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.
Tuesday, June 27, 2006
Wednesday, May 31, 2006
Wednesday's Thought
Personally I feel as I age that the contrast between life's beauty and sadness only intensifies and the question "WHY?" only resounds louder. Life is a difficult place to find comfort. Maybe if I were a different person I would be depressed or maybe I would be a Buddhist nun. But here in my present, I'm moving forward with the two only truths I have discovered thus far . . . 1) life is tenacious, and 2) sad and angry people don't usually have much to offer, so if a choice must be made it's better to look for the rainbows even if they are extremely elusive.
Monday, May 22, 2006
Sweet and Sorrowful
Not many expatriates delivery in Malawi. Endemic horror stories convince most that they must escape the hospitals Malawians cannot choose to escape. Of course I intimately know many problems that plague the health care system here, but somehow I still find the alacrity of flight disturbing. I am not saying I would not leave myself if I felt the care I required was more readily available outside. I am saying it disturbs me. It seems that individual decisions to leave reveal our shallow roots. We say, "I like you but I cannot REALLY trust you." "I will work with you but I will always keep my 'get outta jail, free' card in my back pocket." The subtle message being, "we can work at becoming equals but we are not equal." A constant reminder that we are in this world but not of it. Dominique and Patricio, unlike most, decided they would stay and have their baby at Kamuzu Central Hospital.
Tarek introduced us in January. Dominque's due date was the end of March. I was thrilled with the idea of accompanying a couple through the process of pregnancy to birth and beyond, and I instantly fell in love with Dominque's calm certainty as well as with Patricio's energy and adoration for his growing family.
May 9, I met them at the hospital to give them a tour of the labor ward, several weeks before the expected arrival. But Tarek had scanned her just moments before and said the baby was not growing well, he said there was little amniotic fluid and it needed to come out soon. Tarek decided to recheck in two days.
May 11th, the story was the same. Dominique hoped for a vaginal birth and wanted to try an induction, so we began. Inductions are slow. I gave her the first dose of medication to ripen her cervix and we waited. I listened to the baby's heart. And we waited. Two hours later Tarek agreed that we could continue at my house (which is a 5 minute drive from the hospital) and so we packed up and headed there. I cooked and listened and we waited.
After four hours I gave her the second dose. Dominque said she felt well and I listened, but the baby was changing. As the silence between each beat spread, I could feel my heart filling the time with it's own accelerating rhythm. I called Tarek and we quickly agreed that the induction had failed and it was time to move to a caesarian.
Within 30 minutes Dominique was on the operating table, Mr Banda (the Malawian anesthetist) was placing her spinal, Lisa (the Australian pediatrician) was helping me assemble the resuscitation equipment, and Tarek and the scrub nurses were ready to begin. Poor Patricio was left alone in the empty hall looking incredibly anxious, sitting on the single available chair.
Within two minutes of the first incision, a little girl was wiggling in my hands. It took her a minute to pink up - Lisa and I held our breaths in subconscious solidarity - and then she did, and she was beautiful. Mr Banda was the first to give Patricio the good news. I came out a minute later to get the chitengi from Patricio and was surprised to find him talking with Clement (all the Malawian women bring a new colorful chitengi to wrap their little ones in and Dominique had done the same much to the enjoyment of the Malawian nurses). Apparently Clement called me but when I didn't answer he suspected something was happening and headed to the labor ward where he was told that we were in theatre. Patricio said he appeared like an angel, "just when I was ready to kill myself he walked through the door and took away the knife."
It was the most beautiful caesarian ever; one of the most beautiful births. After Dominique was wheeled out of the theatre, everyone who participated stood around together and took pictures as a group. There was a moment when Patricio held his baby girl looking at her with such amazing love, and Tarek and Clement were also gazing over his shoulders adoringly. That was definitely my favorite part, three men completely awestruck by a tiny little girl (2.5kg).
Dominique and Patricio stayed in the hospital Thursday and Friday and then Saturday Tarek said it would be alright if they continued their convalescence at my home. Every morning felt like Christmas - the feeling that an incredible vision was waiting; every morning waking up to see the beautiful baby. Every evening coming home felt like peace. Tuesday Tarek said they could go home and they did. Before they left, after several nameless days, they gave her a name, Lua Joanne Alvarez.
Saturday night, the night new life entered my home, I got a call, someone speaking Chichewa I could not understand. It was the same number I had seen a few time in the previous nights but I always thought it was a wrong number so I just hung up. This time I asked Clement to talk. He said it was the headman from Mbizi saying the baby died. I didn't sleep well, wondering if it was really true, realizing someone had been calling me for help and I had hung up. In the morning Ireen's father called and said her baby had indeed died, he said she didn't have enough milk to give her baby. I told him I would come. He said they would wait for me to bury the body.
I called Deb and of course she wanted to come so we headed out to the village together. When we arrived, women encircled the house and Ireen's father met our car with red eyes and tear stained cheeks. He led us to the house and the women made way for us. Inside little Alinafe was laid out on a grass mat covered by chitengies, which were pulled down for us to see her face. Ireen sat next to her on the floor ceaselessly rocking back and forth and ceaselessly crying, "Mwana anga Mwana anga" (My baby My baby). The women echoed her with their wails. Deb and I cried.
Ireen's father told us that the baby had been "crying too much in the night" and Ireen felt she didn't have enough milk. She had even told me that when I saw her last, but I saw milk in the baby's mouth as she nursed and so I just encouraged Ireen to eat well, drink much, and breastfeed often. She knew. I didn't. They had taken Alinafe to the clinic on Thursday and she died Friday.
After a short while the women placed the body in a small cloth lined box and carried it away from the circle of homes. The men walked with us until we reached the field at that point Ireen's father said he had to stay because the men couldn't go on but that we should continue with the women. Deb and I followed the procession, the last two in the line.
We followed the barefoot women through the fallow fields. I wished I was also barefoot so that the earth could absorb some of my sorrow; so that I too could feel its firmness under me and feel reassured. We walked through fields towards a conspicuous group of trees and as we walked I gathered a small handle of the purple and orange flowers that sprouted up between the drying stalks of maize.
When we entered the circle of trees, the women stopped around a small freshly dug hole. A couple women took turns digging the earth until the size and shape of the hole met their satisfaction, while others wailed. Then Deb helped them lower the small casket into the ground. Once the casket was positioned, the women climbed out, and three or four at a time, they took turns with the hoes to push the dirt back again. As they dug I tossed the flowers down, but someone recovered them and shook them free of dirt. In the end a little mound stood where the hole had been, the woman handed me the flowers, made a small pit at the head of the mound with her hand, and gestured for me to put them there. I did.
We followed the women back out to the houses again. Ireen and her parents told us we must continue to visit even though we had buried our baby. We exchanged greetings with the village headman. We promised to return and then we left.
Tarek introduced us in January. Dominque's due date was the end of March. I was thrilled with the idea of accompanying a couple through the process of pregnancy to birth and beyond, and I instantly fell in love with Dominque's calm certainty as well as with Patricio's energy and adoration for his growing family.
May 9, I met them at the hospital to give them a tour of the labor ward, several weeks before the expected arrival. But Tarek had scanned her just moments before and said the baby was not growing well, he said there was little amniotic fluid and it needed to come out soon. Tarek decided to recheck in two days.
May 11th, the story was the same. Dominique hoped for a vaginal birth and wanted to try an induction, so we began. Inductions are slow. I gave her the first dose of medication to ripen her cervix and we waited. I listened to the baby's heart. And we waited. Two hours later Tarek agreed that we could continue at my house (which is a 5 minute drive from the hospital) and so we packed up and headed there. I cooked and listened and we waited.
After four hours I gave her the second dose. Dominque said she felt well and I listened, but the baby was changing. As the silence between each beat spread, I could feel my heart filling the time with it's own accelerating rhythm. I called Tarek and we quickly agreed that the induction had failed and it was time to move to a caesarian.
Within 30 minutes Dominique was on the operating table, Mr Banda (the Malawian anesthetist) was placing her spinal, Lisa (the Australian pediatrician) was helping me assemble the resuscitation equipment, and Tarek and the scrub nurses were ready to begin. Poor Patricio was left alone in the empty hall looking incredibly anxious, sitting on the single available chair.
Within two minutes of the first incision, a little girl was wiggling in my hands. It took her a minute to pink up - Lisa and I held our breaths in subconscious solidarity - and then she did, and she was beautiful. Mr Banda was the first to give Patricio the good news. I came out a minute later to get the chitengi from Patricio and was surprised to find him talking with Clement (all the Malawian women bring a new colorful chitengi to wrap their little ones in and Dominique had done the same much to the enjoyment of the Malawian nurses). Apparently Clement called me but when I didn't answer he suspected something was happening and headed to the labor ward where he was told that we were in theatre. Patricio said he appeared like an angel, "just when I was ready to kill myself he walked through the door and took away the knife."
It was the most beautiful caesarian ever; one of the most beautiful births. After Dominique was wheeled out of the theatre, everyone who participated stood around together and took pictures as a group. There was a moment when Patricio held his baby girl looking at her with such amazing love, and Tarek and Clement were also gazing over his shoulders adoringly. That was definitely my favorite part, three men completely awestruck by a tiny little girl (2.5kg).
Dominique and Patricio stayed in the hospital Thursday and Friday and then Saturday Tarek said it would be alright if they continued their convalescence at my home. Every morning felt like Christmas - the feeling that an incredible vision was waiting; every morning waking up to see the beautiful baby. Every evening coming home felt like peace. Tuesday Tarek said they could go home and they did. Before they left, after several nameless days, they gave her a name, Lua Joanne Alvarez.
Saturday night, the night new life entered my home, I got a call, someone speaking Chichewa I could not understand. It was the same number I had seen a few time in the previous nights but I always thought it was a wrong number so I just hung up. This time I asked Clement to talk. He said it was the headman from Mbizi saying the baby died. I didn't sleep well, wondering if it was really true, realizing someone had been calling me for help and I had hung up. In the morning Ireen's father called and said her baby had indeed died, he said she didn't have enough milk to give her baby. I told him I would come. He said they would wait for me to bury the body.
I called Deb and of course she wanted to come so we headed out to the village together. When we arrived, women encircled the house and Ireen's father met our car with red eyes and tear stained cheeks. He led us to the house and the women made way for us. Inside little Alinafe was laid out on a grass mat covered by chitengies, which were pulled down for us to see her face. Ireen sat next to her on the floor ceaselessly rocking back and forth and ceaselessly crying, "Mwana anga Mwana anga" (My baby My baby). The women echoed her with their wails. Deb and I cried.
