received the phone call.

When I hung up the phone I cried until my eyes were red and swollen, angry at myself and the world for failing once again. I went to her funeral, I sobbed with the women, and watched men lower another tiny casket into the Earth. Why can’t we stop this?!

The same week Memory died, the President came with presidential fanfare to cut the ribbon at the new Lighthouse Clinic. HIV is hitting Malawi hard, of the almost 13 million Malawians it is estimated that 1 million are AIDS orphans and in response donors and the government are rushing to stem the tide, channeling resources to increase access to testing, counseling and anti-retro viral therapy. The original Lighthouse clinic, which serves as a center for counseling, testing, and treatment, was built behind KCH several years ago. It is a well-run but completely overwhelmed clinic (it is not uncommon for someone to wait most of the day to be seen). The new Lighthouse will hopefully relieve some of the burden and provide easier access for those living near Bottom. Structurally it is a simple but beautiful clinic. Clearly well thought-out, the facilities include a snack bar as well as a touch-screen computer system for tracking patients and monitoring their treatment.

HIV/AIDS deserves attention, activism, and research. Individuals suffering with the disease deserve compassionate care and treatment. Families and communities need support and education. Still, somehow I feel bitter. What about the women and babies? Maternal mortality is not a new problem. The outrageously high infant mortality rate is not new. Maternal and infant mortality offer no new and interesting challenges for epidemiology research, no new possibilities for fancy pharmaceuticals. We know what is killing these women and their babies. It is the same constellation of conditions that has killed women and babies throughout time.

The new beautiful Lighthouse is located directly behind Bottom Hospital and to access it you must walk through Bottom, past the collection of buildings whose numerous face-lifts no longer fool anyone. The day the President came, throngs of people lined the path through the hospital grounds to the clinic behind. Women wearing chitinges especially printed for the occasion danced and hooted along side drummers, while police and military personnel kept the crowd in neat even rows monitoring the entrance of those heading towards the clinic. No more than ten meters away from the festivities, women in the labor ward continued their work, focused only on the efforts of their bodies. That day, as usual, most of the women pushed their babies into the world with great effort and pain but without problem. That day, as usual, two women arrived with severe problems their babies dead, their own lives threatened.

I took blood samples from the women for the lab. The police nodded at me in my scrubs, with my stethoscope around my neck, and I walked through the crowd across the path from the labor ward to the lab. Minutes later I crossed back carrying 2 pints of blood.

I heard later that at the opening ceremony the President decided to change Bottom Hospital to Bwaila Hospital. Apparently the river running past the Hospital was once called Bwaila. Certainly Bwaila Lighthouse sounds much better than Bottom Lighthouse. I’m sure that many people will talk and write about the new Bwaila Lighthouse in the papers, hopefully in international news, and most likely in proposals. Bwaila matches the image of the clinic but obscures something else.

Last week I noticed that some of the nurses have started substituting Bwaila for Bottom on forms. I tried it out myself but one of the long-term clinical officers saw my note and with a deep throaty laugh said, “Joanne, Bwaila?! This is still Bottom.” Indeed it is. One of those women died that night. Another died the following day.