This morning over my mug of tea I read this in the BMJ,
The Human Development Report estimates that the additional cost needed to achieve the millennium development goals on water and sanitation [i.e. to halve the number of people without access to safe drinking water and sanitation by 2015] is US$10billion a year - half what the developed world spends annually on mineral water.
Eshelby K. Dying for a Drink. BMJ 24 Mar 2007; 334: 610-612.
It’s a short article worth reading, critiquing the development approach which has prioritized healthcare over clean water and sanitation and continues to fumble these goals despite proclaimed intent. [Just as a point of clarification, healthcare deserves to be priority but is inseparably linked to clean water and sanitation.] The article ultimately begs the question that is ever ready on my lips . . . where is our commitment? . . . can we justify these inequalities? . . . do we really want to try?
Friday, April 20, 2007
Tuesday, March 20, 2007
An Anniversary
I remember the months leading up to my departure by the accompanying whirl of emotions. Coming to Malawi was a compulsion. I am not particularly brave. I only knew somehow that life would never be what it should if I stayed, so I bought my one-way ticket and prepared for a death of sorts - purging my possessions, pruning my life, giving my parents a small file with instructions for what-ifs and signing a power of attorney. I knew exactly what I was losing without any idea of what I would gain.
I cried at the airport. My dear friend Megan laughed at my tears reminding me I was following my heart. I, the small child, wanted to walk with her hand-in-hand all the way to the gate. Instead we parted and I remained with only the echo of her gentle laughter for strength.
I knew once I left the States my life would change forever. I could visualize a line – thin and definite – set in space and time. Some days I saw a thread, other days a finger run through sand but regardless of the image I knew my always comfortable and often happy life would change. Perhaps the woman I would become would not want to return to that life, perhaps she would be unable to return. She – that unknown woman and her life – frightened me.
In some ways I was right, there have been many changes. Two years have passed. I miss my friends and family immensely but I feel no need to leave Malawi. I have found great love. I have cried to exhaustion many times. I am content. At times I am devastated, at times angry and tortured, at times humbled, at times filled with peace and light. The force that brought me here roots me to this spot. As I drove last weekend from Lilongwe to Zomba – the road twisting over rolling green fields towards distant blue mountains, neat village homes clustered along the way – I thought, “This is a beautiful country and I am grateful to be here.”
In other deeper ways I have not changed at all. I am the same person I was at five although my eyes have seen much more. My hands have held much more. My heart holds much more. Still inside, the mix of emotions feels the same. The internal voice remains unchanged. The sequence of thoughts leads me along a well-worn path. I wonder how many lifetimes it takes to progress, to transform experience into wisdom, to love without ego, to perceive the world differently, not simply to act differently but to see differently? To believe differently?
I cried at the airport. My dear friend Megan laughed at my tears reminding me I was following my heart. I, the small child, wanted to walk with her hand-in-hand all the way to the gate. Instead we parted and I remained with only the echo of her gentle laughter for strength.
I knew once I left the States my life would change forever. I could visualize a line – thin and definite – set in space and time. Some days I saw a thread, other days a finger run through sand but regardless of the image I knew my always comfortable and often happy life would change. Perhaps the woman I would become would not want to return to that life, perhaps she would be unable to return. She – that unknown woman and her life – frightened me.
In some ways I was right, there have been many changes. Two years have passed. I miss my friends and family immensely but I feel no need to leave Malawi. I have found great love. I have cried to exhaustion many times. I am content. At times I am devastated, at times angry and tortured, at times humbled, at times filled with peace and light. The force that brought me here roots me to this spot. As I drove last weekend from Lilongwe to Zomba – the road twisting over rolling green fields towards distant blue mountains, neat village homes clustered along the way – I thought, “This is a beautiful country and I am grateful to be here.”
In other deeper ways I have not changed at all. I am the same person I was at five although my eyes have seen much more. My hands have held much more. My heart holds much more. Still inside, the mix of emotions feels the same. The internal voice remains unchanged. The sequence of thoughts leads me along a well-worn path. I wonder how many lifetimes it takes to progress, to transform experience into wisdom, to love without ego, to perceive the world differently, not simply to act differently but to see differently? To believe differently?
A Name Change
Several weeks ago I received another unwanted phone call. Just before 7am Mrs. Manga called to tell me that 8-month-old Memory had died. Instantly I felt devastated, exhausted, and furious with myself. Eight months previously Memory’s mother had died hours after the premature birth. Mrs. Manga - the employer of Memory’s mother - kindly took it upon herself to help as much as she could. She gave the grandmother a room, money for food, blankets and clothes for the baby but was still unable to afford the necessary formula. So, I bought the formula, they cared for the baby, and in my periodic visits I watched Memory transform from a delicate baby of 1kg into a healthy infant.
The day Memory was admitted into the hospital, Mrs Manga called me. I visited several days later and found her hot, listless, and breathing quickly. The clinicians had her on a regimen of anti-malarials and antibiotics. I felt satisfied with her care, handed her grandmother more formula and left. A week or so later Mrs Manga called to let me know that Memory had been discharged but that the fever continued. She wanted to take Memory to another hospital. I never followed up. That was one week before I received the phone call.
When I hung up the phone I cried until my eyes were red and swollen, angry at myself and the world for failing once again. I went to her funeral, I sobbed with the women, and watched men lower another tiny casket into the Earth. Why can’t we stop this?!
The same week Memory died, the President came with presidential fanfare to cut the ribbon at the new Lighthouse Clinic. HIV is hitting Malawi hard, of the almost 13 million Malawians it is estimated that 1 million are AIDS orphans and in response donors and the government are rushing to stem the tide, channeling resources to increase access to testing, counseling and anti-retro viral therapy. The original Lighthouse clinic, which serves as a center for counseling, testing, and treatment, was built behind KCH several years ago. It is a well-run but completely overwhelmed clinic (it is not uncommon for someone to wait most of the day to be seen). The new Lighthouse will hopefully relieve some of the burden and provide easier access for those living near Bottom. Structurally it is a simple but beautiful clinic. Clearly well thought-out, the facilities include a snack bar as well as a touch-screen computer system for tracking patients and monitoring their treatment.
HIV/AIDS deserves attention, activism, and research. Individuals suffering with the disease deserve compassionate care and treatment. Families and communities need support and education. Still, somehow I feel bitter. What about the women and babies? Maternal mortality is not a new problem. The outrageously high infant mortality rate is not new. Maternal and infant mortality offer no new and interesting challenges for epidemiology research, no new possibilities for fancy pharmaceuticals. We know what is killing these women and their babies. It is the same constellation of conditions that has killed women and babies throughout time.
The new beautiful Lighthouse is located directly behind Bottom Hospital and to access it you must walk through Bottom, past the collection of buildings whose numerous face-lifts no longer fool anyone. The day the President came, throngs of people lined the path through the hospital grounds to the clinic behind. Women wearing chitinges especially printed for the occasion danced and hooted along side drummers, while police and military personnel kept the crowd in neat even rows monitoring the entrance of those heading towards the clinic. No more than ten meters away from the festivities, women in the labor ward continued their work, focused only on the efforts of their bodies. That day, as usual, most of the women pushed their babies into the world with great effort and pain but without problem. That day, as usual, two women arrived with severe problems their babies dead, their own lives threatened.
I took blood samples from the women for the lab. The police nodded at me in my scrubs, with my stethoscope around my neck, and I walked through the crowd across the path from the labor ward to the lab. Minutes later I crossed back carrying 2 pints of blood.
I heard later that at the opening ceremony the President decided to change Bottom Hospital to Bwaila Hospital. Apparently the river running past the Hospital was once called Bwaila. Certainly Bwaila Lighthouse sounds much better than Bottom Lighthouse. I’m sure that many people will talk and write about the new Bwaila Lighthouse in the papers, hopefully in international news, and most likely in proposals. Bwaila matches the image of the clinic but obscures something else.
Last week I noticed that some of the nurses have started substituting Bwaila for Bottom on forms. I tried it out myself but one of the long-term clinical officers saw my note and with a deep throaty laugh said, “Joanne, Bwaila?! This is still Bottom.” Indeed it is. One of those women died that night. Another died the following day.
The day Memory was admitted into the hospital, Mrs Manga called me. I visited several days later and found her hot, listless, and breathing quickly. The clinicians had her on a regimen of anti-malarials and antibiotics. I felt satisfied with her care, handed her grandmother more formula and left. A week or so later Mrs Manga called to let me know that Memory had been discharged but that the fever continued. She wanted to take Memory to another hospital. I never followed up. That was one week before I received the phone call.
When I hung up the phone I cried until my eyes were red and swollen, angry at myself and the world for failing once again. I went to her funeral, I sobbed with the women, and watched men lower another tiny casket into the Earth. Why can’t we stop this?!
The same week Memory died, the President came with presidential fanfare to cut the ribbon at the new Lighthouse Clinic. HIV is hitting Malawi hard, of the almost 13 million Malawians it is estimated that 1 million are AIDS orphans and in response donors and the government are rushing to stem the tide, channeling resources to increase access to testing, counseling and anti-retro viral therapy. The original Lighthouse clinic, which serves as a center for counseling, testing, and treatment, was built behind KCH several years ago. It is a well-run but completely overwhelmed clinic (it is not uncommon for someone to wait most of the day to be seen). The new Lighthouse will hopefully relieve some of the burden and provide easier access for those living near Bottom. Structurally it is a simple but beautiful clinic. Clearly well thought-out, the facilities include a snack bar as well as a touch-screen computer system for tracking patients and monitoring their treatment.
HIV/AIDS deserves attention, activism, and research. Individuals suffering with the disease deserve compassionate care and treatment. Families and communities need support and education. Still, somehow I feel bitter. What about the women and babies? Maternal mortality is not a new problem. The outrageously high infant mortality rate is not new. Maternal and infant mortality offer no new and interesting challenges for epidemiology research, no new possibilities for fancy pharmaceuticals. We know what is killing these women and their babies. It is the same constellation of conditions that has killed women and babies throughout time.