Ireen's father told us that the baby had been "crying too much in the night" and Ireen felt she didn't have enough milk. She had even told me that when I saw her last, but I saw milk in the baby's mouth as she nursed and so I just encouraged Ireen to eat well, drink much, and breastfeed often. She knew. I didn't. They had taken Alinafe to the clinic on Thursday and she died Friday.
After a short while the women placed the body in a small cloth lined box and carried it away from the circle of homes. The men walked with us until we reached the field at that point Ireen's father said he had to stay because the men couldn't go on but that we should continue with the women. Deb and I followed the procession, the last two in the line.
We followed the barefoot women through the fallow fields. I wished I was also barefoot so that the earth could absorb some of my sorrow; so that I too could feel its firmness under me and feel reassured. We walked through fields towards a conspicuous group of trees and as we walked I gathered a small handle of the purple and orange flowers that sprouted up between the drying stalks of maize.
When we entered the circle of trees, the women stopped around a small freshly dug hole. A couple women took turns digging the earth until the size and shape of the hole met their satisfaction, while others wailed. Then Deb helped them lower the small casket into the ground. Once the casket was positioned, the women climbed out, and three or four at a time, they took turns with the hoes to push the dirt back again. As they dug I tossed the flowers down, but someone recovered them and shook them free of dirt. In the end a little mound stood where the hole had been, the woman handed me the flowers, made a small pit at the head of the mound with her hand, and gestured for me to put them there. I did.
We followed the women back out to the houses again. Ireen and her parents told us we must continue to visit even though we had buried our baby. We exchanged greetings with the village headman. We promised to return and then we left.
Tuesday, May 02, 2006
Ireen
My stories weave in and out of each other, sometimes I give updates and sometimes you never hear what happens to the people I introduce you to. Ireen’s present is a happy one and her story deserves an update (March 27, 2006). Ireen is the young girl who had an unbelievable but true hemoglobin of 1.7 a couple weeks after giving birth. At the time I thought she would surely die, but 10 pints later she was smiling and packing her bags on her way back to the village. Deb and I promised to visit and we arranged a date to meet her at a nearby health center (since directions to a hut in a village off the main road are nearly unintelligible, especially when you’re getting them through a translator). Deb and I arrived at the health center as planned on a Friday to find Ireen’s father, a handsome man despite a few missing front teeth, her mother who is also stunningly beautiful but probably just passes 4 feet tall, Ireen, and the baby girl waiting.
Surprisingly her father speaks good English and as he directed us over the 20 kilometers of dirt roads back to their village he narrated the whole way. As we drove away from the main road we approached two hills that rise suddenly from the land like enormous boulders. Ireen’s father said we should remember to drive towards the hills. He told us the name of both (which I don’t remember) and that we should look for the mouth on the second hill. There is a crescent shaped crevice in the second hill that does indeed look like a soft smile. As we drove past he said in a serious tone, “It’s a very nice mouth, isn’t it?” Deb and I mumbled an agreement and stifled our laughs.
In the village, as it seems to happen in the village, we were welcomed like royalty. The father proudly introduced children and grandchildren, making each of the little ones kneel and shake our hands (that is the way children traditionally greet adults). At one point I counted over 20 children under the age of 10, all smiling and sitting calmly, dressed in literal rags (you can easily imagine the population pyramid of Malawi, no WHO graph necessary). With my paltry Chichewa I think I understood the father tell all the adults we met, including the village headman, that Ireen had run out of blood and we gave her ours (5 pints and 5 pints). We did help retrieve the blood from the bank and make sure that it went into her veins but we certainly didn’t give five pints each (I’ll have to correct that story).
Ireen looked great; I could see pink gums and a pink tongue when she laughed. We asked her if they had given her any medicine at the hospital and she said they gave her iron pills, but when it took her and her mother a good 5-10 minutes of searching to find the pills, I got the idea that she’s not taking them. The baby did not look so great; in the four hours we spent together, she just slept and slept. Finally I told Ireen to wake her and feed her, and I told her not to let her sleep so long without eating. When she did nurse, her sucking was weak, and although she grimaced she did not cry. Before we left the family fed us a meal of nsima and beans and then filled my trunk with sugar cane, green maize, and sweet potatoes.
Two weeks later, Deb and I returned. We passed the house and just as we were turning around Ireen’s father ran up breathless. He said someone told him, “Your strangers just drove by,” and so he took off after us. When we got back to the house everyone was laughing about how we just passed right by. I had worried about the baby but she was much improved, squirming, crying, nursing, acting like a normal baby. She also peed straight through my dress within my first five minutes there. This time Ireen’s father took us to his mother’s house which sat on a nearby hill (not the smiling hill) and had an amazing view. Ireen’s grandmother thanked us profusely and told us that so often when you go to the health center, the clinician just gives you a pain killer and continues to read the paper. She thanked us for taking action and saving Ireen’s life. Ireen’s great-grandmother nodded in agreement. The grandmother wanted to give us something and Ireen’s father said they would cook chicken for us next time (a big deal). Once again they served us nsima, this time with okra and pumpkin leaves (yum), and then filled my trunk sugar cane, pumpkins, and sweet potatoes. We come with so little and then end up driving away with their food. At least there is happiness on both ends. Next time I want to bring kid’s clothes, that will be fun to distribute (used clothes are cheap in the market).
Surprisingly her father speaks good English and as he directed us over the 20 kilometers of dirt roads back to their village he narrated the whole way. As we drove away from the main road we approached two hills that rise suddenly from the land like enormous boulders. Ireen’s father said we should remember to drive towards the hills. He told us the name of both (which I don’t remember) and that we should look for the mouth on the second hill. There is a crescent shaped crevice in the second hill that does indeed look like a soft smile. As we drove past he said in a serious tone, “It’s a very nice mouth, isn’t it?” Deb and I mumbled an agreement and stifled our laughs.
In the village, as it seems to happen in the village, we were welcomed like royalty. The father proudly introduced children and grandchildren, making each of the little ones kneel and shake our hands (that is the way children traditionally greet adults). At one point I counted over 20 children under the age of 10, all smiling and sitting calmly, dressed in literal rags (you can easily imagine the population pyramid of Malawi, no WHO graph necessary). With my paltry Chichewa I think I understood the father tell all the adults we met, including the village headman, that Ireen had run out of blood and we gave her ours (5 pints and 5 pints). We did help retrieve the blood from the bank and make sure that it went into her veins but we certainly didn’t give five pints each (I’ll have to correct that story).
Ireen looked great; I could see pink gums and a pink tongue when she laughed. We asked her if they had given her any medicine at the hospital and she said they gave her iron pills, but when it took her and her mother a good 5-10 minutes of searching to find the pills, I got the idea that she’s not taking them. The baby did not look so great; in the four hours we spent together, she just slept and slept. Finally I told Ireen to wake her and feed her, and I told her not to let her sleep so long without eating. When she did nurse, her sucking was weak, and although she grimaced she did not cry. Before we left the family fed us a meal of nsima and beans and then filled my trunk with sugar cane, green maize, and sweet potatoes.
Two weeks later, Deb and I returned. We passed the house and just as we were turning around Ireen’s father ran up breathless. He said someone told him, “Your strangers just drove by,” and so he took off after us. When we got back to the house everyone was laughing about how we just passed right by. I had worried about the baby but she was much improved, squirming, crying, nursing, acting like a normal baby. She also peed straight through my dress within my first five minutes there. This time Ireen’s father took us to his mother’s house which sat on a nearby hill (not the smiling hill) and had an amazing view. Ireen’s grandmother thanked us profusely and told us that so often when you go to the health center, the clinician just gives you a pain killer and continues to read the paper. She thanked us for taking action and saving Ireen’s life. Ireen’s great-grandmother nodded in agreement. The grandmother wanted to give us something and Ireen’s father said they would cook chicken for us next time (a big deal). Once again they served us nsima, this time with okra and pumpkin leaves (yum), and then filled my trunk sugar cane, pumpkins, and sweet potatoes. We come with so little and then end up driving away with their food. At least there is happiness on both ends. Next time I want to bring kid’s clothes, that will be fun to distribute (used clothes are cheap in the market).
Cromwell
For those of you who have read my earlier posts you remember Cromwell my Malawian running buddy who had a stroke at the age of 29 (see post May 30, 2005). A few months ago he left Lilongwe and moved to North to Kasungu to stay with his parents. I saw him before he left. He was both physicially and psychologically damaged. He is able to walk unassisted, but is still severly affected by the stroke and cannot use his left hand at all. He has had no physical improvement in the last many months, but I always lie and tell him he looks a bit better everytime he asks me what I think. Psychologically, well, he just seems sad.
This past weekend he came to Lilongwe for a doctor's visit and I stopped by to visit. I found him unchanged. We talked a bit and then he showed me his recent chest X-ray. It was an eerie sight. His heart fills about two-third of his chest cavity and has taken the shap of a large droopy "L". Apparently the problem is due to faulty valves; something that no one ever picked up - and even if they had, there is no heart surgeon in Malawi. So, over years and years of his heart trying to compensate for his poor valves, it has grown into an enormous disfigured muscle. I felt so sad sitting with him, looking through that window in his chest, realizing that nothing can done. Death is inevitable of course, but for him it will most likely come soon. I doubt he will reach the young life expectancy here of 37, he is 30 now.
I told him I was so sorry, he said in a sad resigned tone, "Don't worry about me, Joanne, that's part of life."
This past weekend he came to Lilongwe for a doctor's visit and I stopped by to visit. I found him unchanged. We talked a bit and then he showed me his recent chest X-ray. It was an eerie sight. His heart fills about two-third of his chest cavity and has taken the shap of a large droopy "L". Apparently the problem is due to faulty valves; something that no one ever picked up - and even if they had, there is no heart surgeon in Malawi. So, over years and years of his heart trying to compensate for his poor valves, it has grown into an enormous disfigured muscle. I felt so sad sitting with him, looking through that window in his chest, realizing that nothing can done. Death is inevitable of course, but for him it will most likely come soon. I doubt he will reach the young life expectancy here of 37, he is 30 now.
I told him I was so sorry, he said in a sad resigned tone, "Don't worry about me, Joanne, that's part of life."
Saving Lives
Last Tuesday my big dream for the Embassy came true . . . we had our first blood drive in benefit of the local hospitals and clinics. It was fabulous. I was hoping for about 20 donors and I don’t think we would have even reached that number if it had not been for Anna and Tyler Sparks who spread the word across Lilongwe and walked around USAID, CDC and the Embassy signing people up.
