Monday, September 24, 2012


My patient died last night.
What does an 11 year old boy think about while he is dying?  He lies on a plastic bed in the merciless fluorescent light, surrounded by the relentless noise of babies crying and machines beeping, with the occasional sound of mothers wailing when their children die.  He watches tubes inserted, seizures, and CPR in the surrounding beds. Does he have hope?  Is he afraid?  Is he thinking of football games he’s played, or his school friends?  Is he missing his dead mom? 
My heart breaks that his last moments were spent in that chaos and filth.  I pray that he just felt tired, and that he fell asleep, and felt no pain.  I am so truly, profoundly sorry that I couldn’t save him.  Please don’t write to me and tell me about how it’s not my fault.  I know with my head that there was a complicated path that eventually lead to his death, and I know that I am only human, and that we are limited here.
And yet, my son is 11.  He is solid, and boisterous, and robust.  He has dreams, and a future. ALL boys should be pestering their little sisters, and building forts out of sticks.  They should feel safe, and have faith that they will be protected and loved while they go about the work of growing up.  Instead, this sweet soul lay in that war zone, holding his grandmother’s hand for several days before he died. 
I wish I could have altered that path.  I am so sad that we, as human beings, have allowed this to happen to our children.  I pray for that little boy’s soul. I don’t have a great concept of heaven, and I don’t pretend to know what comes next.  But for him, I hope he is with his parents.  I hope that he died painlessly, and that he is now whole and strong.  I am grateful for the time I spent taking care of him. I am honored to have witnessed his quiet courage.  And I am so terribly sorry.

Saturday, September 22, 2012

The view from the front line

The view from the front line is horrific.  It is like a nightmare.  The room is hot and damp with the smell of vomit and urine.  The walls are filthy, and crawling with insects.  Children lie, as many as eight infants to a hospital bed, on wet chitenjes, filthy tape securing dubious IV lines in awful places.  Some children are on bubble CPAP, and have large plastic tubes secured with graying bandages occluding their noses and forcing in oxygen.  Anxious mothers, many of whom cannot read or tell time, are entrusted with giving all of the oral medications, and feeding their children through nasogastric tubes.   They sit by their bedsides, filling the narrow spaces between the beds, among the beeping machines which run from extension cords that cross the room.  Rusted IV poles, which come disconnected from their stands when you touch them, teeter over the bedsides, with often-neglected, empty IV bags hanging from them. Oxygen is divided among children using a “splitter”, so that each child’s oxygen input might be less than ideal, but is better than none.  The mothers do not sleep.  Children seize, or vomit, or thrash in feverish delirium.  Some die, and new ones always arrive.  Sometimes there are no nurses for the 40 patients, and often there are few doctors or clinical officers.  The sharps containers are on the floor, and are often overflowing.  There is garbage everywhere, and flies land on the eyes and mouths and sores and bandages of the sweating, dirty children.  Cockroaches scurry underneath the beds, and yet still the women sit on the floor to eat or try to nap.  There is a guard who stands at the door to the makeshift “emergency zone”, and he tries to minimize the crowding, but still the room is full and hot.

On the first bed is a boy who breaks my heart. He is 11 years old, and he has the haunted, hollowed-eyed look of starvation.  He weighs about 35 lbs.  He is very bright, and wants to be a doctor. He has been having profuse, watery diarrhea, which we have been unable to stop, and has become severely malnourished and dehydrated. I am fairly certain that he is dying.  And still, when you ask this sweet child how he is each day, he is unfailingly polite, and slowly opens his eyes and says, through cracked lips, “I am fine, and how are you?”

His “gogo”, who is probably in her seventies, is mostly toothless, and is sharp as a tack, stands by his side, day and night, fanning him with her cloth to keep the flies away. She feeds him oral rehydration solution, and now fortified milk, from a plastic cup. She gives his meds, probably about 25 total pills per day, as scheduled, and she never complains. She laughed as she showed me her ankles today, which are swollen almost to the knee.  He lies sometimes with his head in her lap. He lies on his side and you can see every bone in his body, every vertebrae on his back.  His hip bones are alarming, and he is often mostly naked, as he is unable to control his bowels and must be changed frequently.  Although he is 16, he has no dignity, no privacy. He is so weak, and so thin, and he has had such diarrhea and so many fevers.  He lies on that bed in the unrelenting noise and filth, and suffers. I hate watching him suffer. I hate watching his patient, courageous, trusting grandmother suffer. Although I know the odds are against him, I pray so hard that he survives this. I pray that his pain and suffering end, that his dreams of a future are realized.  I wish for him strength and peace, courage and a life into adulthood.

Tuesday, September 18, 2012

Off the cuff

I never take the time to blog.  When I do, I often write most of a story, then stop, revise, edit, revise, and never actually finish and post them.   I probably have 6 half-done blogs on the computer. So tonight, I will post whatever I write, and not hem and haw over details until I have lost interest.  It will be an “off the cuff” post.  