The new beautiful Lighthouse is located directly behind Bottom Hospital and to access it you must walk through Bottom, past the collection of buildings whose numerous face-lifts no longer fool anyone. The day the President came, throngs of people lined the path through the hospital grounds to the clinic behind. Women wearing chitinges especially printed for the occasion danced and hooted along side drummers, while police and military personnel kept the crowd in neat even rows monitoring the entrance of those heading towards the clinic. No more than ten meters away from the festivities, women in the labor ward continued their work, focused only on the efforts of their bodies. That day, as usual, most of the women pushed their babies into the world with great effort and pain but without problem. That day, as usual, two women arrived with severe problems their babies dead, their own lives threatened.
I took blood samples from the women for the lab. The police nodded at me in my scrubs, with my stethoscope around my neck, and I walked through the crowd across the path from the labor ward to the lab. Minutes later I crossed back carrying 2 pints of blood.
I heard later that at the opening ceremony the President decided to change Bottom Hospital to Bwaila Hospital. Apparently the river running past the Hospital was once called Bwaila. Certainly Bwaila Lighthouse sounds much better than Bottom Lighthouse. I’m sure that many people will talk and write about the new Bwaila Lighthouse in the papers, hopefully in international news, and most likely in proposals. Bwaila matches the image of the clinic but obscures something else.
Last week I noticed that some of the nurses have started substituting Bwaila for Bottom on forms. I tried it out myself but one of the long-term clinical officers saw my note and with a deep throaty laugh said, “Joanne, Bwaila?! This is still Bottom.” Indeed it is. One of those women died that night. Another died the following day.
Wednesday, February 07, 2007
Purpose
It is incredibly difficult to accept that life and death are so intimately entwined. I do not know how to accept. I only stand and bear witness to the play of their relationship with a bit of awe and a bit of horror. As I watch, I notice - within me - respect growing slowly steadily. My hands are ready. I will offer what I can. The result is not of me. I have been told this and tell myself this for motives of self-preservation but I am also taught this by the miracles that happen under my fingers. They are not mine, either. Perhaps the true essence of my role – despite the movement, the internal struggle, the noise – is that of a witness; someone who continues to stand, to welcome, and to bid farewell.
Monday, February 05, 2007
Loss and Love
When I walked into the ward on Friday morning, 15 minutes passed before I saw Malika lying face down on a bare green mattress in a black winter coat and red underwear, still and grunting, her mother squatting to clean a puddle of blood from the floor with an old chitengi. The nurse said she had hemorrhaged. Before she started the next sentence I ran to get an IV, urinary catheter, and tubes for blood samples. Someone else brought the oxygen concentrator and another nurse searched the hospital to find a face mask or a nasal cannula. The whiteness inside her eyelids and of her gums reminded me of fair skin stretched tightly over clinched knuckles. She arrived the previous night, labored until early morning and delivered a stillborn, her second dead child, and then she bled. The few lines in her chart said she was given 10 units of Pitocin (the standard dose of oxytocin given to all women) nothing else. The night had been busy for the two nurses and the single clinical officer and Malika in the farthest corner of the room was dying inconspicuously.
After a few hours, three liters of fluid and 2 pints of blood, she looked around weakly, her original Hb of 2.3 (normal is 12-14) probably hovered somewhere between 4 and 5. Her mother handed her a cell phone which she accepted then returned. We started to hope. I went to theatre for a c-section and when I came back Deb told me Malika called the nurse and to say she had started bleeding again. I looked and saw a slow trickle of blood, the towel between her legs was soaked although Deb said she had just changed it. We called Dr Tarek Meguid. He came quickly, examined her, and then stood for long minutes debating whether to remove the uterus of a 23-year-old with no living children. I went to get more blood and order fresh frozen plasma and returned to find them in theatre. I felt a vague sense relief to know a decision had been made.
At that point I got caught up with Masauko who arrived with his wife and 2-year-old son. His son’s tongue and fingernails were also pale, his face, and hands, and feet swollen. Masauko said Peter refused to eat and had recently weaned. He looked malnourished. I took the family to Lisa who tenderly and slowly examined Peter, drew blood to check his Hb and gave them instructions to meet her in the hospital Saturday morning.
When I took Peter’s blood to the lab I found 3 bags of fresh frozen plasma for Malika precariously placed on the edge of a wooden table. I asked the lab technician what time they had arrived, he said before 1pm, it was now after 3:30. Trying to contain my fury I asked why they were still on the table. He responded that he went to lunch; the other lab technician added that someone from the ward said they would come to collect it. I reminded them that the woman was hemorrhaging and that her life depended on the blood products. They smiled meekly. I ran to theatre and was told that Malika had been transferred to the ICU at KCH. Luckily I found an ambulance outside and once I explained the situation to the driver, he promised he would not go into town to buy light bulbs as planned, but instead go straight to deliver the blood.
That night at dinner with friends Tarek said Malika had started producing urine. A hopeful sign.
Saturday morning I headed to KCH to meet Peter and his mom. On my way down the hall I stopped in the ICU. A concerned anesthetist sat at Malika’s bedside, he said she was no longer producing urine and he could not get the results of the labs he needed because the hospital had no reagents. She looked almost hopeless, unconscious, eyes half open, a ventilator breathing for her. I continued toward Pediatrics but before I found Peter, I found sister Namaleu with over 100 patients in the malnutrition ward on her third consecutive shift with no relief coming for the night shift or for the Sunday day shift. I returned to the hospital entrance and found Masauko’s wife, I brought them to Pediatrics where sister Namaleu stopped everything to weigh and exam the boy. She said he would be admitted for a minimum of three weeks. Confident that he was in good albeit overworked and exhausted hands, I left and went upstairs to the female ward to visit Clement’s aunt who had been admitted the day before. I found her, looking weak and a single nurse caring for the entire ward of over 80 patients. On my way out I met Lisa and together we peaked into the ICU again to see Tarek and the chief anesthetist fretfully discussing Malika.
I left the hospital and rushed to buy a crate of fanta orange and unfortunately a cake, which I planned to bake, my contribution to Grace’s (Frank’s daughter) first birthday party. From there I collected Clement and rushed to meet Deb, Zack, and Johan. Deb and Zack arrived on January 17th for 5-week visit with 3-month-old Johan. I began counting down the days to their arrival months ago but now I refuse to look at a calendar and see the steady approach of February 18th.
We had planned to drive to Ireen’s village and were determined to go despite the unrelenting rain and our late start. Mr. Nanthowa had shown up at Bottom the previous Monday with a bag of mangoes and cucumbers that he brought me on his bike 40 kilometers through the rain (later I learned that trip also involved fording a neck high river while carrying his bike over his head). Unfortunately I was at the Embassy but I asked the nurse who kindly called me to tell him I would come Saturday. I had told him several times that I would bring a surprise the next time I visited. I could hardly contain my excitement at the thought of his family seeing Deb with me.
Zack borrowed a four wheel drive vehicle and we set out. I usually arrive in the village in the morning and was certain Mr Nanthowa had given up hope but Clement insisted, “He still has hope.” The first 34 kilometers were slippery but thankfully uneventful but that 35th kilometer held on to us for a while. After consulting a few people walking the roads, we decided on what they claimed was the less slippery route but they forgot to warn us about the 50 yard stretch of new dirt with ditches on either side. At that point the Pajero slowly came to a stop and sank a few inches. Clement, Deb, and I jumped out of the car into the rain and rising muddy rivulets. We all laughed and Clement said, “Now this is getting good.” We dug with our hands, shoved grass and pieces of bush under the wheels, Zack rocked the car forward and back, and the rain came down. We continued laughing until our lips were blue and the twelve men who had appeared one-by-one struggle and failed again and again to dislodge the car. Finally, after about an hour, the car broke free and we, 14 men and 2 women shouted euphorically. Johan sleepily opened his eyes.
Back in the car Deb and I removed our clothes, wrapped our cold bodies in dry chitengis and laughed at the thought of showing up to a village wrapped only in a cloth. The rain continued but we made the last 5 kilometers without a problem. As we pulled up to the cluster of huts Mr Nanthowa emerged grinning ear to ear to welcome me. I took his arm, gently pulling him to where Deb and Johan were climbing down and said, “Mr. Nanthowa, your surprise. . .” Mr Nanthowa screamed joyfully, grabbed Johan and began dancing saying “CONGRATULATIONS, CONGRATULATIONS!” As the rest of us laughed histerically, poor startled Johan was passed down a sea of arms attached to smiling faces and loud voices.
Within minutes a fire was built. Ireen lent Deb and me shirts. I laughed and struggled to dress modestly - pulling dry clothes over wet skin while holding up the slipping chitengi - in a small room overflowing with people. They gave us hot tea and fresh cornbread. They asked us to stay the night. I wanted so much to curl up by that fire rather than face the rain and road again but I agreed when Deb, Zack, and Clement said it was time to go. They killed and plucked a chicken since we could not give them time to prepare it for us. Mr Nanthowa took me into another room, Mrs Nanthowa handed me a bag of peanuts and he said, “I don’t have the words to tell you how thankful I am.” I thought of him riding in the rain, fording the river, calling me his daughter. I could only smile and shake my head, I didn’t have the words. When I tell Clement about thing things Mr Nanthowa does he says, “that is love.” And I wonder how many people are capable offering such love and how many are blessed enough to receive it.
As the goodbyes were passed round and round Mr Nanthowa explained another route to Clement, but uncertain whether Clement truly would find the way Mr Nanthowa insisted repeatedly that he come with us a certain distance then walk home. We said no again and again and again but somehow he ended up sitting next to me in the car directing us back. At one point he led us straight across a field, and he was right, we would not have found the road. Finally about 6 kilometers from his village, he stepped out into the rain with his bare feet, and stood and waved until he receded in the distance and the fog of the windows and the dark of the setting sun.
On our way home as we passed the hospital we mentioned Malika but hurried towards hot showers and chicken dinner. Sunday I glanced towards the hospital but could not bear the thought of going to the ICU. I did not want to know. Monday morning I learned she had died Saturday night.