At the end of the day, 45 pints sat in a box, on their way to saving lives. The representative from Malawi Blood Transfusion Service (MBTS – they are the ones who collect, test, store, and distribute the blood nationwide) said it was one of their most successful drives ever. Even the US Ambassador donated and promised that he would wear his “I donated blood” sticker to Parliament.
On the whole, people were incredibly enthusiastic and many asked when the next drive would be, so they could mark it on their calendars. I was told that a large group of Peace Corps (PC)volunteers who were in town also wanted to donate but since they need individual medical clearance from the PC physician, they were unable to donate. However, the PC director did say they will organize their own drive soon. The fun part is that these are people who are not allowed to donate blood in the States because they live in a malaria endemic area.
Apparently in a meeting this morning the Ambassador raved once again about the blood drive and said that for the next drive, in September, we should involve the Germans, French, and British too. I am sooo happy.
Just as a background note, MBTS says they need about 1500 pints of blood each month to meet the demand and currently they only receive about 500. The majority of the blood is used for children (malaria induced anemia is a huge killer), for peripartum women, and trauma victims. During the rainy season, which is also the malaria season, the demand for blood increases dramatically and because there are many days when there is simply no blood available, the number of preventable deaths (especially among children) also increases. Less than a pint of blood can save the life of an anemic child! Globally, it is estimated that 43% of children under the age of 5 are anemic.
My next idea is to maintain a “food pantry” just for formula to give to the orphans of women who die in childbirth.
At the end of the day, 45 pints sat in a box, on their way to saving lives. The representative from Malawi Blood Transfusion Service (MBTS – they are the ones who collect, test, store, and distribute the blood nationwide) said it was one of their most successful drives ever. Even the US Ambassador donated and promised that he would wear his “I donated blood” sticker to Parliament.
On the whole, people were incredibly enthusiastic and many asked when the next drive would be, so they could mark it on their calendars. I was told that a large group of Peace Corps (PC)volunteers who were in town also wanted to donate but since they need individual medical clearance from the PC physician, they were unable to donate. However, the PC director did say they will organize their own drive soon. The fun part is that these are people who are not allowed to donate blood in the States because they live in a malaria endemic area.
Apparently in a meeting this morning the Ambassador raved once again about the blood drive and said that for the next drive, in September, we should involve the Germans, French, and British too. I am sooo happy.
Just as a background note, MBTS says they need about 1500 pints of blood each month to meet the demand and currently they only receive about 500. The majority of the blood is used for children (malaria induced anemia is a huge killer), for peripartum women, and trauma victims. During the rainy season, which is also the malaria season, the demand for blood increases dramatically and because there are many days when there is simply no blood available, the number of preventable deaths (especially among children) also increases. Less than a pint of blood can save the life of an anemic child! Globally, it is estimated that 43% of children under the age of 5 are anemic.
My next idea is to maintain a “food pantry” just for formula to give to the orphans of women who die in childbirth.
Love and Heroes
When is someone amazing? When is a feat of love or bravery above what we should expect from ourselves and neighbors on this planet? Is it simply when we sacrifice comfort? Is it when our act does not benefit us? Or, is it only when we face death? . . .
Perhaps we are amazing and heroic anytime our love is tested and we respond out of love, rather than fear.
I am currently reading, “We wish to inform you that tomorrow we will be killed with our families,” by Philip Gourevitch and was struck again by the story of Paul Rusesabagina (the Rwandan hotel manager whose story was told in the movie “Hotel Rwanda”). When interviewed, he said he believed he was one of many doing everything in their power to save those they could, only afterwards did he realize he was one of very few.
What I am coming to believe is that being human is a struggle, and being poor is a greater struggle. It’s not about being African or about tribal warfare (those are excuses made by the perpetrators and by the international community which chose blindness). Love, for us, is as natural as hate; both take cultivation and both can flourish in the same environments.
Thankfully the majority of us will never face a situation that demands so much from us; in the West the stakes are rarely as high. But we all have opportunities to practice love and bravery daily, in our speech, in our actions, and in the politics we support.
Perhaps we are amazing and heroic anytime our love is tested and we respond out of love, rather than fear.
I am currently reading, “We wish to inform you that tomorrow we will be killed with our families,” by Philip Gourevitch and was struck again by the story of Paul Rusesabagina (the Rwandan hotel manager whose story was told in the movie “Hotel Rwanda”). When interviewed, he said he believed he was one of many doing everything in their power to save those they could, only afterwards did he realize he was one of very few.
What I am coming to believe is that being human is a struggle, and being poor is a greater struggle. It’s not about being African or about tribal warfare (those are excuses made by the perpetrators and by the international community which chose blindness). Love, for us, is as natural as hate; both take cultivation and both can flourish in the same environments.
Thankfully the majority of us will never face a situation that demands so much from us; in the West the stakes are rarely as high. But we all have opportunities to practice love and bravery daily, in our speech, in our actions, and in the politics we support.
Monday, April 10, 2006
Remember Us
After a few hours the mother arrived with an expressionless face and devastated eyes. We sat down with the nursery nurse and when we learned that the father was outside, we called him in so he could also learn how to make milk for his daughter from the powder in a can. Both mother and husband listened attentively, and when the mother-in-law became confused the son-in-law explained the process again. I gave them a ride to the mortuary. The mother carried her daughter’s things on her head, to and from the car, in a bag that almost eclipsed her upright figure. As the men pushed the body of her daughter into the ambulance that would take them to the village, I held her shoulders and then helped her in after the still form wrapped in an old blue blanket. I told the father I would meet him Saturday at 10am at Bottom hospital, to give him more formula, and then we would travel together to his village.
Saturday at 9:54 I left my house, Nathan called a minute later to say he was waiting at Bottom, I told him I was on my way. I got stuck in traffic and arrived at 10:15. He greeted me with a friendly smile and we drove back together 50 kilometers to his home. I realized that he had biked 20 kilometers from his house to a larger town, then boarded a minibus for the remaining 30km and was waiting for me by 10, in a suit. I imagine it was his only suit, threadbare with a tear in the knee. I imagined his wife in heavy labor making her way those 50 kilometers to Bottom Hospital.
Nathan is a farmer with four children. He farms maize and some years tobacco, but not this year. He speaks good English, but he says he just trys. On the way Nathan told me that I should name the child. I suggested a few of my favorite Chewa names but after turning them over on his tongue a few times, it was clear none really satisfied him. I asked him what name he thought would fit and without hesitating he said “Chikumbutsu.” (Good thing I asked, that would have never come from me!) He said it means “Remember us.” I told him it was a good name and he smiled softly.
We first went to his home where he introduced me to his parents and sisters, and they gave me the biggest cucumbers I have ever seen. All of his siblings live within meters of each other in neat mud brick homes with well swept dirt yards. Three of his sisters and his mother sat on the ground preparing pumpkin leaves for cooking and his father leaned back in a chair looking well, although I later learned he has tuberculosis.
From there we went to his wife’s family home, another 12 km away. He said that her family was keeping his children because they needed children around in such a time of sadness. Nathan said he would collect the children in a couple weeks. When we arrived, he ushered me into a small dark room where many female relatives quickly gathered. I held Chikumbutsu as he called her name for the first time. His four year old daughter Pamela climbed into his lap. The women expressed their gratitude. I told them I was sorry. His oldest son Clement went to the field and returned with pumpkins and maize to fill my back seat. So much gratitude for so little, after too much had happened. Then I departed.
Nathan promised he would accompany me until I was sure of the road and Pamela began to cry as he climbed in and so he lovingly took her on to his lap again. We drove about a kilometer and I assured him that I would find my way. The two of them got out and he thanked me again. In my rearview mirror I watched Nathan walking away, back towards the house, with Pamela on his shoulders.
Ennui
This life made up of countless ordinary moments; they just walk by one by one without adventure or tragedy or heroism. Life is the space before and after memories. Life is waiting. The story grows in the telling, in the imagining, but in the living it is just one minute followed by another.
Monday, March 27, 2006
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!
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!
Tuesday, March 21, 2006
Grace
I just went to visit Frank and his baby Grace. He told me everyone has started calling her Joana.
Monday, March 20, 2006
Heart-Warming
During the hand-shaking rounds on my second day at the Embassy, Elizabeth told me that her guard Frank's wife died at Kamuzu Central Hospital the day after giving birth just one week previously. Elizabeth and her partner played an active role in ensuring that the wife received adequate prenatal care and everything seemed to be going well. Frank is 28, his wife Grace was 26. The two of them met, fell-in-love, married and got pregnant within the span of two years. Elizabeth said they were both kind and naturally bright people who should have been doing better in life but were poor because they were born poor and their families were poor. Grace's death was a huge shock to everyone.
About a week later I met Frank at Elizabeth's and together we made our way to his mother-in-law's house where his baby girl was staying. Frank told me more of their story on my second visit. He said that Grace delivered in a health center and everything went well with the birth. After seeing his wife and sharing the thrill of their new daughter, he ran home to gather food and other items they needed. When he got back to the hospital the nurse told him that his wife was incredibly sick and would be transferred to the ICU at KCH. The next day everything seemed to deteriorate. Neither Frank nor his wife knew what was happening, but he said there was a moment when she realized she was dying. She cried about leaving him and the children. (Grace also had a boy, he is six years old now. His dad abandoned Grace as soon as he learned she was pregnant. Frank considers this boy his son and the boy has never known another dad.) They cried together, and she made him promise to take good care of their daughter.
After he finished the story Frank looked at the boy lovingly and as he tearfully shook his head he said, "This one gives me a lot of problems, every night he asks, "Where's mom? Where's mom? And he just cries when I work night shifts and don't come home."
Frank showed me the death certificate; it said "toxemia of pregnancy." Grace died from eclampsia, a little understood disease of pregnancy the end result of which is multi-system organ failure. Although women do become preeclamptic in the developed world they rarely develop eclampsia (the diagnosis is given once a woman seizes) and very rarely die. Here, this is a much more common cause of death for various absurd reasons (I'll leave out speech). Frequently, the diagnosis is not made until there is a seizure, which happens fairly late in the pathological process.
Frank is clearly a special person and adores his little Grace. Although she doesn't live in his house, he lives only 1000 meters away and spends all his off-duty time with her. He asked me to come visit regularly to make sure she is healthy and growing well, and she is. She's sweet and chubby and usually bundled in multiple layers of tenderly knitted outfits (sweating in the African heat), clearly a dearly loved child. I don't do much, just hold her, and reassure Frank, and deliver formula when his supply runs low. He's a great dad.