It occurs to me that my motivation for writing is usually an event that is particularly overwhelming, and therefore usually negative, so the impression I must give of myself is of a woman who lives very close to the edge and views horrific tragedies daily.  I was, in fact, fairly close to the proverbial edge last year, but I’m climbing down now.  This year, despite the profound anxiety I had before our return this summer,  has been significantly better than last year, for several reasons.  I think the key to “success” with five kids is routine, and we have established one now that is comfortable and familiar.  This is not to say that I don’t have a majority of days where I sit in shell-shocked silence and observe the din that surrounds me: babies banging on metal pans with metal spoons, the wails of injustice being perpetrated upon one of our children  by a parent or sibling, the relentless mantra of motherhood in the background:”Mom?” Mom?” Mom?”all combining in a painful cacophony.  No, this is not Disney.  We have developed a fairly stable nanny/housekeeper situation, and are learning to more effectively manage the madness required to care for five children with two full-timeworking parents.  We have a nanny for the twins during the day named Mary. She shows up at 6:30, when we are getting the children ready for school, and takes care of the twins while we play the fun “hunt for the school shoes” game and try to convince Aine she must eat something other than popcorn for breakfast. Mary stays until 3.   Lucy, who cleans the house (thank God), works from 10 am until 6 pm, although we are usually home by 5 or 5:30. 
We have been teaching all of the nannies to cook “Azungu” food, which consists so far of pasta sauce, mashed potatoes, and Aine’s staple, “Mama Soup”.  Sometimes, if we plan ahead and have been able to assemble all of the ingredients, she cooks dinner for us before we get home, or shortly thereafter.  This area of our lives clearly has untapped potential, but it requires somepre- planning to take the time to teach them to cook, and so we have not yet pursued tit further.   Lucy and Mary work Monday to Friday, and on Friday Martha comes.  She now sleeps in a small room just outside the house, with a baby monitor, and stays through Sunday evening.  This means most nights Dave and I (well, let’s be honest, mostly Dave.) listen for the babies ourselves now, with the exception of the weekends. Friday night is always family night, which means we watch a movie and eat junk food. Saturday is date night, and once a month Dave and I stay at a local hotel for a night.

My children seem happy, and adore each other (for the most part).  They seem to be thriving at school, and they have a group of friends in our complex that they love and play with daily.  The twins are a toddling, drooling, biting, grinning disaster.  They waddle through the house and slide down the carpeted stairs at lightning speed, leaving a trail of detritus and destruction in their paths.  They worship their older brother and sisters.  I have never seen a big brother who is better than Eamonn.  He picks the babies up when they cry.  He holds them up to the light switch and revels in their delight at the predictable magic that is electricity.  He doesn’t want us to put them to bed at night without him kissing them goodnight. He is like a small adult; he sees and delights in the wonder of watching the babies grow.  And as a bonus, he never has to change their diapers or stay up at night with them.

Life in Malawi has gotten easier.  Petrol and diesel, although not ubiquitous, are much more available than they were last year.  Plus, we have been loaned another car, which has truly transformed our lives, and probably drastically affected our fitness level.  The cost of living continues to be outrageous, and it hasn’t gotten very hot yet, but so far neither Dave nor I have had any kind of emotional outburst since we returned.  We are much more Zen. 

So if I have given the impression, through my blog posts, that life is unbearable, or that I am depressed or on the verge of a nervous breakdown, I apologize.  That's so Last Year. I am much happier here, now. My work is fulfilling, and feels meaningful.  We spend a lot of time together as a family, and our lives are much simpler.  I feel like I fit in here.  I like that the pace of life is slower in Malaw i(except on the roads.  That drives me crazy. People drive SO SLOWLY here, and it incenses the New-Yorker in me).

On that note, it is almost 8:45 pm, and therefore past my bedtime…

Wednesday, August 8, 2012

Drama in the Dark

A quick one:

On Sunday we had no electricity for about 12 hours, from 8 am until 8 pm. There was a rumor that this was because Hillary Clinton visited Lilongwe that day (for about 5 hours), but I have thus far been unable to correlate the two events.  It was a long, somewhat boring day, especially challenging because no electricity means no coffee, and life is just harder when you’re under-caffeinated.  We did arts and crafts (then spent twice as long cajoling the kids into cleaning up after themselves).  We built blanket forts in the living room (then spent twice as long cajoling the kids into cleaning up after themselves).  We brought pizza back for dinner (then cleaned it up ourselves, because it was just easier). Eventually, at about 6:30 pm, I decided it was bedtime.  I lay on the bed and let the twins crawl on me and drool in my hair, while the girls brushed their teeth in the bathroom.  It was pitch dark by this time, so they had a wine bottle with a tall wax candle in it burning on the edge of the sink (only the best for the Fitzgerald kids).  Suddenly, from behind the closed door, I heard a loud crash, and the sound of shattered glass.  This was followed closely by the high-pitched sound of AIne’s voice as she screamed “Fire!!!” There was the muffled sound of movement and then the anguished cry from Malawi, “I pooped my pants!!”