After a few hours, three liters of fluid and 2 pints of blood, she looked around weakly, her original Hb of 2.3 (normal is 12-14) probably hovered somewhere between 4 and 5. Her mother handed her a cell phone which she accepted then returned. We started to hope. I went to theatre for a c-section and when I came back Deb told me Malika called the nurse and to say she had started bleeding again. I looked and saw a slow trickle of blood, the towel between her legs was soaked although Deb said she had just changed it. We called Dr Tarek Meguid. He came quickly, examined her, and then stood for long minutes debating whether to remove the uterus of a 23-year-old with no living children. I went to get more blood and order fresh frozen plasma and returned to find them in theatre. I felt a vague sense relief to know a decision had been made.
At that point I got caught up with Masauko who arrived with his wife and 2-year-old son. His son’s tongue and fingernails were also pale, his face, and hands, and feet swollen. Masauko said Peter refused to eat and had recently weaned. He looked malnourished. I took the family to Lisa who tenderly and slowly examined Peter, drew blood to check his Hb and gave them instructions to meet her in the hospital Saturday morning.
When I took Peter’s blood to the lab I found 3 bags of fresh frozen plasma for Malika precariously placed on the edge of a wooden table. I asked the lab technician what time they had arrived, he said before 1pm, it was now after 3:30. Trying to contain my fury I asked why they were still on the table. He responded that he went to lunch; the other lab technician added that someone from the ward said they would come to collect it. I reminded them that the woman was hemorrhaging and that her life depended on the blood products. They smiled meekly. I ran to theatre and was told that Malika had been transferred to the ICU at KCH. Luckily I found an ambulance outside and once I explained the situation to the driver, he promised he would not go into town to buy light bulbs as planned, but instead go straight to deliver the blood.
That night at dinner with friends Tarek said Malika had started producing urine. A hopeful sign.
Saturday morning I headed to KCH to meet Peter and his mom. On my way down the hall I stopped in the ICU. A concerned anesthetist sat at Malika’s bedside, he said she was no longer producing urine and he could not get the results of the labs he needed because the hospital had no reagents. She looked almost hopeless, unconscious, eyes half open, a ventilator breathing for her. I continued toward Pediatrics but before I found Peter, I found sister Namaleu with over 100 patients in the malnutrition ward on her third consecutive shift with no relief coming for the night shift or for the Sunday day shift. I returned to the hospital entrance and found Masauko’s wife, I brought them to Pediatrics where sister Namaleu stopped everything to weigh and exam the boy. She said he would be admitted for a minimum of three weeks. Confident that he was in good albeit overworked and exhausted hands, I left and went upstairs to the female ward to visit Clement’s aunt who had been admitted the day before. I found her, looking weak and a single nurse caring for the entire ward of over 80 patients. On my way out I met Lisa and together we peaked into the ICU again to see Tarek and the chief anesthetist fretfully discussing Malika.
I left the hospital and rushed to buy a crate of fanta orange and unfortunately a cake, which I planned to bake, my contribution to Grace’s (Frank’s daughter) first birthday party. From there I collected Clement and rushed to meet Deb, Zack, and Johan. Deb and Zack arrived on January 17th for 5-week visit with 3-month-old Johan. I began counting down the days to their arrival months ago but now I refuse to look at a calendar and see the steady approach of February 18th.
We had planned to drive to Ireen’s village and were determined to go despite the unrelenting rain and our late start. Mr. Nanthowa had shown up at Bottom the previous Monday with a bag of mangoes and cucumbers that he brought me on his bike 40 kilometers through the rain (later I learned that trip also involved fording a neck high river while carrying his bike over his head). Unfortunately I was at the Embassy but I asked the nurse who kindly called me to tell him I would come Saturday. I had told him several times that I would bring a surprise the next time I visited. I could hardly contain my excitement at the thought of his family seeing Deb with me.
Zack borrowed a four wheel drive vehicle and we set out. I usually arrive in the village in the morning and was certain Mr Nanthowa had given up hope but Clement insisted, “He still has hope.” The first 34 kilometers were slippery but thankfully uneventful but that 35th kilometer held on to us for a while. After consulting a few people walking the roads, we decided on what they claimed was the less slippery route but they forgot to warn us about the 50 yard stretch of new dirt with ditches on either side. At that point the Pajero slowly came to a stop and sank a few inches. Clement, Deb, and I jumped out of the car into the rain and rising muddy rivulets. We all laughed and Clement said, “Now this is getting good.” We dug with our hands, shoved grass and pieces of bush under the wheels, Zack rocked the car forward and back, and the rain came down. We continued laughing until our lips were blue and the twelve men who had appeared one-by-one struggle and failed again and again to dislodge the car. Finally, after about an hour, the car broke free and we, 14 men and 2 women shouted euphorically. Johan sleepily opened his eyes.
Back in the car Deb and I removed our clothes, wrapped our cold bodies in dry chitengis and laughed at the thought of showing up to a village wrapped only in a cloth. The rain continued but we made the last 5 kilometers without a problem. As we pulled up to the cluster of huts Mr Nanthowa emerged grinning ear to ear to welcome me. I took his arm, gently pulling him to where Deb and Johan were climbing down and said, “Mr. Nanthowa, your surprise. . .” Mr Nanthowa screamed joyfully, grabbed Johan and began dancing saying “CONGRATULATIONS, CONGRATULATIONS!” As the rest of us laughed histerically, poor startled Johan was passed down a sea of arms attached to smiling faces and loud voices.
Within minutes a fire was built. Ireen lent Deb and me shirts. I laughed and struggled to dress modestly - pulling dry clothes over wet skin while holding up the slipping chitengi - in a small room overflowing with people. They gave us hot tea and fresh cornbread. They asked us to stay the night. I wanted so much to curl up by that fire rather than face the rain and road again but I agreed when Deb, Zack, and Clement said it was time to go. They killed and plucked a chicken since we could not give them time to prepare it for us. Mr Nanthowa took me into another room, Mrs Nanthowa handed me a bag of peanuts and he said, “I don’t have the words to tell you how thankful I am.” I thought of him riding in the rain, fording the river, calling me his daughter. I could only smile and shake my head, I didn’t have the words. When I tell Clement about thing things Mr Nanthowa does he says, “that is love.” And I wonder how many people are capable offering such love and how many are blessed enough to receive it.
As the goodbyes were passed round and round Mr Nanthowa explained another route to Clement, but uncertain whether Clement truly would find the way Mr Nanthowa insisted repeatedly that he come with us a certain distance then walk home. We said no again and again and again but somehow he ended up sitting next to me in the car directing us back. At one point he led us straight across a field, and he was right, we would not have found the road. Finally about 6 kilometers from his village, he stepped out into the rain with his bare feet, and stood and waved until he receded in the distance and the fog of the windows and the dark of the setting sun.
On our way home as we passed the hospital we mentioned Malika but hurried towards hot showers and chicken dinner. Sunday I glanced towards the hospital but could not bear the thought of going to the ICU. I did not want to know. Monday morning I learned she had died Saturday night.
Tuesday, January 30, 2007
Taken
Today during lunch a friend accompanied me to the headquarters of Chisomo Street Children’s Project. My intention was to talk to someone about Ganizani and friends/brothers who would be able to do a better job of researching their situation and background. Cosmas a nice Malawian in his late 20s greeted us and invited me to tell him what I knew about the boys. I told him about the boys in City Center and their house in Saint, about the conflicting stories of the whereabouts of their families, and the conflicting stories of their relationship to each other. When I finished Cosmas said, “Ganizani Nelson, both his parents are alive. He has been moving between relatives and may have finally left home due to the lack of freedom.” Apparently, he was in their system but preferred smoking marijuana to attending elementary school and was consequently kicked out. Cosmas struck me as a very patient and kind person with a strong no-nonsense streak. I was not really surprised by what I heard; it makes me laugh at myself and at Ganizani. I told Cosmas that next time I saw Ganizani I would let him know that we met – I’m sure he won’t be pleased by that fact. He’s 13. He deserves another chance and another but I need to be a little tougher. I think the new tactic will be the promise of food if and only if he goes back to the program. I am glad that there are social workers roaming the streets trying to get kids back into school and back into families.
Mostly Infruriating but Slightly Hilarous
Last August Clement submitted the paperwork and fees to apply for a passport. Our goal was to obtain it in time for him to travel to Zambia with my parents in October. In December he was told the passport should be ready soon. He went to Blantyre to collect it but after many phone calls and trips to various offices he reached his contact person who told him to go to Zomba. Dutifully he went to Zomba and was told that the person who had it was not around. They said they would bring it to Lilongwe. The guy came but there was no passport. A month later he went back to Blantyre and found out that his original contact left his job and the person who took over the position had been away but, “luckily just came back.” When Clement met that man he was told that his passport simply needed the signature of someone else, who was sick but “should be in tomorrow.” The following day he found the man of the highly desirable signature who then told him there was something wrong with his birth certificate. After some discussion he reconsidered, the birth certificate was fine but Clement needed a letter from the hospital requesting urgent processing of a passport (after 5 and ½ months!). (In my mind I was hearing something like, “How about $100” but Clement insisted that, he just really needed a letter.) While Clement stayed in Blantyre his friend Mavuto spent an entire day running around Lilongwe to different administrative offices trying to convince any other person in possession of an authoritative stamp and signature to sign the letter. The next morning I faxed the letter. This mollified the Blantyre signature man who then said the passport would be out within the week. The following Friday (the third or fourth day Clement called) he was told that the passport was out and that he could come pick it up. Clement called his father in Zomba who said he would go collect it Monday. Monday afternoon Clement’s father called and told him that the man who supposedly had the passport was in police custody. He was told that hopefully the man would be released on bail Tuesday and then would be able to hand over the passport. Clement says if the man is not released he will personally visit him in his cell and demand to be given his passport. (Apparently no one else at the office can find/give him the passport.)