Last week Elizabeth stopped by to tell me that Frank took Grace for her well-baby check and was told that she was the healthiest baby of all those who visited the clinic that day. Elizabeth said Frank was glowing.
Yesterday Frank called to tell me that he had something to tell me and he would come to the Embassy today to see me. ? ? ?
This morning I found Frank waiting for me at the entrace of the Embassy and he said that he decided to volunteer at the Crisis Nursery one day every week, "as a way to thank you people for everything you've done for me." I felt like laughing and crying all at once. This is someone who works six days a week and earns about US$30 a month, has lost his wife, is raising two children and still has a surplus of love to share with orphans. Frank just laughed at my reaction, said "Thank you" and "When are you coming?"
"Tuesday, I'll see you and Grace Tuesday."
About a week later I met Frank at Elizabeth's and together we made our way to his mother-in-law's house where his baby girl was staying. Frank told me more of their story on my second visit. He said that Grace delivered in a health center and everything went well with the birth. After seeing his wife and sharing the thrill of their new daughter, he ran home to gather food and other items they needed. When he got back to the hospital the nurse told him that his wife was incredibly sick and would be transferred to the ICU at KCH. The next day everything seemed to deteriorate. Neither Frank nor his wife knew what was happening, but he said there was a moment when she realized she was dying. She cried about leaving him and the children. (Grace also had a boy, he is six years old now. His dad abandoned Grace as soon as he learned she was pregnant. Frank considers this boy his son and the boy has never known another dad.) They cried together, and she made him promise to take good care of their daughter.
After he finished the story Frank looked at the boy lovingly and as he tearfully shook his head he said, "This one gives me a lot of problems, every night he asks, "Where's mom? Where's mom? And he just cries when I work night shifts and don't come home."
Frank showed me the death certificate; it said "toxemia of pregnancy." Grace died from eclampsia, a little understood disease of pregnancy the end result of which is multi-system organ failure. Although women do become preeclamptic in the developed world they rarely develop eclampsia (the diagnosis is given once a woman seizes) and very rarely die. Here, this is a much more common cause of death for various absurd reasons (I'll leave out speech). Frequently, the diagnosis is not made until there is a seizure, which happens fairly late in the pathological process.
Frank is clearly a special person and adores his little Grace. Although she doesn't live in his house, he lives only 1000 meters away and spends all his off-duty time with her. He asked me to come visit regularly to make sure she is healthy and growing well, and she is. She's sweet and chubby and usually bundled in multiple layers of tenderly knitted outfits (sweating in the African heat), clearly a dearly loved child. I don't do much, just hold her, and reassure Frank, and deliver formula when his supply runs low. He's a great dad.
Last week Elizabeth stopped by to tell me that Frank took Grace for her well-baby check and was told that she was the healthiest baby of all those who visited the clinic that day. Elizabeth said Frank was glowing.
Yesterday Frank called to tell me that he had something to tell me and he would come to the Embassy today to see me. ? ? ?
This morning I found Frank waiting for me at the entrace of the Embassy and he said that he decided to volunteer at the Crisis Nursery one day every week, "as a way to thank you people for everything you've done for me." I felt like laughing and crying all at once. This is someone who works six days a week and earns about US$30 a month, has lost his wife, is raising two children and still has a surplus of love to share with orphans. Frank just laughed at my reaction, said "Thank you" and "When are you coming?"
"Tuesday, I'll see you and Grace Tuesday."
Sunday, March 12, 2006
Simple Joy
The world is an incredible place to be in . . . I feel alive and happy, so I decided this would be a good moment to write an entry. Clement and I just returned from our friends' house in Natenji, a green 20km South of Lilongwe. Malawi is stunningly beautiful at the moment. The hills and distant mountains transformed from barren brown to lush green with the attentive care of the rains. The maize grows thick and tall in the fields and they say this year there will be a record harvest, maybe enough to feed the entire population (usually in a good year 25% of the population faces food insecurity, this year it was closer to 80%).
Our friends are lovely. I am constantly in awe of and grateful for the people who color my life. Patricio is Chilean and works on wildlife conservation projects. Dominique, his Belgian/Congolese wife, is a nurse who now works with health outreach projects. They are a beautiful couple on multiple levels. Dominique is 7 months pregnant and they have asked me to attend their birth. It is a huge honor and will be the first birth of a friend that I will attend as a midwife.
We spent the afternoon leisurely eating a delicious meal and discussing the pieces of Malawi we love. Here is a smattering from our list: the calmness of the people, the peacefulness of the country, the beauty of the land, the beautiful women and adorable kids. Dominique and Patricio live near a village and they talked about the laughter and song of the women lilting into their yard. Patricio said, "the women here are incredible, they get up at 4am, cook, carry water, work in the fields, clean, tend their families, and then in the evening they sing. Sometimes I just want to shake them and tell them to please rest." Dominique talked about the dancing, how health messages are learned as songs and dances, and then shared by women volunteers with people in their communities. She noted that everyone, young and old, is happy to participate; everyone is equally willing to get up in front of a group and dance with the simple joy of movement and without a grain of self-consciousness.
Of course for me, many of the good moments are also birth related. I had a couple sweet birth moments recently. . .
(1) About a week ago there was one woman who was having a particularly difficult birth. Birth is painful for most women but a few women truly suffer with their labor beyond what others experience. This woman cried for hours, often calling for the nurses who could do little to comfort her; incessantly changing positions to try and find relief. I was with her when she finally delivered. At the first cry of the baby, the laboring women occupying the bed next to her let out a laugh of pure glee and began clapping.
I cleaned the woman, told her she had a boy, and arranged her and her little boy in the bed. A few minutes later the maid shouted her name from the doorway. (The patients' caretakers wait outside and will occasionally ask the maids to find out if their relative has delivered.)
She responded, "INE!" (I am).
"MWACHIRA?" (Have you delivered?)
"EI!" (Yes)
"WACHIANI?" (what is it?)
She clutched her baby happily but looked at me, completely exhausted and confused "Wachiani?"
Her neighbor, who witnessed the whole thing, laughed again between her own contractions.
"Mwamuna," I said.
"MWAMUNA!"
(2) There was a really sweet girl who came into the labor ward at the beginning of my night shift last week. She said she was 20 but looked closer to 16. Her expression was intense, focused, innocent, and fearful. Looking at her still, she looked like a normal young girl, but movement made her jerky and a bit imbalanced, maybe polio? maybe muscular dystrophy? She came first in early labor and was sent out but her contractions continued so was eventually settled into a bed in the ward. I kept an eye on her, just noticing her, and feeling a bit protective.
Another nurse attended her delivery in the early morning hours but the ward was almost empty so I stood maybe 15 feet away and watched. This particular nurse is a very sweet woman but sometimes assumes the persona of a little soldier, shouting directions and orders at the laboring women as she walks between the beds. And so she stood, shouting directions on how to push as the girl grabbed her knees, shut her eyes tightly, and pushed with all her might. Every now and then she would open her big fearful eyes, look briefly at the nurse, and then snap them shut to push again tensely and intensely.
The girl did a beautiful job. The baby was born and I watched the nurse lay it on the girl's belly, wipe it and cut the cord. But I also noticed the still blue legs remained still. At that point I retrieved the baby from the mom, gave her a few breaths until she became pink and cried. When I took her back to her young mom, the girl held out her arms with fingers spread wide, craning her neck, as though she was reaching with all her will for the most precious thing. As she took the baby from me and brought her gingerly to her chest, everything softened; her limbs and expression taking on peace. "Wamkazi," (Girl) I said. She opened her eyes - now big, soft, and warm - met my gaze and then closed them again. She was holding the most precious thing.
Our friends are lovely. I am constantly in awe of and grateful for the people who color my life. Patricio is Chilean and works on wildlife conservation projects. Dominique, his Belgian/Congolese wife, is a nurse who now works with health outreach projects. They are a beautiful couple on multiple levels. Dominique is 7 months pregnant and they have asked me to attend their birth. It is a huge honor and will be the first birth of a friend that I will attend as a midwife.
We spent the afternoon leisurely eating a delicious meal and discussing the pieces of Malawi we love. Here is a smattering from our list: the calmness of the people, the peacefulness of the country, the beauty of the land, the beautiful women and adorable kids. Dominique and Patricio live near a village and they talked about the laughter and song of the women lilting into their yard. Patricio said, "the women here are incredible, they get up at 4am, cook, carry water, work in the fields, clean, tend their families, and then in the evening they sing. Sometimes I just want to shake them and tell them to please rest." Dominique talked about the dancing, how health messages are learned as songs and dances, and then shared by women volunteers with people in their communities. She noted that everyone, young and old, is happy to participate; everyone is equally willing to get up in front of a group and dance with the simple joy of movement and without a grain of self-consciousness.
Of course for me, many of the good moments are also birth related. I had a couple sweet birth moments recently. . .
(1) About a week ago there was one woman who was having a particularly difficult birth. Birth is painful for most women but a few women truly suffer with their labor beyond what others experience. This woman cried for hours, often calling for the nurses who could do little to comfort her; incessantly changing positions to try and find relief. I was with her when she finally delivered. At the first cry of the baby, the laboring women occupying the bed next to her let out a laugh of pure glee and began clapping.
I cleaned the woman, told her she had a boy, and arranged her and her little boy in the bed. A few minutes later the maid shouted her name from the doorway. (The patients' caretakers wait outside and will occasionally ask the maids to find out if their relative has delivered.)
She responded, "INE!" (I am).
"MWACHIRA?" (Have you delivered?)
"EI!" (Yes)
"WACHIANI?" (what is it?)
She clutched her baby happily but looked at me, completely exhausted and confused "Wachiani?"
Her neighbor, who witnessed the whole thing, laughed again between her own contractions.
"Mwamuna," I said.
"MWAMUNA!"
(2) There was a really sweet girl who came into the labor ward at the beginning of my night shift last week. She said she was 20 but looked closer to 16. Her expression was intense, focused, innocent, and fearful. Looking at her still, she looked like a normal young girl, but movement made her jerky and a bit imbalanced, maybe polio? maybe muscular dystrophy? She came first in early labor and was sent out but her contractions continued so was eventually settled into a bed in the ward. I kept an eye on her, just noticing her, and feeling a bit protective.
Another nurse attended her delivery in the early morning hours but the ward was almost empty so I stood maybe 15 feet away and watched. This particular nurse is a very sweet woman but sometimes assumes the persona of a little soldier, shouting directions and orders at the laboring women as she walks between the beds. And so she stood, shouting directions on how to push as the girl grabbed her knees, shut her eyes tightly, and pushed with all her might. Every now and then she would open her big fearful eyes, look briefly at the nurse, and then snap them shut to push again tensely and intensely.