I leapt up, startled twins dragged in the crook of each elbow and flashlight in hand, although I did not see any obvious signs of fire. Putting the babies down outside I opened the door.  Both girls were standing in the bathroom, afraid to move, surrounded by shards of broken glass.  There was no fire.  Poor Malawi stood looking forlorn and physically uncomfortable, her jeans unbuttoned.

Aine had knocked the wine bottle over with her elbow while brushing her teeth. Always expecting a natural disaster of some kind (no idea where she gets that from), she had screamed in anticipation of fire.  Malawi, who had just started to settle down onto the potty, leapt up and soiled herself in the process.  Unable or unwilling to deal with the enormity of the situation (did I mention that our bathroom floor is dark brown?), I extricated the girls from the room and Malawi from her pants, then made the executive decision to abandon the bathroom until electricity was restored.   God Bless my husband, he cleaned the majority of the mess while I had a quiet nervous breakdown.

On the upside, it makes a good story.

Sunday, July 29, 2012

The value of a "better" death

Why am I here, and is it really worth it?

How many times have Dave and I asked ourselves that question?  Some days, when I have experienced some small success, I think perhaps I have been valuable.  Other days, when the overwhelming magnitude of the cycle of poverty and disease hits me, I feel insignificant and ineffective.  Occasionally I do actual math (always a stretch fort me), and try to calculate the cost to us of our presence here, in true financial terms, and the number is staggering (on the order of several hundred thousand dollars in lost income potential/loss of retirement savings/loan interest accrual during deferment…there is a blog coming soon about our financial meltdown).  What if I had simply donated all of that money to someone, and stayed home?  Could we being doing something different that would make a bigger difference in the lives of the people we serve?

My visit home was very revealing and a little depressing to me in some ways. Several people whose opinions really matter to me asked me that dreaded question, the one that resonates in the dark of my room at night when I can’t sleep. “Why are you here?”  The futility of our contribution in the face of the enormity of the world’s problems is submitted as evidence that I should not be in Malawi.  Our effort, our money, our sweat and tears, are truly a waste of time.  Nothing will change. People will still starve.  Children will still die of malnutrition and preventable diseases.  The problem is too big, and the solution is too complicated.  Life is too short to spend working against the inevitable.  And secretly, when the house is quiet at night and I am alone with my fears, I am afraid that they are right.

I was volunteering in the makeshift “Emergency Room” at the central hospital one weekend day when a small girl was brought in.  She was about three, and was naked, but wrapped in a wet chitenge.  She had been at one of the local hospitals in the outlying districts, and had been treated for malnutrition.  When children get Kwashiorkor, which is one form of starvation, their body often swells from lack of protein in the blood.  When the swelling goes down their skin, which has been stretched by the swelling of the body, sloughs off and peels.  This leaves them without a layer of protection against bacteria and even fungus, and they are like burn victims, very likely to get infections.  This child was cold, and lying in her own urine.  Her skin had sloughed off most of her body, leaving bleeding, weeping tissue underneath.  She had a rotting bandage over her arm, and when I took it off the skin peeled with it, revealing a deep wet hole in her arm, where an IV had been left to fester.  I could see the muscle beneath the hole. Her eyes were half-open, and flies continued to land on her lids.  Her torso, damp, cold, and peeling, was crawling with ants.  I put my fingers to her wrist, and felt a pulse. Although I knew there was likely no point, I appealed to the nurse standing next to me for a dry blanket to keep the flies off of her face.  “She’s not dead yet, you disgusting scavengers,” I thought as I worked to rid her small body of insects and untangle her from her wrap.  Together the nurse and I warmed IV fluid bags in a hot-water bath, wrapped them in blankets, and placed them around her little body.  We put in a new IV, through which we gently bolused her with warmed fluids.  The nurse brought out a metal contraption that we placed over her and covered with blankets, forming a tent to keep the flies from returning, and to seal in the heat we were hoping to generate with the fluid bags. We gave her a dose of antibiotics, and placed her I a soft clean bed in the “ICU”.  We warmed milk, and I fed her through a nasogastric tube.  I was overjoyed when, a few hours into our efforts, she opened her eyes and looked at me.  I talked to her in what I hoped was a calming, gentle voice, knowing that she had likely never seen a Mzungu before, and assured her that we would keep her safe and dry.  I told her that her mama was nearby.  She seemed to understand me, and I left that night feeling hope and filled with gratitude for the opportunity to have taken care of her.