As if that is not enough, another ridiculous drama is running concurrently. Clement - along with the other interns who have been assigned to Kamuzu Central Hospital - is fighting to receive a salary. After graduation, clinical officer interns must complete a year internship at a government hospital or clinic where they are posted by the Ministry of Health. The hospital or clinic in turn is supposed to provide them with housing and a small stipend. Now two months into their internship, those allocated to KCH have yet to receive anything . . . Okay, that’s not entirely true, they have been provided a small house (supposedly for 10-15 interns) located about 5 kilometers from the hospital. The house is furnished with a single twin bed and the interns have not been given any money for transportation, or even food.
Daily, a rotating group of interns visit the various administrative offices at the hospital and Ministry to beg. Of course the people they seek are often in meetings, and when they are caught in the office unaware they point the interns in the direction of someone else in another office across town who points them right back. “Come again at 5pm.” “Come back tomorrow.” “Get a letter from the hospital saying they can’t afford to give you anything,” etcetera.
Without pay or housing the interns are still expected to work 60-80hrs per week. Unlike residency programs in the States - where immediately after graduation you occupy the lowest rung of the medical hierarchy, with layers of experienced physicians above you, accessible for consultation and who ultimately remain responsible for the patients - these intern step into full wards alone. (Consultants are often not present at all or are completely overwhelmed by their own patient lists and responsibilities.) Interns have little to no informational resources, minimal medical resources, and little to no supervision; setting up a precarious situation for everyone involved. But, the alternative is wards full of patients without anyone to assess and treat them.
THE HOSPITAL DESPERATELY NEEDS CLINICIANS and the administration is essentially chasing them away. Several of Clement’s peers have already left KCH and those remaining are already becoming disenchanted by the government system. Hospital administrators should be grateful that they have enthusiastic clinicians willing to work in overcrowded hospitals for as little as $50/mo. I feel like screaming at the administrators, “HAVE YOU SEEN THE WARDS IN YOUR HOSPITAL?! WHAT ARE YOU THINKING?”
Certainly the people who attend KCH need these interns. Just a small illustration of that. . . Clement told me that he had a patient yesterday with pleural effusion who had been pushed from one person to anther without any investigation or treatment. By the time he reached Clement he was breathing with great difficulty. Clement drained the fluid, drew labs, and ordered a chest x-ray. Even without the results, the man was so grateful to be helped that he insisted on having Clement's phone number. Telling Clement that the next time he had a problem he would contact him directly. Clement told him that he might not be at KCH the next time but the man persisted, he said he would come to Clement regardless if he had to travel across the country. He also told Clement that he wanted to visit him at his house to which Clement responded that he didn't have a house. The man unwilling to be put off and still holding out his hand said dismissively, "I'll find you and we'll chat."
Last night when Clement narrated the most recent episodes of these ongoing sagas all I could do was laugh. Clement is applying for medical school in a few other African countries moving closer to his dream of becoming a pediatrician and serving those who have the most difficulty accessing care, but not surprisingly he is also looking forward to a few years outside Malawi.
As if that is not enough, another ridiculous drama is running concurrently. Clement - along with the other interns who have been assigned to Kamuzu Central Hospital - is fighting to receive a salary. After graduation, clinical officer interns must complete a year internship at a government hospital or clinic where they are posted by the Ministry of Health. The hospital or clinic in turn is supposed to provide them with housing and a small stipend. Now two months into their internship, those allocated to KCH have yet to receive anything . . . Okay, that’s not entirely true, they have been provided a small house (supposedly for 10-15 interns) located about 5 kilometers from the hospital. The house is furnished with a single twin bed and the interns have not been given any money for transportation, or even food.
Daily, a rotating group of interns visit the various administrative offices at the hospital and Ministry to beg. Of course the people they seek are often in meetings, and when they are caught in the office unaware they point the interns in the direction of someone else in another office across town who points them right back. “Come again at 5pm.” “Come back tomorrow.” “Get a letter from the hospital saying they can’t afford to give you anything,” etcetera.
Without pay or housing the interns are still expected to work 60-80hrs per week. Unlike residency programs in the States - where immediately after graduation you occupy the lowest rung of the medical hierarchy, with layers of experienced physicians above you, accessible for consultation and who ultimately remain responsible for the patients - these intern step into full wards alone. (Consultants are often not present at all or are completely overwhelmed by their own patient lists and responsibilities.) Interns have little to no informational resources, minimal medical resources, and little to no supervision; setting up a precarious situation for everyone involved. But, the alternative is wards full of patients without anyone to assess and treat them.
THE HOSPITAL DESPERATELY NEEDS CLINICIANS and the administration is essentially chasing them away. Several of Clement’s peers have already left KCH and those remaining are already becoming disenchanted by the government system. Hospital administrators should be grateful that they have enthusiastic clinicians willing to work in overcrowded hospitals for as little as $50/mo. I feel like screaming at the administrators, “HAVE YOU SEEN THE WARDS IN YOUR HOSPITAL?! WHAT ARE YOU THINKING?”
Certainly the people who attend KCH need these interns. Just a small illustration of that. . . Clement told me that he had a patient yesterday with pleural effusion who had been pushed from one person to anther without any investigation or treatment. By the time he reached Clement he was breathing with great difficulty. Clement drained the fluid, drew labs, and ordered a chest x-ray. Even without the results, the man was so grateful to be helped that he insisted on having Clement's phone number. Telling Clement that the next time he had a problem he would contact him directly. Clement told him that he might not be at KCH the next time but the man persisted, he said he would come to Clement regardless if he had to travel across the country. He also told Clement that he wanted to visit him at his house to which Clement responded that he didn't have a house. The man unwilling to be put off and still holding out his hand said dismissively, "I'll find you and we'll chat."
Last night when Clement narrated the most recent episodes of these ongoing sagas all I could do was laugh. Clement is applying for medical school in a few other African countries moving closer to his dream of becoming a pediatrician and serving those who have the most difficulty accessing care, but not surprisingly he is also looking forward to a few years outside Malawi.
Tuesday, January 09, 2007
Pictures
Many people have asked for pictures. Unfortunately, although I have hundreds, I don't have the time it takes to upload them. However, my dad has posted the pictures from their trip on his realestate website www.mikejorissen.com They are not of the best quality, but you can get an idea and if you've been following the stories, you can probably guess the identities of the people featured in the snapshots.
Sunday, January 07, 2007
An Ending
Thursday afternoon when I answered my phone in the middle of the labor ward my hello was met by hysterical sobbing. After a few seconds the sobbing receded and an unfamiliar voice said, "Boston is no more." Immediately I left Bottom and headed to the Pediatrics ward at Central. As I turned the corner nearing the ward I found Boston's mother, accompanied by a few friends, silently seated on a bench, eyes red and swollen from 30 minutes of devastation.
That afternoon I waited with them there, then drove behind the ambulance that carried mother and child home for their final goodbyes. The next morning Frank called just as they were beginning the burial ceremony. I arrived in time to join and small procession of women carrying wild flowers into the house. While the men sat quietly along the fence outside, the women overfilled the small room with their bodies and songs, Boston's small coffin the centerpiece on a grass mat.
I cried. But this time my tears were not for Boston. His time here was an eternity of suffering; anyone could see an old man staring out from his eyes. I cried for his mother. At 31 she has already buried two husbands and now she is burying her last born child. I cried thinking of the lightness on her hips; the sudden absence of this child who was always on her hip or back, or in her arms with his head pressed against her chest. I cried for the emptiness of her arms and for the other women at Bottom who arrive with expectations and large bellies, and return home with a small bundle to place in the ground. I cried for the women in the room many of whom surely had lost their own children and who were expected to go back to life, to drawing water, cooking, and cleaning.
Sometimes in the hospital when I am resuscitating a severely asphyxiated baby - one who is hovering between worlds - I talk to them and try to convince them to stay. It is a moment, I believe requiring absolute honesty. I cannot tell them life will be a pleasant journey. Being born to a poor woman in one of the world’s poorest countries (and perhaps to an HIV positive mother), the only enticement I can offer is the promise of their mother’s love. And, I plead that they will stay so her heart may grow with the experience of that love.
After an hour or so in the house, with the women singing hymns, we moved outside. The coffin was placed in the center of the road and encircled by the separate but now closer groups of men and women. A minister and a few other male members of the community stood to speak before the walk began to the burial site. As we walked I realized we were easily two hundred people and this sight led me to think about the differences between Malawi and the US in the ways we mark life and death, and in the ways we cherish life. Here life’s fragility presents itself bluntly nakedly and yet the end of each life remains a significant event. In the States many of us still believe we are invincible, we do everything to sustain life and yet how many deceased adults would draw such a crowd to their funeral on a Friday afternoon?
At the graveyard the minister spoke again, a few family members lay flowers on the coffin lid and then three men lowered it into the Earth. After topping the coffin with rows of sticks and a grass mat, the men took turns with shovels to fill the hole. Sitting in the tall grass to my right Boston’s mother was silent. The baby on his mother’s lap to my left pulled at my hair. In the dirt at the head of the small mound someone placed crude black metal cross, scrawled letters in white paint read “Boston Kauda 11/2005-1/2007.” The grave next to Boston’s had no little cross only three sticks and a stone, which was at that moment being traversed by a large elegant snail.
From there we returned to the house. People branching off along the way until only a small gathering of family remained. I too said goodbye to Boston’s mother, shook hands with Frank, and returned home.
That afternoon I waited with them there, then drove behind the ambulance that carried mother and child home for their final goodbyes. The next morning Frank called just as they were beginning the burial ceremony. I arrived in time to join and small procession of women carrying wild flowers into the house. While the men sat quietly along the fence outside, the women overfilled the small room with their bodies and songs, Boston's small coffin the centerpiece on a grass mat.
I cried. But this time my tears were not for Boston. His time here was an eternity of suffering; anyone could see an old man staring out from his eyes. I cried for his mother. At 31 she has already buried two husbands and now she is burying her last born child. I cried thinking of the lightness on her hips; the sudden absence of this child who was always on her hip or back, or in her arms with his head pressed against her chest. I cried for the emptiness of her arms and for the other women at Bottom who arrive with expectations and large bellies, and return home with a small bundle to place in the ground. I cried for the women in the room many of whom surely had lost their own children and who were expected to go back to life, to drawing water, cooking, and cleaning.