The girl did a beautiful job. The baby was born and I watched the nurse lay it on the girl's belly, wipe it and cut the cord. But I also noticed the still blue legs remained still. At that point I retrieved the baby from the mom, gave her a few breaths until she became pink and cried. When I took her back to her young mom, the girl held out her arms with fingers spread wide, craning her neck, as though she was reaching with all her will for the most precious thing. As she took the baby from me and brought her gingerly to her chest, everything softened; her limbs and expression taking on peace. "Wamkazi," (Girl) I said. She opened her eyes - now big, soft, and warm - met my gaze and then closed them again. She was holding the most precious thing.
Thank You
Thank you for your empathetic responses, your comments, emails, and telephone calls. Thank you for reading, for acknowledging, for feeling, for sharing this with me. Thank you for being here. Whether I know of your presence or not, I am deeply appreciative.
A few people have asked me for my updated contact information, so here it is:
Joanne Jorissen
PO Box 30543
Lilongwe, Malawi
AFRICA
tel: 011-265-8-525-951 (as directly dialled from the States)
time difference: Malawi is 6 hours ahead of the East Coast and 9 hours ahead of the West Coast.
calling cards: you can find cheap calling cards $.02/min - check the link on this site "call Malawi"
e: joanne_jorissen@yahoo.com
A few people have asked me for my updated contact information, so here it is:
Joanne Jorissen
PO Box 30543
Lilongwe, Malawi
AFRICA
tel: 011-265-8-525-951 (as directly dialled from the States)
time difference: Malawi is 6 hours ahead of the East Coast and 9 hours ahead of the West Coast.
calling cards: you can find cheap calling cards $.02/min - check the link on this site "call Malawi"
e: joanne_jorissen@yahoo.com
Thursday, March 09, 2006
Gabriel
Gabriel. I don't think I mentioned that his name was Gabriel. The second time I went to the village to collect him along with grandma, Anije (who actually turned out to be his great-aunt, but that will come later in the telling), I asked her his name. She just shook her head. Thirty minutes later when the admitting nurse at the hospital asked her she said, "Gabriel." And so, just like that he became someone. From the time of my last entry until this Monday grandma and Gabriel were regulars on the malnutrition ward. I stopped by every few days to check-in on the two of them, and usually found grandma roaming around with peanut strapped to her back. He was so tiny, sometimes you had to consciously look at the form of her chitingi to see his small bulge.
On the ward his health improved significantly; his little bum healed, the thrush sores in his mouth healed, his little cheeks started filling out a bit, and my fantasies of seeing him as a chubby little kid took flight. The stay was clearly doing much good for Gabriel but it was a strain on Anije. Everytime grandma saw me or Clement or Lisa, the pediatrician, she always asked brightly when they could leave. About two weeks ago I called a social worker Friday evening to see if I could get the baby placed at a nursery in town. The nursery, "Crisis Nursery" is run out of a home, and staffed by a mix of paid Malawians and many volunteers. It's clean and the babies get plenty of attention and good care. The social worker met me at the hospital Saturday morning and interviewed Anije, me, and the nurse after which she decided that the baby would not survive in the village until it was at least six months old. She made a deal with grandma - they would stay in the ward until the baby weighed 3.2kgs (at that time he weighed 2.9kg) and then we would take him to the nursery and I would pick grandma regularly from the village to come and visit until he was 6 months to 1 year old. The social worker called the nursery and the director said she would come and visit baby and granny the next day. I was so thrilled and impressed by the speed of the process - that would never have happened so quickly and smoothly in the States.
From that point, the program continued . . . my visits, grandma clearly loving but eager to leave, and the little one, improving but failing to gain weight. He hovered around 2.9 for at least a week, reaching 3 on some heavy days but always returning to 2.9. Monday night Clement told me that grandma left without being discharged. She sought him out so he could convey the message to me that her son-in-law was very sick at a hospital in Likuni and she had to go see him and her daughter, and that I should find her there to take little Gabriel. I had to laugh when I realized that she was probably stashing away the money I was giving her for food to fund her escape - without that I was her only way out.
Yesterday, I called the director of Crisis Nursery and she said she had come to meet them previously but couldn't find them. She found another abandoned baby instead who she gathered up and took with her to the nursery. She said she would meet me Thursday to go to Likuni together and collect Gabriel. I wanted to make sure they were at the hospital so yesterday afternoon I went to Likuni and combed every corner of the grounds with the help of a few nurses and maid but did not find them. I thought about going to the village but thought again and decided to go this morning.
Today was not a good day. On my way out of town I dented my car at a gas station (they have these big cement blocks that are low to the ground, too low to be seen, but high enough to do damage) and that was the beginning.
About a kilometer from the turn off of the main road towards the village I met grandma walking with a group of women with no little bulge on her back. I stopped and she told me so many things with incredible emotion but I only picked out that Gabriel died Wednesday. Thankfully her daughter-in-law who was present, spoke English and filled in the details. Apparently she went to see her son-in-law at Likuni but he died shortly thereafter and so she returned to the village to help with preparations for the funeral. The seven women were on their way to Lilongwe for the funeral when I met them. Wednesday, Gabriel began coughing and as they were heading back to the hospital, he died. Anije said we should go together to the house to see the body and then I could give them a lift back to Lilongwe.
As soon as I heard he died tears starting spilling on to my cheeks. We drove the 600 meters back towards the house, parked the car and then walked the last 500. There were so many women the whole way, lining the path to the house, silent, watching. Anije led us, moaning and crying with each step, her daughter-in-law took my hand in hers and we cried together silently. When we approached the house an older woman I didn't know took my other hand and the two of them led me inside behind Anije. The small dark room was filled with women and in the middle on a single thatch mat was the little wrapped body. A path opened for me, someone pulled the cloth down to reveal his face, and instantly the room filled with wailing and sobbing. . The scene was heartbreaking but I also felt so much love and support in that small room, in a way I have never previously experienced.
I just sobbed, loudly, messily; the women around me, touching my arms, crying with such love and pain. What really broked me was when one by one, all the women got up, came to me, looked me in the eyes, and silently shook my hand. Their immense gratitude surprised and overwhelmed me. I felt I had failed them and failed Gabriel, but at that moment I also felt, that I would never leave this world whether it's Malawi or somewhere similar. I will give them anything. I will give myself. We stayed only thirty minutes or so before we headed back to the car. Along the way Anije's husband and Gabriel's grandfather intercepted us. They each shook my hand and said thank you and sorry. Gabriel's grandfather said, "He has died, but he has really been loved. Don't worry." (I'm a slobbering mess again as I'm typing this in the internet cafe.)
From there, seven women piled into my 5-seater sedan and we drove to Lilongwe. Along the way Eliza, Anije's daughter-in-law told me that Anije was the aunt of the girl who died and the woman, who I thought was the 17-year-old's older sister was actually her mother and Anije's sister. Discerning blood relationships is difficult because the bottom line is that many women care for the children around them as their own. In the end, blood in only one of many lines of love and connection.
I dropped the women outside another house of mourning. Anije said thank you and that I should continue to visit the village. Eliza said there was so way to thank me. I said, "I wish I could have done more, I'm sorry." And I do, I know I shouldn't go down this path of thinking but it's difficult not to, what if I had gone to the village Wednesday afternoon or Tuesday morning to Likuni hospital???
* * *
My mom told me that all my entries are too sad and that I need to write about the good moments and the beauty of Malawi. Several friends have also told me that the stopped reading because it is too depressing. I promise I was planning to write a happy entry and I will but I appreciate your presence and compassion through this most recent heartbreak.
On the ward his health improved significantly; his little bum healed, the thrush sores in his mouth healed, his little cheeks started filling out a bit, and my fantasies of seeing him as a chubby little kid took flight. The stay was clearly doing much good for Gabriel but it was a strain on Anije. Everytime grandma saw me or Clement or Lisa, the pediatrician, she always asked brightly when they could leave. About two weeks ago I called a social worker Friday evening to see if I could get the baby placed at a nursery in town. The nursery, "Crisis Nursery" is run out of a home, and staffed by a mix of paid Malawians and many volunteers. It's clean and the babies get plenty of attention and good care. The social worker met me at the hospital Saturday morning and interviewed Anije, me, and the nurse after which she decided that the baby would not survive in the village until it was at least six months old. She made a deal with grandma - they would stay in the ward until the baby weighed 3.2kgs (at that time he weighed 2.9kg) and then we would take him to the nursery and I would pick grandma regularly from the village to come and visit until he was 6 months to 1 year old. The social worker called the nursery and the director said she would come and visit baby and granny the next day. I was so thrilled and impressed by the speed of the process - that would never have happened so quickly and smoothly in the States.
From that point, the program continued . . . my visits, grandma clearly loving but eager to leave, and the little one, improving but failing to gain weight. He hovered around 2.9 for at least a week, reaching 3 on some heavy days but always returning to 2.9. Monday night Clement told me that grandma left without being discharged. She sought him out so he could convey the message to me that her son-in-law was very sick at a hospital in Likuni and she had to go see him and her daughter, and that I should find her there to take little Gabriel. I had to laugh when I realized that she was probably stashing away the money I was giving her for food to fund her escape - without that I was her only way out.
Yesterday, I called the director of Crisis Nursery and she said she had come to meet them previously but couldn't find them. She found another abandoned baby instead who she gathered up and took with her to the nursery. She said she would meet me Thursday to go to Likuni together and collect Gabriel. I wanted to make sure they were at the hospital so yesterday afternoon I went to Likuni and combed every corner of the grounds with the help of a few nurses and maid but did not find them. I thought about going to the village but thought again and decided to go this morning.
Today was not a good day. On my way out of town I dented my car at a gas station (they have these big cement blocks that are low to the ground, too low to be seen, but high enough to do damage) and that was the beginning.
About a kilometer from the turn off of the main road towards the village I met grandma walking with a group of women with no little bulge on her back. I stopped and she told me so many things with incredible emotion but I only picked out that Gabriel died Wednesday. Thankfully her daughter-in-law who was present, spoke English and filled in the details. Apparently she went to see her son-in-law at Likuni but he died shortly thereafter and so she returned to the village to help with preparations for the funeral. The seven women were on their way to Lilongwe for the funeral when I met them. Wednesday, Gabriel began coughing and as they were heading back to the hospital, he died. Anije said we should go together to the house to see the body and then I could give them a lift back to Lilongwe.