Sometimes in the hospital when I am resuscitating a severely asphyxiated baby - one who is hovering between worlds - I talk to them and try to convince them to stay. It is a moment, I believe requiring absolute honesty. I cannot tell them life will be a pleasant journey. Being born to a poor woman in one of the world’s poorest countries (and perhaps to an HIV positive mother), the only enticement I can offer is the promise of their mother’s love. And, I plead that they will stay so her heart may grow with the experience of that love.
After an hour or so in the house, with the women singing hymns, we moved outside. The coffin was placed in the center of the road and encircled by the separate but now closer groups of men and women. A minister and a few other male members of the community stood to speak before the walk began to the burial site. As we walked I realized we were easily two hundred people and this sight led me to think about the differences between Malawi and the US in the ways we mark life and death, and in the ways we cherish life. Here life’s fragility presents itself bluntly nakedly and yet the end of each life remains a significant event. In the States many of us still believe we are invincible, we do everything to sustain life and yet how many deceased adults would draw such a crowd to their funeral on a Friday afternoon?
At the graveyard the minister spoke again, a few family members lay flowers on the coffin lid and then three men lowered it into the Earth. After topping the coffin with rows of sticks and a grass mat, the men took turns with shovels to fill the hole. Sitting in the tall grass to my right Boston’s mother was silent. The baby on his mother’s lap to my left pulled at my hair. In the dirt at the head of the small mound someone placed crude black metal cross, scrawled letters in white paint read “Boston Kauda 11/2005-1/2007.” The grave next to Boston’s had no little cross only three sticks and a stone, which was at that moment being traversed by a large elegant snail.
From there we returned to the house. People branching off along the way until only a small gathering of family remained. I too said goodbye to Boston’s mother, shook hands with Frank, and returned home.
Wednesday, January 03, 2007
Boston
Boston is 14 months old. He is not walking or talking and weighs just over 6kgs. Boston’s mother brought him regularly to the feeding program at the house of Frank’s mother-in-law. When I visited her at home with Boston several weeks ago, I held him in my arms and could feel the reverberations of illness in his lungs against my chest with every breath he took. I don’t know if he has ever been healthy; I have never seen him well. His father died last year. His mother is unemployed and lives with her parents and her two older children (ages 4 and 6). She is thin although not sickly in appearance, but the image of Boston in her arms portents an ominous fate. Most likely this mother will lose her child, her children will lose their mother, her parents will lose their daughter and their support. Death is inevitable but the order here is wrong.
During that visit Sister Namaleu and I convinced Boston’s mother to take him to the pediatric ward; he has been there ever since. Last week I visited and he looked better. I held him in my arms resting his head against my chest emitting a weak cry of complaint only occasionally. Boston has a soft brown stuffed triceratops. It lives by his side. When I passed Boston to another friend I took his little dinosaur and with exaggerated sounds made it give him big kisses on the cheek. In response, Boston smiled faintly. I imagined that inside he was laughing convulsively like a healthy little boy, squealing with glee as I did it again and again. I’m sure that’s what he would have done. I was thrilled to see even his little smile.
Yesterday I returned to the hospital and found Boston with an IV line. His mom sat him up to feed him and managed to get a spoonful of milk in his mouth. He cried and coughed until both the milk and phlegm came up. I tried to support him in a seated position but after several minutes of his moaning let him lie back. Sister Namaleu inserted a nasogastric feeding tube. In the crib next to Boston another mother held her baby of perhaps two years also feeding her through a NG tube. Beautiful unbelievably long eyelashes framed her half open eyes, now set deeply in a face that was little more than skin pulled tight over bone. Where is the justice? What do we pray for? For these children to recover from their current illness, only to face another and another? For them to die in peace and let their parents suffer their loss? Without understanding how it might be possible I pray for an end to suffering.
I stopped in Pediatrics today to visit Boston. The girl with the beautiful lashes died last night. Boston continues to deteriorate. He was propped up against folded cloths, awake but still, using all his energy to take in air.
During that visit Sister Namaleu and I convinced Boston’s mother to take him to the pediatric ward; he has been there ever since. Last week I visited and he looked better. I held him in my arms resting his head against my chest emitting a weak cry of complaint only occasionally. Boston has a soft brown stuffed triceratops. It lives by his side. When I passed Boston to another friend I took his little dinosaur and with exaggerated sounds made it give him big kisses on the cheek. In response, Boston smiled faintly. I imagined that inside he was laughing convulsively like a healthy little boy, squealing with glee as I did it again and again. I’m sure that’s what he would have done. I was thrilled to see even his little smile.
Yesterday I returned to the hospital and found Boston with an IV line. His mom sat him up to feed him and managed to get a spoonful of milk in his mouth. He cried and coughed until both the milk and phlegm came up. I tried to support him in a seated position but after several minutes of his moaning let him lie back. Sister Namaleu inserted a nasogastric feeding tube. In the crib next to Boston another mother held her baby of perhaps two years also feeding her through a NG tube. Beautiful unbelievably long eyelashes framed her half open eyes, now set deeply in a face that was little more than skin pulled tight over bone. Where is the justice? What do we pray for? For these children to recover from their current illness, only to face another and another? For them to die in peace and let their parents suffer their loss? Without understanding how it might be possible I pray for an end to suffering.
I stopped in Pediatrics today to visit Boston. The girl with the beautiful lashes died last night. Boston continues to deteriorate. He was propped up against folded cloths, awake but still, using all his energy to take in air.
Wednesday, December 06, 2006
Right
Thursday morning began with a woman named Clara whose distressed baby was emerging feet first; slipping through a partially opened cervix (footling breeches must always be delivered by c-section because, although bodies may slide through before the cervix is completely dilated, the head will most likely become entrapped). I went to theatre to receive the baby. An hour passed between the minute when I heard the alarmingly slow heart rate and the minute when the struggling baby was placed in my hands. I resuscitated her for about 20 minutes before her breathing became regular but even then her lips remained an ominous shade of purple.
I took her to the nursery and returned to the labor ward to find the nurses preparing magnesium sulfate for an eclamptic woman who had just arrived unconscious. Apparently Jessy was on her way to the hospital complaining of a severe headache (a symptom of preeclampsia) accompanied by her mother when she seized. I helped the others prepared and administer the magnesium and then she seized again. We had no medicine to help lower her blood pressure. She seized again. She looked to be less than 30 weeks pregnant (i.e. very premature and barely viable in Malawi) but the only cure for eclampsia is delivery and you must deliver to save the mother's life regardless of the baby's gestational age. The baby’s heart rate sounded strong so I returned to theatre. Lying unconscious, outside the theatre, waiting for a cervical repair to finish, Jessy seized again. Once the section started, I stood to the side with my sterile cloth, expecting to be handed a creature so small and unprepared for extrauterine life. I was please to meet a pink beautiful little girl with a hopeful weight of 1.6kg.
I took her to the nursery and then returned to the labor ward. In a calm voice Msiska called me, “Joanne, can you help?” and I, slowly and calmly walked over to where she stood. My gaze landed on the horrific sight of a baby’s body dangling freely with the head still inside his mother. I ran for gloves and asked Msiska if the baby was still alive, she said that it had been but that it had died. I quickly delivered the head and then felt a slow but strong pulse and ran with the limp baby boy to the resuscitare. While I was resuscitating him another woman began delivering a footling breech on the bed 10 feet behind me. She had come in just moments before; no warning or time to prepare for a section. I handed over the resuscitation and ran to help deliver the head. The little girl needed just a breath or two with the bag and mask to encourage her. Chipeta delivered her twin sister and placed them side by side.
I don’t remember the flow of events for the remainder of the day. I remember eating an apple. I remember assisting a student manage the care of a woman with a moderate hemorrhage. I remember attending a normal birth. I also checked on the babies in nursery periodically throughout the day. Clara’s baby looked distressed and pale despite the oxygen. Jessy’s baby was lovely. The breech boy held steady although his posture suggested damage to the nerves enervating his right arm. Friday was similarly hectic. I assisted with two shoulder distocias, delivered one baby via vacuum and attended a couple normal deliveries as well.
For almost the whole of last week there was no pethadine at Bottom. In other words there was NO pain medicine. Women delivering at Bottom never receive pain medicine during their labors (except in a rare case when it is given to a mom delivering a dead baby). Usually the precious pain medicine is reserved for women who undergo surgeries, but for a week even they received nothing. Women were anesthetized during the surgical procedures but once in the recovery rooms they received nothing, despite the fact that they had been cut through their skin, fat, muscle, and uteruses. Dr. Meguid often talks about these shortages (other common shortages include antibiotics and suture material) in terms of human rights. I think it's appropriate to frame the situation in this way. We have international documents on human rights and women's rights but what does this mean in a practical way? Certainly it is INhumane to use inappropriate suture material on women and increase their risk for abdominal rupture. It is INhumane to withhold antibiotics and risk peritonitis and the not uncommon subsequent hysterectomy. And it is INhumane to withhold pain medication after surgery. Although this is a situation of absent resources and not withheld resources, is it not in actuality withheld when we consider the global picture? We know what is necessary to treat women humanely on a mundane level. We know practically what is involved to provide adequate maternity care. So, where is the commitment?
I went to Bottom on Sunday just to check on all my babies. Clara's baby had died Saturday night. Jessy's baby, the twins and Esmilo's breech boy were doing well. Jessy was also doing great. I recognized her name but looking at her did not recognize her face. I could not remember how I was involved in her birth until I read the baby's file. Just a couple days before she was swollen and unconscious, Sunday she was laughing, walking, and nursing her baby.
Today I spent my usual half day at Bottom (the morning at Bottom, the afternoon at the Embassy). I walked in and did two deliveries within 15 minutes, the first was an undiagnosed stillborn anencephalic baby; the second was a nice normal girl delivered by a 15 year old. Anencephaly is a rare event, according to my perusal of various sources the incidence lies somewhere between 1 in 100,000 to 1 in 70,000. I have seen 5 since coming to Bottom. Considering that Bottom has only 12,000 births a year and I am only present for a fraction of these, this number is incredibly concerning. I am going to start keeping a log. I checked in the nursery again and was devastated to learn that Jessy's baby died unexpectedly last night. The nurse said Jessy breastfed the baby and then the baby had an apneic attack from which she never recovered. I did not see Jessy but I can only imagine her heartbreak. Just before noon I attended 19 year old Elena's delivery, it was a beautiful birth and she had a boy.