As soon as I heard he died tears starting spilling on to my cheeks. We drove the 600 meters back towards the house, parked the car and then walked the last 500. There were so many women the whole way, lining the path to the house, silent, watching. Anije led us, moaning and crying with each step, her daughter-in-law took my hand in hers and we cried together silently. When we approached the house an older woman I didn't know took my other hand and the two of them led me inside behind Anije. The small dark room was filled with women and in the middle on a single thatch mat was the little wrapped body. A path opened for me, someone pulled the cloth down to reveal his face, and instantly the room filled with wailing and sobbing. . The scene was heartbreaking but I also felt so much love and support in that small room, in a way I have never previously experienced.
I just sobbed, loudly, messily; the women around me, touching my arms, crying with such love and pain. What really broked me was when one by one, all the women got up, came to me, looked me in the eyes, and silently shook my hand. Their immense gratitude surprised and overwhelmed me. I felt I had failed them and failed Gabriel, but at that moment I also felt, that I would never leave this world whether it's Malawi or somewhere similar. I will give them anything. I will give myself. We stayed only thirty minutes or so before we headed back to the car. Along the way Anije's husband and Gabriel's grandfather intercepted us. They each shook my hand and said thank you and sorry. Gabriel's grandfather said, "He has died, but he has really been loved. Don't worry." (I'm a slobbering mess again as I'm typing this in the internet cafe.)
From there, seven women piled into my 5-seater sedan and we drove to Lilongwe. Along the way Eliza, Anije's daughter-in-law told me that Anije was the aunt of the girl who died and the woman, who I thought was the 17-year-old's older sister was actually her mother and Anije's sister. Discerning blood relationships is difficult because the bottom line is that many women care for the children around them as their own. In the end, blood in only one of many lines of love and connection.
I dropped the women outside another house of mourning. Anije said thank you and that I should continue to visit the village. Eliza said there was so way to thank me. I said, "I wish I could have done more, I'm sorry." And I do, I know I shouldn't go down this path of thinking but it's difficult not to, what if I had gone to the village Wednesday afternoon or Tuesday morning to Likuni hospital???
* * *
My mom told me that all my entries are too sad and that I need to write about the good moments and the beauty of Malawi. Several friends have also told me that the stopped reading because it is too depressing. I promise I was planning to write a happy entry and I will but I appreciate your presence and compassion through this most recent heartbreak.
Monday, February 20, 2006
Rediscovering Humor
Wednesday I called Lisa and asked her if she would come out to the village with me to see the baby. My initial thought was to go early in the day, to make sure the baby was still alive and then, if it was, to bring Lisa in the evening but Lisa made herself immediately available, saying she had not yet been to a village and the three of us -. Deb, Lisa, and I - headed out to Mbewe. When we arrived we found the grandmother, baby, aunt, and a gaggle of children in the yard. We exchanged greetings and then Lisa unwrapped the little boy carefully looking him over, head to toe. She said that his prominent overriding sutures signified brain atrophy. His eyes were clear but she noted that they did not track movement. She said the thrush sores in his mouth would not improve despite the anti-fungal medicine until his general condition improved. She said his lungs and heart sounded good but that their rhythms portended a bad outcome. (She said his heart should have been beating at a minimal rate of 160 beats per minute but it hovered between 100 and 110bpm). She turned him over and what should have been a chubby brown little bum was bony, pink, and raw.
She said he was wasted and stunted, that his diagnosis was “Failure To Thrive (FTT),” and that he would not survive in the village. He was more active than he was the day I first took him to the hospital, but his movements were lethargic and although at times he grimaced, he never cried. Lisa said either way his prognosis was not very good. She asked if the grandmother would go to the hospital immediately but she said she wasn’t ready. We agreed that I would return early the next morning to take them back to KCH and Lisa would meet me at KCH to ensure that they were quickly and definitely admitted to Ward C, the malnutrition ward. Lisa said she wasn’t sure if the baby would survive the night. Even so, I felt hopeful. I was so grateful that she agreed to come along. I learned a lot from her quick assessment and I felt that life inside this baby was fighting to continue and now at least we could give it a fair chance.
Lisa is great. She’s one of those people who confronts desperate situations with determination, a smile, and a sense of humor. She had Deb and I cracking up all the way back to Lilongwe. She told us the story of an infant she had been seeing. The first time Lisa saw her, the girl was incredibly sick and weak and unable to eat. She gave her treatment and scheduled the mother to return for a follow-up visit. When the mom came back, she was eager to show Lisa how much the child had improved. Lisa asked, “Can she eat?” The mother enthusiastically replied, “Oh, yes! She can eat porridge!” Lisa, then asked, “Is she eating?” And the mother, still enthusiastic said, “Oh, no. There is no food,” quickly adding with a proud smile, “but if there were food, she would be eating!” There are countless small horrifying incidents, and if your proclivity is to cry, the stream of tears will be endless. It’s good to remember that laughter is an alternative.
I returned Thursday morning, arriving in the village at 7am. We were supposed to meet Lisa at 7:30 but in my planning I forgot to account for the village concept of time (or rather the absence of a concept of time) and so by 8am we were just getting in the car to return to Lilongwe. Lisa of course was there to meet us and helped expedite the admission process. The baby weighed 2.4kg (0.5kg less than a week and a half before). She said the trick would be to hope that he wasn’t wasted and stunted to such a degree that his weight for length actually appeared normal, in which case he’d be denied admission. We crossed our fingers and the admitting nurse calculated that his weight was less than 60% of what it should have been for his length – he was in! Lisa said she would also help with formula and that she would be checking in on the baby regularly. I gave the grandmother a little money for food and told her I would be back soon.
Friday I quickly peeked in on the baby and then went again today. He is looking better. His sutures are still prominent but his face appeared slightly fuller and, to his grandmother’s delight, he met and held my gaze as I spoon-fed him formula. Unfortunately his little bum looks worse, he now has a small ulcer forming. Lisa gave them some Vaseline to act as a barrier and the grandmother is using it but, with the constant flow of diarrhea, it’s hard to keep him dry. (This would be one case for those super absorbent landfill overfilling generally wasteful American diapers that I would definitely approve.) The grandmother was happy to show me how much he improved and was eager to know when she could return to the village. What she doesn’t know is that the baby will not be discharged until his weight is over 80% of the norm for his height, which could take weeks. I’m not sure if she sees my involvement with their family as a blessing or a curse. (If she knew she might be there for weeks, I imagine she’d see me as a curse.)
Although the baby is improving, the gain is tenuous and it would certainly regress if she returned. I do feel bad for her though, and slightly (just slightly) guilty about knowing that her stay may be a long one. She sleeps on the cement floor, under the crib her grandson shares with another child, side-by-side with about ten to fifteen other guardians. She has no mat or even a single change of clothes. The ward is divided into various sections by chest high cement walls, which help control the traffic flow, but do nothing to dampen the deafening acoustics of a couple hundred children crying. I imagine she doesn’t sleep much.
She said he was wasted and stunted, that his diagnosis was “Failure To Thrive (FTT),” and that he would not survive in the village. He was more active than he was the day I first took him to the hospital, but his movements were lethargic and although at times he grimaced, he never cried. Lisa said either way his prognosis was not very good. She asked if the grandmother would go to the hospital immediately but she said she wasn’t ready. We agreed that I would return early the next morning to take them back to KCH and Lisa would meet me at KCH to ensure that they were quickly and definitely admitted to Ward C, the malnutrition ward. Lisa said she wasn’t sure if the baby would survive the night. Even so, I felt hopeful. I was so grateful that she agreed to come along. I learned a lot from her quick assessment and I felt that life inside this baby was fighting to continue and now at least we could give it a fair chance.
Lisa is great. She’s one of those people who confronts desperate situations with determination, a smile, and a sense of humor. She had Deb and I cracking up all the way back to Lilongwe. She told us the story of an infant she had been seeing. The first time Lisa saw her, the girl was incredibly sick and weak and unable to eat. She gave her treatment and scheduled the mother to return for a follow-up visit. When the mom came back, she was eager to show Lisa how much the child had improved. Lisa asked, “Can she eat?” The mother enthusiastically replied, “Oh, yes! She can eat porridge!” Lisa, then asked, “Is she eating?” And the mother, still enthusiastic said, “Oh, no. There is no food,” quickly adding with a proud smile, “but if there were food, she would be eating!” There are countless small horrifying incidents, and if your proclivity is to cry, the stream of tears will be endless. It’s good to remember that laughter is an alternative.
I returned Thursday morning, arriving in the village at 7am. We were supposed to meet Lisa at 7:30 but in my planning I forgot to account for the village concept of time (or rather the absence of a concept of time) and so by 8am we were just getting in the car to return to Lilongwe. Lisa of course was there to meet us and helped expedite the admission process. The baby weighed 2.4kg (0.5kg less than a week and a half before). She said the trick would be to hope that he wasn’t wasted and stunted to such a degree that his weight for length actually appeared normal, in which case he’d be denied admission. We crossed our fingers and the admitting nurse calculated that his weight was less than 60% of what it should have been for his length – he was in! Lisa said she would also help with formula and that she would be checking in on the baby regularly. I gave the grandmother a little money for food and told her I would be back soon.
Friday I quickly peeked in on the baby and then went again today. He is looking better. His sutures are still prominent but his face appeared slightly fuller and, to his grandmother’s delight, he met and held my gaze as I spoon-fed him formula. Unfortunately his little bum looks worse, he now has a small ulcer forming. Lisa gave them some Vaseline to act as a barrier and the grandmother is using it but, with the constant flow of diarrhea, it’s hard to keep him dry. (This would be one case for those super absorbent landfill overfilling generally wasteful American diapers that I would definitely approve.) The grandmother was happy to show me how much he improved and was eager to know when she could return to the village. What she doesn’t know is that the baby will not be discharged until his weight is over 80% of the norm for his height, which could take weeks. I’m not sure if she sees my involvement with their family as a blessing or a curse. (If she knew she might be there for weeks, I imagine she’d see me as a curse.)
Although the baby is improving, the gain is tenuous and it would certainly regress if she returned. I do feel bad for her though, and slightly (just slightly) guilty about knowing that her stay may be a long one. She sleeps on the cement floor, under the crib her grandson shares with another child, side-by-side with about ten to fifteen other guardians. She has no mat or even a single change of clothes. The ward is divided into various sections by chest high cement walls, which help control the traffic flow, but do nothing to dampen the deafening acoustics of a couple hundred children crying. I imagine she doesn’t sleep much.
Monday, February 13, 2006
Senseless
Margret died in the ICU on Friday night. Another 19-year-old dead. Another motherless baby. Deb went to visit her last night in the ICU and was told that she arrested again and died on Friday. We couldn't find her guardians, they took the body to the village sometime on Sunday, but I did get the name of the village. With a bit of luck we may be able to track down her daughter and find out what we can do to help. At this moment I feel numb. Another life lost and the downward spiral started because a vaginal pack was left inside after suturing a normal tear?! It's infuriating and senseless and unfair. I hope that someone is keeping score of all this suffering and loss. Is there any meaning? any hope? any lesson in any of this?
The little baby boy I delivered a two Wednesdays ago and had to resuscitate, has a chest wall defect and may have some other abnomalities. Dr Mwansambo, the Pediatrician, thinks his heart may be positioned on the right side of his chest. He is still in the nursery in a borderline condition. Wait and see.
The little baby boy I delivered a two Wednesdays ago and had to resuscitate, has a chest wall defect and may have some other abnomalities. Dr Mwansambo, the Pediatrician, thinks his heart may be positioned on the right side of his chest. He is still in the nursery in a borderline condition. Wait and see.
Saturday, February 11, 2006
A Week's End
Thursday, Clement called me to tell me that the baby had been discharged and that the two guardians were waiting for me to take them back to the village. I met them at the hospital and the little boy looked a bit better but he is still way too tiny and way too weak, at least his eyes were clear. I dropped them off and promised to return Saturday.
I also saw Margret in the hospital, she was conscious and in the process of being transferred out of ICU to a medical ward. She was so happy to see me (although I think she might be confusing me and Deb but I'll still accept the love), gave me a big hug and wouldn't let me go. I told Deb and she promised to visit Friday night.
This morning I found the aunt with the little one wrapped to her back, just a tiny head peaking over the chitengi. He is so frail. I fantasize about watching him transform into a chubby little boy who will run and jump and scream just for the fun of it. Now, looking at him I hope he will hang on to life. I stayed in the village for about an hour. Long enough to get teary-eyed a few times and long enough to feed him a small bottle of formula. He is still to weak even to suck, I just squeeze a bit in his mouth and wait until he swallows and try not to let him choak. His poor little mouth is covered with sores caused by yeast and the aunt is treating him with an antifungal but I'm not sure if it is improving. I imagine his little immune system is completely overworked, trying to keep down so many small insults without the help of a mother's anitbodies from breastmilk.
There is a wonderful Austrailian pediatrician, Lisa, who works on HIV/AIDS research projects for the University of North Carolina out of Bottom. UNC has had a presence at Bottom for many years and they do help patients who enroll in their studies a great deal but it seems (from my perspective) that involvement with the rest of the population at Bottom has been minimal to known, at least until recently. Lisa comes and rounds on the babies in the nursery at least twice a week now and she told me if there is ever a baby I am particularly concerned about to call her. In the two times I've followed her around the nursery I've already learned so much. Anyway, I'm thinking I will ask her to check on my little village baby.
After I returned from the village I went to see Doreen and Dalitso. They were a soothing vision. Dalitso is a beautiful chubby little 3-month-old boy who is now smiling and cooing. Meanwhile, Doreen is managing to express milk and go to school full-time Monday thru Friday. All in all they are doing great and the chicken Sarah bought them has laid nine eggs. Unfortunately, Doreen did tell me that she did not have any food - I wonder how often that is happening.
Deb just told me that she went to visit Margret, with the orange Fanta she requested in hand, but when she reached the medical ward none of the nurses even knew Margret. Incredible?!! Finally, guardians of other patients in the ward told Deb that Margret had been transferred back to ICU. She found her unconscious back on the ventilator. Apparently Margret started having seizures and very low oxygen saturation (the normal level is 100 but she was around 30).
I also saw Margret in the hospital, she was conscious and in the process of being transferred out of ICU to a medical ward. She was so happy to see me (although I think she might be confusing me and Deb but I'll still accept the love), gave me a big hug and wouldn't let me go. I told Deb and she promised to visit Friday night.
This morning I found the aunt with the little one wrapped to her back, just a tiny head peaking over the chitengi. He is so frail. I fantasize about watching him transform into a chubby little boy who will run and jump and scream just for the fun of it. Now, looking at him I hope he will hang on to life. I stayed in the village for about an hour. Long enough to get teary-eyed a few times and long enough to feed him a small bottle of formula. He is still to weak even to suck, I just squeeze a bit in his mouth and wait until he swallows and try not to let him choak. His poor little mouth is covered with sores caused by yeast and the aunt is treating him with an antifungal but I'm not sure if it is improving. I imagine his little immune system is completely overworked, trying to keep down so many small insults without the help of a mother's anitbodies from breastmilk.
There is a wonderful Austrailian pediatrician, Lisa, who works on HIV/AIDS research projects for the University of North Carolina out of Bottom. UNC has had a presence at Bottom for many years and they do help patients who enroll in their studies a great deal but it seems (from my perspective) that involvement with the rest of the population at Bottom has been minimal to known, at least until recently. Lisa comes and rounds on the babies in the nursery at least twice a week now and she told me if there is ever a baby I am particularly concerned about to call her. In the two times I've followed her around the nursery I've already learned so much. Anyway, I'm thinking I will ask her to check on my little village baby.
After I returned from the village I went to see Doreen and Dalitso. They were a soothing vision. Dalitso is a beautiful chubby little 3-month-old boy who is now smiling and cooing. Meanwhile, Doreen is managing to express milk and go to school full-time Monday thru Friday. All in all they are doing great and the chicken Sarah bought them has laid nine eggs. Unfortunately, Doreen did tell me that she did not have any food - I wonder how often that is happening.
Deb just told me that she went to visit Margret, with the orange Fanta she requested in hand, but when she reached the medical ward none of the nurses even knew Margret. Incredible?!! Finally, guardians of other patients in the ward told Deb that Margret had been transferred back to ICU. She found her unconscious back on the ventilator. Apparently Margret started having seizures and very low oxygen saturation (the normal level is 100 but she was around 30).
Guest Entry by Sarah Stone
After reading Joanne's blog and imagining her for months, I got to visit her this past December. I arrived on the day after Christmas. On my second day in Lliongwe, I woke up early and put on Joanne's blue scrubs. We drove to Bottom together - matching outfits and pony tails. The last time Joanne and I were dressed in an identical manner was at a 9th grade volleyball game. I want to write about wearing Joanne's clothes because it felt like slipping on a new skin and shedding an old one.
My Mother and I have been emailing about my trip - so many people have been responding to the emails I sent from Malawi with different perspectives, a lot of words about soul searching and life changing. Mom's perspective has been one that I was expecting - suffering is a human condition. Joanne's mother and I had a similar conversation one night before I left to go to Malawi. Suffering is something I am familar with. I have spent the last several years working with children and families that are invisible to most of America - whether they be in Detroit, Applachia, or East Austin, TX. I often battle with the underlying question of "Why?"
Inherent in this for me though is my struggle to buck back at the idea that suffering and injustice should be accepted at some or any level - that it is just the way things are and always have been and always will be. At the same time I am violently aware that there are many times when all I can do is bear witness so that injustice and pain are not suffered alone.
I feel like this when I read Joanne's blog and I felt this the entire time I was in Malawi. I felt it when I held a baby whose legs were no bigger than my pointer finger and whose countenance was that of an old man. I couldn't get it out of my head as I held him to comfort his cries that he was already tired and so angry that he was just born - it seemed that he had already lived a life of dissapointment and that the flies crawling on his body were just one more annoyance.
I feel like this when I read Joanne's blog and I felt this the entire time I was in Malawi. I felt it when I held a baby whose legs were no bigger than my pointer finger and whose countenance was that of an old man. I couldn't get it out of my head as I held him to comfort his cries that he was already tired and so angry that he was just born - it seemed that he had already lived a life of dissapointment and that the flies crawling on his body were just one more annoyance.
My Mom wrote about how she didn't think it would be a life changing experience for me to go to Africa - and it wasn't necessarily - it was more of a life affirming and clarifying experience. I want to live a life that is true. I want to live brave. Living a life of purpose requires that I am clear on what is important to me and what is not and that my ideals and values are reflected in my every day living. My trip to Africa propelled me on this path in a way that hasn't happend for quite some time. I am having the feeling that this is making sense to all of you who have read Joanne's blog. I think that Joanne is the bravest and most true to herself person that I know.
My trip to Africa clarified the following for me:
- my connection to the human spirit, I have a deeper and stronger sense of being connected to people around the world
- my connection to how what I use/misuse/throw away is related to the resources that other people have/don't have
- my connection to living a life that is giving of love to the world; the importance of being more loving and kind is paramount to me after my trip.
Sunday, February 05, 2006
Heartbreak
Saturday was overwhelming. I started the day working a half shift at Bottom. The nurses are even more understaffed than usual because half of them are out on a two-week training. Of the remaining few, many are working well over 40 hours a week, so a few more hours of my time is the least I can give. It was a slow morning, even though I attended three deliveries. Unfortunately, the baby of the girl I spent the most time with in the morning needed resuscitation after a very prolonged second stage and failed vacuum; a sad start to the day.
After leaving Bottom I went to Mbewe village to deliver formula to the orphaned baby of the 17-year-old. Deb came along with me this time and I was incredibly grateful for her company. I was planning a quick visit - seeing the grandmother briefly and handing over several large tubs of formula - but, that is not the way it happened. I found the house again without a problem and the baby's aunt welcomed me with a warm smile. Apparently she had been caring for the baby but when I arrived the baby was somewhere with another woman. She urshered us into the house and instructed us to sit on the mat while she went to retrieve the baby.
My heart sunk the moment she placed him in my hands. He was wrapped in two wet chitengis, he was still, and, even though he was a month old on Feb 3, he weighed no more than a newborn. I unwrapped him to examine him in a thin ray of light that filtered though the slats in the wall, and saw greenish pus crusted over his eyes and a lightpink rash sprinkled over his body. I could see his ribs with each of the infrequent breaths he took and touched his sunken fontanells (a sign of dehydration). He was slightly febrile and when I wipped and parted his eyelids all I could see was red. I asked the aunt how long he had been like this. She said his eyes had had pus for three days but he had not had diarrhea. I asked her to prepare some formula which she did immediately (she said the other cans had finished so I'm not sure who was feeding him or what he was being fed). With obvious difficulty he managed to swallow and suck a bit. After he took about an ounce, he wiggled slightly and then unloaded a lot of diarrhea. I told the aunt we needed to take him immediately to the health center. She looked distressed and I have no idea if it was because I was taking her away from other chores and children, or if it was a lack of money, or if she resented this extra-mouth. I can only say that it broke my heart to find this baby so close to death in the village and no one seeming concerned about his rapidly deteriorating health.