I took her to the nursery and returned to the labor ward to find the nurses preparing magnesium sulfate for an eclamptic woman who had just arrived unconscious. Apparently Jessy was on her way to the hospital complaining of a severe headache (a symptom of preeclampsia) accompanied by her mother when she seized. I helped the others prepared and administer the magnesium and then she seized again. We had no medicine to help lower her blood pressure. She seized again. She looked to be less than 30 weeks pregnant (i.e. very premature and barely viable in Malawi) but the only cure for eclampsia is delivery and you must deliver to save the mother's life regardless of the baby's gestational age. The baby’s heart rate sounded strong so I returned to theatre. Lying unconscious, outside the theatre, waiting for a cervical repair to finish, Jessy seized again. Once the section started, I stood to the side with my sterile cloth, expecting to be handed a creature so small and unprepared for extrauterine life. I was please to meet a pink beautiful little girl with a hopeful weight of 1.6kg.
I took her to the nursery and then returned to the labor ward. In a calm voice Msiska called me, “Joanne, can you help?” and I, slowly and calmly walked over to where she stood. My gaze landed on the horrific sight of a baby’s body dangling freely with the head still inside his mother. I ran for gloves and asked Msiska if the baby was still alive, she said that it had been but that it had died. I quickly delivered the head and then felt a slow but strong pulse and ran with the limp baby boy to the resuscitare. While I was resuscitating him another woman began delivering a footling breech on the bed 10 feet behind me. She had come in just moments before; no warning or time to prepare for a section. I handed over the resuscitation and ran to help deliver the head. The little girl needed just a breath or two with the bag and mask to encourage her. Chipeta delivered her twin sister and placed them side by side.
I don’t remember the flow of events for the remainder of the day. I remember eating an apple. I remember assisting a student manage the care of a woman with a moderate hemorrhage. I remember attending a normal birth. I also checked on the babies in nursery periodically throughout the day. Clara’s baby looked distressed and pale despite the oxygen. Jessy’s baby was lovely. The breech boy held steady although his posture suggested damage to the nerves enervating his right arm. Friday was similarly hectic. I assisted with two shoulder distocias, delivered one baby via vacuum and attended a couple normal deliveries as well.
For almost the whole of last week there was no pethadine at Bottom. In other words there was NO pain medicine. Women delivering at Bottom never receive pain medicine during their labors (except in a rare case when it is given to a mom delivering a dead baby). Usually the precious pain medicine is reserved for women who undergo surgeries, but for a week even they received nothing. Women were anesthetized during the surgical procedures but once in the recovery rooms they received nothing, despite the fact that they had been cut through their skin, fat, muscle, and uteruses. Dr. Meguid often talks about these shortages (other common shortages include antibiotics and suture material) in terms of human rights. I think it's appropriate to frame the situation in this way. We have international documents on human rights and women's rights but what does this mean in a practical way? Certainly it is INhumane to use inappropriate suture material on women and increase their risk for abdominal rupture. It is INhumane to withhold antibiotics and risk peritonitis and the not uncommon subsequent hysterectomy. And it is INhumane to withhold pain medication after surgery. Although this is a situation of absent resources and not withheld resources, is it not in actuality withheld when we consider the global picture? We know what is necessary to treat women humanely on a mundane level. We know practically what is involved to provide adequate maternity care. So, where is the commitment?
I went to Bottom on Sunday just to check on all my babies. Clara's baby had died Saturday night. Jessy's baby, the twins and Esmilo's breech boy were doing well. Jessy was also doing great. I recognized her name but looking at her did not recognize her face. I could not remember how I was involved in her birth until I read the baby's file. Just a couple days before she was swollen and unconscious, Sunday she was laughing, walking, and nursing her baby.
Today I spent my usual half day at Bottom (the morning at Bottom, the afternoon at the Embassy). I walked in and did two deliveries within 15 minutes, the first was an undiagnosed stillborn anencephalic baby; the second was a nice normal girl delivered by a 15 year old. Anencephaly is a rare event, according to my perusal of various sources the incidence lies somewhere between 1 in 100,000 to 1 in 70,000. I have seen 5 since coming to Bottom. Considering that Bottom has only 12,000 births a year and I am only present for a fraction of these, this number is incredibly concerning. I am going to start keeping a log. I checked in the nursery again and was devastated to learn that Jessy's baby died unexpectedly last night. The nurse said Jessy breastfed the baby and then the baby had an apneic attack from which she never recovered. I did not see Jessy but I can only imagine her heartbreak. Just before noon I attended 19 year old Elena's delivery, it was a beautiful birth and she had a boy.
Monday, November 27, 2006
Streetkids
Ganizani - and another boy who looks nothing like him but whom he calls his brother - beg outside the PTC grocery store almost every day. Ganizani is 13. His brother is 11. They swear they go to school. I doubt it. Usually, when I shop there, I buy them bread. Last month I told him I wanted to see his home. Clement and I met them outside the PTC one Saturday morning and they directed us across town, moving from paved roads to dirt roads, from green to dust, landing at last in an area where rent (I was told by a Malawian friend) ranges from the equivalent of US$1-3/month. On the way we stopped at a market to buy 50kgs of maize and 5 kgs of beans. Then the two skinny boys excitedly and awkwardly carried the bag between them to their small mud brick home.
Ganizani speaks as a child anxious to grow up, deepening his voice as he raises it, so it becomes lower than seems natural for his size and age. He says he is the oldest of five siblings who live there. Before their parents died they rented a larger house, but once their parents died the landlord evicted them and they just wandered and squatted until someone gave them their current house. Ganizani leans on the door just inches higher than his head and as he talks it comes off the frame. He tries repairing it with a piece of string as he continues. He says usually they walk across town to the PTC and return home just a few kwacha, with this little money they buy maize flour and share it between them; if they don’t have any money, they don’t eat. Their clothes are torn and filthy. They sleep on the bare earth floor without blankets.
This is the effect of extreme poverty and HIV (perhaps that is redundant, perhaps I should simply say this is the effect of extreme poverty). And, I am tempted to ask whether this is also the effect of extreme wealth. Today I saw Ganizani again in front of the PTC, he said the maize had finished and I promised to buy more. What do we do? buy food and blankets? have someone repair their door? make sure these five kids can eat and go to school? set up a trust fund? Am I creating dependency, as my very proactive and vocal Malawian friend Lexa says? Am I harming the country more by acquiescing to basic physical needs without a clear vision for the future? Lexa says kids with parents will take their food and when they leave the house everything will be stolen. She says I need to send them home.
Should I find the distant and most likely impoverished relatives who have not claimed this band of orphans and force them together? Should I send them to an overcrowded orphanage? Is it reckless to feed them now knowing I will leave the country before they are adults? Are these actions for my benefit or theirs? I don’t know. I only know I don’t want them going hungry and I don’t want to ignore them, and waiting for social transformation or a vision will not fill their bellies today.
Ganizani speaks as a child anxious to grow up, deepening his voice as he raises it, so it becomes lower than seems natural for his size and age. He says he is the oldest of five siblings who live there. Before their parents died they rented a larger house, but once their parents died the landlord evicted them and they just wandered and squatted until someone gave them their current house. Ganizani leans on the door just inches higher than his head and as he talks it comes off the frame. He tries repairing it with a piece of string as he continues. He says usually they walk across town to the PTC and return home just a few kwacha, with this little money they buy maize flour and share it between them; if they don’t have any money, they don’t eat. Their clothes are torn and filthy. They sleep on the bare earth floor without blankets.
This is the effect of extreme poverty and HIV (perhaps that is redundant, perhaps I should simply say this is the effect of extreme poverty). And, I am tempted to ask whether this is also the effect of extreme wealth. Today I saw Ganizani again in front of the PTC, he said the maize had finished and I promised to buy more. What do we do? buy food and blankets? have someone repair their door? make sure these five kids can eat and go to school? set up a trust fund? Am I creating dependency, as my very proactive and vocal Malawian friend Lexa says? Am I harming the country more by acquiescing to basic physical needs without a clear vision for the future? Lexa says kids with parents will take their food and when they leave the house everything will be stolen. She says I need to send them home.
Should I find the distant and most likely impoverished relatives who have not claimed this band of orphans and force them together? Should I send them to an overcrowded orphanage? Is it reckless to feed them now knowing I will leave the country before they are adults? Are these actions for my benefit or theirs? I don’t know. I only know I don’t want them going hungry and I don’t want to ignore them, and waiting for social transformation or a vision will not fill their bellies today.
31
November 14th 2006, my eyes opened and moments later the sky opened, releasing the no-longer-bearable-weight of the year’s first rain. I thought briefly of all the homes I have visited with flecks of sky shinning through their tin roofs, of all the mud brick village huts with decrepit thatch roofs, and then of all the fields sitting ready, waiting; dry soil tilled in neat expectant rows. Rain would beget work and happiness and hope; it was a good omen for a birthday. In the past people sowed their fields at the same time every year but the increasingly unpredictable timing of the rains has prompted change. People now wait to see that the rains have come to stay before planting, to avoid the withering of tender crops, coaxed from the soil by early rain then betrayed by relentless heat.
Monday, November 20, 2006
The Parents' Visit
My parents arrived October 9th. I hadn’t seen my folks since I left home in March 2005 and I was so excited about their arrival, I worried about passing out at the airport from sheer excitement. I also worried that somehow they might end up in Thailand or Germany instead of Malawi. Although both my parents lived for years in South America this was their first trip outside the US (besides Mexico) since 1972. Luckily, they arrived intact although exhausted with all of their luggage on the expected date. I didn’t pass out but it was wonderful to see them and the visit improved from there. I can say that for the past 14 years I have recognized that my parents are remarkable people but even so they managed to impress me.
For those of you who don’t know my family, here’s the abbreviated history of my parents. Before they were married my mother worked as a nurse in the Altiplano of Bolivia for six years helping to set up and run a clinic. During the same time period my dad lived and worked in the favelas outside Recife, Brazil. When they talk about their time in South America their eyes sparkle and they turn contemplative. In the late 1960s they both believed they would spend their lives there, but circumstances brought them back to the US – to Detroit, even though my mom is from east Texas – and their lives changed completely. My mom became a pediatric nurse practitioner, my dad became a social worker, they found jobs, they met, married, had me, later adopted my brother, moved to Texas, my dad gave up social work for real-estate, my mother worked in the newborn nursery and raised us, then retired about 10 years ago, my dad still works in real-estate.
In many ways moving across the world actually deepened my relationship with my parents. They know my struggles intimately as their own and find more frequent occasions to share bits of wisdom, especially that gained from reflection on their time abroad almost 40 years ago. In my family, I am not an original but I’m okay with that. As we drove the 30 minutes from the airport to my house, past scenes of boys herding cattle, untended roaming goats, and women carrying bundles on their heads, my dad said, “This feels very comfortable.” For him this was a return.
My dad kept his own journal quite religiously throughout their three weeks here and I’ve asked him to post a sampling of his impressions; he has not yet committed to that but says he will post pictures at some point. I think we did as much as physically possible without totally exhausting everyone. We went to Bottom. We went to the lake. We went on safari in Zambia and saw lions with a kill, a leopard, countless elephants, giraffes, zebra, and even a python. We went to Mr Nankuntho’s village, where he did indeed kill the promised goat (and Clement skinned it). We went to Mua Mission, a hundred-year-old Catholic mission; the Canadian priest who has run the mission for the last 40 years was initiated into the Chewa tribe and, with the permission of the chiefs, has created a museum filled with cultural information about three of the largest ethnic groups in Malawi, notably elevating the local culture rather than desecrating it. We went to Zomba Mountain and finished with a visit to Clement’s home village in Mangochi (home village meaning the village of his father’s father not the place he grew up) to meet his extended family. My parents ate nsmia, drank tobwa, drank water from bore holes, used latrines, kissed babies, learned the basic greetings in Chichewa, received gifts of dried fish, mangos, and a live chicken, and ended each day smiling. Not a moment of culture shock and not a moment of illness.
For me, I loved seeing what has become mudane with all the light and color their eyes gave to it, and I realized again - but a bit more profoundly - that I am surrounded by an amazing community of friends. The only downside of the visit came with passing thoughts about how many miles separate me from my family, the rarity of our visits, and the inevitable aging of my parents. (During their visit my dad turned 71 and my mom turned 75; if I could force them to commit to another 30 years on this planet I certainly would.) They left on October 26th with smiles and hundreds of photos and a few carvings and countless memories; they said the visit was transformative. Last week my dad called and asked if they could return on the weekend. I wish they would.
For those of you who don’t know my family, here’s the abbreviated history of my parents. Before they were married my mother worked as a nurse in the Altiplano of Bolivia for six years helping to set up and run a clinic. During the same time period my dad lived and worked in the favelas outside Recife, Brazil. When they talk about their time in South America their eyes sparkle and they turn contemplative. In the late 1960s they both believed they would spend their lives there, but circumstances brought them back to the US – to Detroit, even though my mom is from east Texas – and their lives changed completely. My mom became a pediatric nurse practitioner, my dad became a social worker, they found jobs, they met, married, had me, later adopted my brother, moved to Texas, my dad gave up social work for real-estate, my mother worked in the newborn nursery and raised us, then retired about 10 years ago, my dad still works in real-estate.
In many ways moving across the world actually deepened my relationship with my parents. They know my struggles intimately as their own and find more frequent occasions to share bits of wisdom, especially that gained from reflection on their time abroad almost 40 years ago. In my family, I am not an original but I’m okay with that. As we drove the 30 minutes from the airport to my house, past scenes of boys herding cattle, untended roaming goats, and women carrying bundles on their heads, my dad said, “This feels very comfortable.” For him this was a return.
My dad kept his own journal quite religiously throughout their three weeks here and I’ve asked him to post a sampling of his impressions; he has not yet committed to that but says he will post pictures at some point. I think we did as much as physically possible without totally exhausting everyone. We went to Bottom. We went to the lake. We went on safari in Zambia and saw lions with a kill, a leopard, countless elephants, giraffes, zebra, and even a python. We went to Mr Nankuntho’s village, where he did indeed kill the promised goat (and Clement skinned it). We went to Mua Mission, a hundred-year-old Catholic mission; the Canadian priest who has run the mission for the last 40 years was initiated into the Chewa tribe and, with the permission of the chiefs, has created a museum filled with cultural information about three of the largest ethnic groups in Malawi, notably elevating the local culture rather than desecrating it. We went to Zomba Mountain and finished with a visit to Clement’s home village in Mangochi (home village meaning the village of his father’s father not the place he grew up) to meet his extended family. My parents ate nsmia, drank tobwa, drank water from bore holes, used latrines, kissed babies, learned the basic greetings in Chichewa, received gifts of dried fish, mangos, and a live chicken, and ended each day smiling. Not a moment of culture shock and not a moment of illness.
For me, I loved seeing what has become mudane with all the light and color their eyes gave to it, and I realized again - but a bit more profoundly - that I am surrounded by an amazing community of friends. The only downside of the visit came with passing thoughts about how many miles separate me from my family, the rarity of our visits, and the inevitable aging of my parents. (During their visit my dad turned 71 and my mom turned 75; if I could force them to commit to another 30 years on this planet I certainly would.) They left on October 26th with smiles and hundreds of photos and a few carvings and countless memories; they said the visit was transformative. Last week my dad called and asked if they could return on the weekend. I wish they would.
1 in 100
I am still alive and still in Malawi, despite the silence. I struggle at times over which thoughts to post and which to hold back, this struggle combined with the undulating swells of fatigue and procrastination leads to no blogging for weeks and weeks. Sorry. I’m back now and want to begin with the story of a c-section from early October.
A 24-year-old woman with her first pregnancy was sent to theatre because her baby wanted to emerge bottom first. (All primips with breech babies are sectioned at Bottom; multips with breeches are allowed to deliver vaginally.) After the anesthetist placed the spinal the woman began an involved monologue clearly captivating the scrub nurse, anesthetist and clinical officer. They added laughter and an occasional short question but only that. A smattering of words filtered though the dullness of my Chichewa speaking mind but still hardly enough to compile a satisfactory picture. When I asked what she was saying, the scrub nurse responded that when the anesthetist placed the spinal he told her the medicine would work as they chatted so clearly she interpreted that to mean that chatting was an essential component for pain relief. “She’s just telling stories from her life; she’s a farmer, she’s talking about her farm.” I wanted more substance but clearly no one wanted to waste time translating for me and miss part of her story.
Following another stretch of narrative, the small audience released a trickle of laughter and the clinical officer casually remarked, “She’s one in a hundred.” The scrub nurse then turned to me to translate the amusing comment made by the patient, which was simply that her husband loved her very much. Personally surprised more by their reaction, than by her statement I asked for clarification. The clinical officer said bluntly, “It is very rare that a woman can say outright that her husband loves her.” At once I felt charmed by this sweet beloved woman who chatted her way to a good outcome and deeply sad for the 99 women who live everyday with and for an unloving partner.
A 24-year-old woman with her first pregnancy was sent to theatre because her baby wanted to emerge bottom first. (All primips with breech babies are sectioned at Bottom; multips with breeches are allowed to deliver vaginally.) After the anesthetist placed the spinal the woman began an involved monologue clearly captivating the scrub nurse, anesthetist and clinical officer. They added laughter and an occasional short question but only that. A smattering of words filtered though the dullness of my Chichewa speaking mind but still hardly enough to compile a satisfactory picture. When I asked what she was saying, the scrub nurse responded that when the anesthetist placed the spinal he told her the medicine would work as they chatted so clearly she interpreted that to mean that chatting was an essential component for pain relief. “She’s just telling stories from her life; she’s a farmer, she’s talking about her farm.” I wanted more substance but clearly no one wanted to waste time translating for me and miss part of her story.
Following another stretch of narrative, the small audience released a trickle of laughter and the clinical officer casually remarked, “She’s one in a hundred.” The scrub nurse then turned to me to translate the amusing comment made by the patient, which was simply that her husband loved her very much. Personally surprised more by their reaction, than by her statement I asked for clarification. The clinical officer said bluntly, “It is very rare that a woman can say outright that her husband loves her.” At once I felt charmed by this sweet beloved woman who chatted her way to a good outcome and deeply sad for the 99 women who live everyday with and for an unloving partner.
Tuesday, October 03, 2006
A New Slant on Personal Incompetence
Last week the nurses had difficulty hearing the fetal heart of a particular woman - even when the baby is well, we occasionally struggle to find the heart with our simple fetoscopes. Luckily there is an ultrasound machine just across the hall so we can walk her a few feet to confirm or dispel our fears.
That day the clinical officer who scanned the woman decided he saw a still heart; he told the nurses and he told the woman. It was her first pregnancy and now she believed she was laboring to deliver a dead baby; her anguish resounded clearly in her cries with each contraction. Several hours later, when the woman was well into an abnormally protracted labor, Msiska decided to listen in again and heard a heartbeat. She called me over and I also heard the heartbeat. Together we scanned the woman and clearly saw the heart beating. We told the woman her baby was fine and a section was arranged. In theatre I was handed a baby boy who needed some resuscitation but quickly perked up. He only cried through couple breaths and then calmly and attentively took in his new world. I wrapped the baby and brought him close to his mother for her to see. The new mom looked at her baby gazing back at her with wide eyes and asked confused, "Is my baby dead?"
A couple days later I saw the clinical officer who initially scanned the woman and had told her her baby was dead. I told him the story and said the baby was very much alive. His response, "God is great!"