As we loaded into the car, the grandmother appeared with bright eyes and a big smile, took the baby in her arms, and also got in. At the health center the nurse told us we would have to take the baby to the hospital in Lilongwe. She weighed the baby, he was only 2.7kgs (5.9lbs). She told me that the prognosis wasn't good. The aunt seemed hesitant about accepting the news of a trip to Lilongwe, but the grandmother said she was ready and I heard the nurse telling the aunt something about being grateful for having care and transport and that the baby was dying. We returned to the house for the cans of formula, the aunt decided to come along, and the four of us set out to Lilongwe.
When we reached the hospital we were able to find a clinical officer to attend to the baby right away (right away after asking a handful of nurses). He wrote out a treatment plan for neonatal sepsis and dehydration, and told us the baby would be admitted to the nursery. Just as a note, there is no clear linear flow or direction given on how to move from being examined to admitted to the treatment rooms to the nursery. There are many benches along the hall outside the ward rooms and by the nursing station and Deb and I just had to keep asking everyone we saw for directions (which were incorrectly given multiple times) and for assistance, which was also reluctantly and slowly given. I am certain that if we had left before the admission process was complete, the family would have remained waiting on the benches for hourse before anything happened. With our insistence we were able to insert a nasogastric feeding tube and took the baby to Children's Ward C for a feeding.
As we rounded the corner to Ward C, I whispered to Deb that we were entering a haunted house. I do think that is a pretty apt description of the ward, low lights flickered on and off while the screams and cries of many children echoed off cement floors, walls, and ceiling. Thankfully, in Ward C we met a very nice accomodating nurse who immediately helped up prepare formula with boiled water (although to my horror, she added tap water to cool the steaming formula). Our little boy finally had a much needed meal and as the formula went down his tube I turned to my neighbor on the bench and saw a father holding his 3 to 5-year-old child (very difficult to determine the age). The child was only a skeleton and the eyes were sunk deeply into the skull. It's an image I'm sure most of us have seen on the television, but it is entirely different to sit next to a child dying of starvation and know that a meal awaits you and that you rarely even experience hunger pains. Of course problems on many levels contribute to and finally culminate in the death of a child from starvation, but to know how little a child requires to preserve life and see (really see) that the world has failed to meet that very humble need is devestating.
From there, and with Clement's help (who joined us along the way), we found the nursery and recruited a nurse's aid to choose which child our little boy would share a crib with. The nursery was full but babies are sometimes placed two and three to a bed; their mothers or guardians sleep on the cement floor next to them. Knowing that they were settled, we left the floor. On our way out we stopped in the ICU to visit Margret, a 19-year-old who had delivered at Bottom via a normal vaginal delivery two weeks before. She had a tear and whoever sutured it left a pack inside her vagina. Several days later she returned septic and then sat on the ward until it was determined that she would need to be transferred to KCH for a laporotomy. Friday got her laporotomy and the diagnosis of sepsis was confirmed. By that point she was so fragile that she was admitted to the ICU and put on a ventilator. The morning she was transferred she gave both Deb and me hugs and kisses and told us to visit her and bring her cold water at KCH. When we saw her Saturday night she was unconscious.
When I finally got home a friend who was visiting from the States called to invite me to dinner but I just couldn't bear the idea, so I stayed home and cried. Clement and I talked for a long while about suffering, hopefull/hopelessness, purpose and many other overwhelming and answerless questions. That put a little softness in-between me and the painful visions of the day.
Sunday, I went to another village to visit another orphaned child. The mother had worked as a housekeeper for a German expat in Lilongwe and he had taken it upon himself to care for the baby as well as to support the family. I went with him to examine the baby. Fortunately the little girl was doing great and the grandparents who are caring for her clearly shower her with love. The problem is once again that her survival depends on the health and capacity of her already frail grandparents, but at least there is hope.
From there I stopped in at Bottom and found the baby I had resuscitated on Saturday still in a borderline state, responsive to touch and sound but breathing too quickly (no fever). After that I returned to KCH and found the little boy screaming in his grandmother's arms (a good sign). I helped her with a feeding, he peed on my leg, and I gave her some soap and cloths. (Once again his cloths were wet. It is quite apparent that the grandmother deeply loves him but I think the problem is with her, her health, and her ability to assess and respond to the ever-changing needs of a newborn). On my way out I checked in on Margaret again. Her condition was about the same, still running a slight fever, now with pneumonia in one lung, but her nurse was hopefully so I tood that as a good sign. Somehow at the end of the day on Sunday I felt a bit better.
After leaving Bottom I went to Mbewe village to deliver formula to the orphaned baby of the 17-year-old. Deb came along with me this time and I was incredibly grateful for her company. I was planning a quick visit - seeing the grandmother briefly and handing over several large tubs of formula - but, that is not the way it happened. I found the house again without a problem and the baby's aunt welcomed me with a warm smile. Apparently she had been caring for the baby but when I arrived the baby was somewhere with another woman. She urshered us into the house and instructed us to sit on the mat while she went to retrieve the baby.
My heart sunk the moment she placed him in my hands. He was wrapped in two wet chitengis, he was still, and, even though he was a month old on Feb 3, he weighed no more than a newborn. I unwrapped him to examine him in a thin ray of light that filtered though the slats in the wall, and saw greenish pus crusted over his eyes and a lightpink rash sprinkled over his body. I could see his ribs with each of the infrequent breaths he took and touched his sunken fontanells (a sign of dehydration). He was slightly febrile and when I wipped and parted his eyelids all I could see was red. I asked the aunt how long he had been like this. She said his eyes had had pus for three days but he had not had diarrhea. I asked her to prepare some formula which she did immediately (she said the other cans had finished so I'm not sure who was feeding him or what he was being fed). With obvious difficulty he managed to swallow and suck a bit. After he took about an ounce, he wiggled slightly and then unloaded a lot of diarrhea. I told the aunt we needed to take him immediately to the health center. She looked distressed and I have no idea if it was because I was taking her away from other chores and children, or if it was a lack of money, or if she resented this extra-mouth. I can only say that it broke my heart to find this baby so close to death in the village and no one seeming concerned about his rapidly deteriorating health.
As we loaded into the car, the grandmother appeared with bright eyes and a big smile, took the baby in her arms, and also got in. At the health center the nurse told us we would have to take the baby to the hospital in Lilongwe. She weighed the baby, he was only 2.7kgs (5.9lbs). She told me that the prognosis wasn't good. The aunt seemed hesitant about accepting the news of a trip to Lilongwe, but the grandmother said she was ready and I heard the nurse telling the aunt something about being grateful for having care and transport and that the baby was dying. We returned to the house for the cans of formula, the aunt decided to come along, and the four of us set out to Lilongwe.
When we reached the hospital we were able to find a clinical officer to attend to the baby right away (right away after asking a handful of nurses). He wrote out a treatment plan for neonatal sepsis and dehydration, and told us the baby would be admitted to the nursery. Just as a note, there is no clear linear flow or direction given on how to move from being examined to admitted to the treatment rooms to the nursery. There are many benches along the hall outside the ward rooms and by the nursing station and Deb and I just had to keep asking everyone we saw for directions (which were incorrectly given multiple times) and for assistance, which was also reluctantly and slowly given. I am certain that if we had left before the admission process was complete, the family would have remained waiting on the benches for hourse before anything happened. With our insistence we were able to insert a nasogastric feeding tube and took the baby to Children's Ward C for a feeding.
As we rounded the corner to Ward C, I whispered to Deb that we were entering a haunted house. I do think that is a pretty apt description of the ward, low lights flickered on and off while the screams and cries of many children echoed off cement floors, walls, and ceiling. Thankfully, in Ward C we met a very nice accomodating nurse who immediately helped up prepare formula with boiled water (although to my horror, she added tap water to cool the steaming formula). Our little boy finally had a much needed meal and as the formula went down his tube I turned to my neighbor on the bench and saw a father holding his 3 to 5-year-old child (very difficult to determine the age). The child was only a skeleton and the eyes were sunk deeply into the skull. It's an image I'm sure most of us have seen on the television, but it is entirely different to sit next to a child dying of starvation and know that a meal awaits you and that you rarely even experience hunger pains. Of course problems on many levels contribute to and finally culminate in the death of a child from starvation, but to know how little a child requires to preserve life and see (really see) that the world has failed to meet that very humble need is devestating.
From there, and with Clement's help (who joined us along the way), we found the nursery and recruited a nurse's aid to choose which child our little boy would share a crib with. The nursery was full but babies are sometimes placed two and three to a bed; their mothers or guardians sleep on the cement floor next to them. Knowing that they were settled, we left the floor. On our way out we stopped in the ICU to visit Margret, a 19-year-old who had delivered at Bottom via a normal vaginal delivery two weeks before. She had a tear and whoever sutured it left a pack inside her vagina. Several days later she returned septic and then sat on the ward until it was determined that she would need to be transferred to KCH for a laporotomy. Friday got her laporotomy and the diagnosis of sepsis was confirmed. By that point she was so fragile that she was admitted to the ICU and put on a ventilator. The morning she was transferred she gave both Deb and me hugs and kisses and told us to visit her and bring her cold water at KCH. When we saw her Saturday night she was unconscious.
When I finally got home a friend who was visiting from the States called to invite me to dinner but I just couldn't bear the idea, so I stayed home and cried. Clement and I talked for a long while about suffering, hopefull/hopelessness, purpose and many other overwhelming and answerless questions. That put a little softness in-between me and the painful visions of the day.
Sunday, I went to another village to visit another orphaned child. The mother had worked as a housekeeper for a German expat in Lilongwe and he had taken it upon himself to care for the baby as well as to support the family. I went with him to examine the baby. Fortunately the little girl was doing great and the grandparents who are caring for her clearly shower her with love. The problem is once again that her survival depends on the health and capacity of her already frail grandparents, but at least there is hope.
From there I stopped in at Bottom and found the baby I had resuscitated on Saturday still in a borderline state, responsive to touch and sound but breathing too quickly (no fever). After that I returned to KCH and found the little boy screaming in his grandmother's arms (a good sign). I helped her with a feeding, he peed on my leg, and I gave her some soap and cloths. (Once again his cloths were wet. It is quite apparent that the grandmother deeply loves him but I think the problem is with her, her health, and her ability to assess and respond to the ever-changing needs of a newborn). On my way out I checked in on Margaret again. Her condition was about the same, still running a slight fever, now with pneumonia in one lung, but her nurse was hopefully so I tood that as a good sign. Somehow at the end of the day on Sunday I felt a bit better.
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