That day the clinical officer who scanned the woman decided he saw a still heart; he told the nurses and he told the woman. It was her first pregnancy and now she believed she was laboring to deliver a dead baby; her anguish resounded clearly in her cries with each contraction. Several hours later, when the woman was well into an abnormally protracted labor, Msiska decided to listen in again and heard a heartbeat. She called me over and I also heard the heartbeat. Together we scanned the woman and clearly saw the heart beating. We told the woman her baby was fine and a section was arranged. In theatre I was handed a baby boy who needed some resuscitation but quickly perked up. He only cried through couple breaths and then calmly and attentively took in his new world. I wrapped the baby and brought him close to his mother for her to see. The new mom looked at her baby gazing back at her with wide eyes and asked confused, "Is my baby dead?"
A couple days later I saw the clinical officer who initially scanned the woman and had told her her baby was dead. I told him the story and said the baby was very much alive. His response, "God is great!"
Wednesday, September 13, 2006
SuperSTAR
I had a pretty crummy week last week and it was followed by an equally crummy weekend. There were some woe-is-me moments and a few tears and then just when I started getting comfortable with my misery Frank called and said we needed to meet. This afternoon I drove over to his work and we sat outside the gate in my car and talked.
Just as a reminder Frank is the superstar dad whose took a personal tragedy (his wife died the day after giving birth to their first and only child in January) and used it as a reason to transform his community (he started a feeding program for 60 orphans and looks out for severely impoverished families in his area).
Two pieces of background information First, Frank's family is in Blantyre (4 hours South of Lilongwe) he lives near his in-laws and spends most of his free time with their family and his daughter (culturally the daughter must be raised by women until she is at least a few years old). Frank also supports his in-laws financially to a great extent and defers to them frequently when decisions must be made concerning his own life. This has been working moderately well but it means that there is no one on his side. Second, in Malawi property grabbing is a problem. The typical scenario of property grabbing happens this way - the husband dies, his family comes and takes everything and anything (including children) from the wife, leaving her destitute. There are groups trying to fight this practice both culturally and legally but it still happens.
Frank has close to nothing but he told me that he anticipated such a scenario, he had heard people talking about his sister-in-law wanting his sofa set. He even confronted her months ago saying that if she wanted it to let him know and give him time so he could save and buy another set. When he confronted her she said, "I could never do that to you."
Well, apparently she could. Last night a large group of men showed up at Frank's house. Frank's reaction was to kindly offer them all his possessions. He said, "Would you like the sofa? Ok? Let me help you with that. How about the radio? Yes? Here it is." And, he actually helped them carry his things out of his house to his mother-in-law's house. They left him his small bed and his clothes, he said they even took the bags he used to store his clothes in.
On hearing this I felt completely outraged, I wanted to scream and call the police and get his daughter away from them. I wanted to stop working with the feeding program that runs out of his mother-in-laws house but he said those actions would just cause more suffering for other people. He said he didn't sleep for much of the night until he realized three things: (1) the experience would make him work harder to save money; (2) it would make him a stronger person; and (3) at last he was free, there was nothing else for them to take.
Just as a reminder Frank is the superstar dad whose took a personal tragedy (his wife died the day after giving birth to their first and only child in January) and used it as a reason to transform his community (he started a feeding program for 60 orphans and looks out for severely impoverished families in his area).
Two pieces of background information First, Frank's family is in Blantyre (4 hours South of Lilongwe) he lives near his in-laws and spends most of his free time with their family and his daughter (culturally the daughter must be raised by women until she is at least a few years old). Frank also supports his in-laws financially to a great extent and defers to them frequently when decisions must be made concerning his own life. This has been working moderately well but it means that there is no one on his side. Second, in Malawi property grabbing is a problem. The typical scenario of property grabbing happens this way - the husband dies, his family comes and takes everything and anything (including children) from the wife, leaving her destitute. There are groups trying to fight this practice both culturally and legally but it still happens.
Frank has close to nothing but he told me that he anticipated such a scenario, he had heard people talking about his sister-in-law wanting his sofa set. He even confronted her months ago saying that if she wanted it to let him know and give him time so he could save and buy another set. When he confronted her she said, "I could never do that to you."
Well, apparently she could. Last night a large group of men showed up at Frank's house. Frank's reaction was to kindly offer them all his possessions. He said, "Would you like the sofa? Ok? Let me help you with that. How about the radio? Yes? Here it is." And, he actually helped them carry his things out of his house to his mother-in-law's house. They left him his small bed and his clothes, he said they even took the bags he used to store his clothes in.
On hearing this I felt completely outraged, I wanted to scream and call the police and get his daughter away from them. I wanted to stop working with the feeding program that runs out of his mother-in-laws house but he said those actions would just cause more suffering for other people. He said he didn't sleep for much of the night until he realized three things: (1) the experience would make him work harder to save money; (2) it would make him a stronger person; and (3) at last he was free, there was nothing else for them to take.
Wednesday, August 30, 2006
Still Dancing
I checked on the little girl today. She's looking well - no fever, no seizures, physically and developmentally normal on day 7 of life.
Monday, August 28, 2006
Miracles
Thursday was a wonderful day. It didn’t start out wonderful but at 5:30 I felt great. I arrived early at Bottom to meet the usual assortment of urgent cases. Almost all 14 beds were occupied but the voice of one woman rose above everyone. Around 9am the midwife monitoring her decided that the baby was distressed. A caesarian was ordered. At 9:40 I was handed a pale listless little girl. I immediately began resuscitation. Usually the nurse who receives the baby in theatre is the one and only person responsible for that baby, luckily this time there were two medical students and a VOS anesthesiologist whose hands were free. The four of us worked on her . . . suction, bag, mask, chest compressions, drugs, oxygen. I looked at her purple lips and thought the worst but kept going. At 10:20 she cried. She cried weakly at first, then coughed, then cried a bit louder and stronger. I was so happy I could have kissed everyone in the room. Honestly, I don’t remember much about the other patients that day. I just moved from birth to nursery and back. I left her pink and squirming under the warmer that afternoon.
Of course I can’t say that everything will turn out well. There is still a chance she may die this week, and if she survives, she might have cerebral palsy, and even if she is intact physically, she might have severe mental disabilities. There are still so many miracles required to carry her through to adulthood whole, but her first miracle happened while I held her in my hands and that’s enough to make me dance and sing today.
Of course I can’t say that everything will turn out well. There is still a chance she may die this week, and if she survives, she might have cerebral palsy, and even if she is intact physically, she might have severe mental disabilities. There are still so many miracles required to carry her through to adulthood whole, but her first miracle happened while I held her in my hands and that’s enough to make me dance and sing today.
Joy
Wednesday Mr Nanthowa (aka Ireen’s dad) showed up at Bottom on a borrowed bicycle with a bag of peas and sweet potatoes from his garden. I realized that seeing him there meant he had rented a bicycle from a neighbor and then cycled 40 kilometers to deliver that bag of home grown goods to me at Bottom and put them in the trunk of my shiny car. Straight away I decided that Friday I would visit and bring a new bike. I thanked him and told him I would visit. Friday morning after a couple baby visits I went to a shop and bought a shiny new black bike for $60 (thanks to Jeff). A worker there helped me fix it with lots of green rope, so that the trunk almost closed and the handle bars just peeked out. I did fine for the first 20km but at the first bump - as I moved from paved to unpaved road - everything came loose. I retied it myself but even with my knotting skills from rock-climbing days, the trunk bounced each time I hit a good bump. Multiple times along the way I considered just leaving the bike somewhere (the clinic, the police station, etc.) and bringing him to collect it, but each time I scolded myself for the thought and continued bumping slowly along.
As I pulled up between the huts, Mrs Nanthowa emerged with a chitinge wrapped around her, fresh from bathing. She said a million things to me in Chichewa, which I didn’t understand, through smiles and laughter and led me to a mat indoors to wait while she dressed. Mr Nanthowa soon appeared, sat on the mat, and shook my hand. He told me I should park my car in the shade. I asked him if he noticed what I brought for him. Instantly his eyes widened, an enormous smile spread across his face, and he took my hand. I was laughing and he was saying, “Congratulations! Congratulations!”
We unloaded the bike and moved it inside where he began the assembly. As family members came by he proudly showed them the bike and in response they clicked their tongues and shook my hand. I told him about my friend giving the money and he gave me his address, enchanted by the thought of sharing his happiness and gratitude with this kind stranger.
Of course before I left, we ate nsima. I told them that my parents would be coming (they’re coming to Malawi in October!) and Mr. Nanthowa said I had to bring them there. He said, “You’re roots are here. Your parents can stay 2 or 3 days. You can come and go but your parents should stay and we’ll kill a goat. And that’s a promise.” I love the idea of my parents in the village sharing nsima with Mr and Mrs Nanthowa, and the entire village present for a goat roast, but I can’t quite imagine them sleeping on the grass mats. Maybe a morning will suffice.
As I pulled up between the huts, Mrs Nanthowa emerged with a chitinge wrapped around her, fresh from bathing. She said a million things to me in Chichewa, which I didn’t understand, through smiles and laughter and led me to a mat indoors to wait while she dressed. Mr Nanthowa soon appeared, sat on the mat, and shook my hand. He told me I should park my car in the shade. I asked him if he noticed what I brought for him. Instantly his eyes widened, an enormous smile spread across his face, and he took my hand. I was laughing and he was saying, “Congratulations! Congratulations!”
We unloaded the bike and moved it inside where he began the assembly. As family members came by he proudly showed them the bike and in response they clicked their tongues and shook my hand. I told him about my friend giving the money and he gave me his address, enchanted by the thought of sharing his happiness and gratitude with this kind stranger.
Of course before I left, we ate nsima. I told them that my parents would be coming (they’re coming to Malawi in October!) and Mr. Nanthowa said I had to bring them there. He said, “You’re roots are here. Your parents can stay 2 or 3 days. You can come and go but your parents should stay and we’ll kill a goat. And that’s a promise.” I love the idea of my parents in the village sharing nsima with Mr and Mrs Nanthowa, and the entire village present for a goat roast, but I can’t quite imagine them sleeping on the grass mats. Maybe a morning will suffice.
Subscribe to:
Posts (Atom)