She died that night, which saddened but did not surprise me.

My question is this: What was the value of my intervention?  The little girl died.  But she died clean, and she died warm, dry, and free of insects.  She died having heard a kind voice, and having seen eyes smiling at her.  Is that worth all of our money and time and sacrifice?  What is the value of dying a “better” death, if that was all I could provide in that setting? 

I do not have the answer.

Sunday, July 22, 2012


So, for the last month, I have been living the dream.  I have had store-bought Starbucks most mornings.  I have shopped obsessively in bright, well-stocked department stores and had ice cream in some form almost every day.  I have spent time with family and friends, and have been truly astounded by the size of the community that we have here in the US, and especially in North Carolina.  We have had people cook us dinners, watch our children, do our dishes, offer us their cars, and bake us cupcakes.  Through the generosity of friends and family, to whom I shamelessly sold African artifacts I had brought from Lilongwe, I raised over $2000 which we will use to help families in Malawi.
It was not, however, the idyllic vacation that we had envisioned.  In the 28 days that we were home, we had 7 doctor appointments, 11 dental appointments (4 with procedures, and an hour away), filed our taxes, I started the fellowship application process, we met with social workers and did paperwork to ensure the twin’s American adoption, we shopped for new clothes and shoes (2 pair each) for all 7 of us, our a/c broke three times, Dave moonlighted 60 hours, and we hosted a total of 15 people over 3 weeks.  All of this without the help of our nannies, and with the use of one Prius, which could only hold 5 of us at a time, and which required new registration, 4 new tires and a jump-start before it was drivable.  Dave took care of it the day after we arrived home from our 40-hour odyssey. 
The plane ride was predictably hellish, with the twins sleeping consecutively, rather than simultaneously, and only for 2 hours at a time.  At one point I let poor Dave sleep, and I kept both twins by myself in the front seat of the plane.  I rigged a barricade with the toddler beds I’d pulled off the wall, and smugly watched the babies destroy the area, while I sat back and ate my fist airplane meal, pleased with my ingenuity.  Our big children watched movies for 12 hours.  When we were exiting the plane the stewardess looked at my pasty, bug-eyed older kids and said, “Oh! You had more?  I thought you just had the babies!”
 The drive from DC to NC (we had to pay for 6 of our tickets home, about $9000, and couldn’t afford to fly our family that last leg)  was much longer than it needed to be, as we stopped at nearly every fast food establishment we passed on the 300 mile journey.   When we finally got to our ridiculously big old house, and I sat in my beautiful, enormous master bathroom, it hit me that there were countless families we knew who would give anything to live in that room.  Perhaps because I was exhausted, I sat on the edge of the tub and had a good old cry.  Sweet Dave, who has learned to accept my mercurial nature and my occasional emotional meltdowns, was supportive as usual. 
The first week I was home I wasn’t much more stable.  I had this acute, unrelenting pain in my heart at the thought that this world could co-exist with the one I had left.  There are simply no similarities between the two places.  And the hallucinogenic effect of sleeplessness and jetlag left me feeling surreal and emotionally labile.  I cried a lot.  People here are so blissfully (willfully?) unaware of their unique experience in the world.  We drive on gorgeous, well-maintained roads and highways lined with wildflowers.  Our children do not starve to death.  We have eradicated or mitigated most major infectious pathogens through aggressive and largely effective public health campaigns.  If our house is on fire, the fire department will come rescue us.  If we are in trouble, we can call 911 and the police will arrive.   We can be reasonably certain that, barring some unforeseen weather event, we will always have easy access to abundant, clean water and a consistent supply of electricity.   If we go to the hospital for a blood transfusion, it is unlikely that they will be out of blood.  Perhaps to our detriment, food is accessible, cheap, and ubiquitous.   America is truly, as our family calls it, the “Land of Milk and Honey”, and I have never in my life been prouder to be an American as I am after living in a place where the government truly doesn’t work.   And yet, as I reveled in the benefits of being home, I also felt deep sadness at the complacency that needs to exist here in order for the differences between the two worlds to be perpetuated.  I felt guilty for enjoying it so much, when so many people we know are so incredibly poor.  We take more than our share here. 
But, then I got some sleep and sunlight, and spent time with my family, and the world brightened.  The next day I was on line at a local grocery store by myself, waiting to buy a spiderman video for the kids, when I realized that I’d left my credit card at home and didn’t have enough cash to buy it. “Don’t you worry, honey,” said an elderly white southern lady from behind me in line, “you just put that on my bill.”  I was touched, but unwilling to accept her generosity; after all, it was a movie, not baby formula.  She insisted.  This kind stranger helped me for no reason (I had no African orphans with me at the time).  This, of course, renewed my faith in humanity and buoyed my spirits significantly.  I began to relax and enjoy the perks of life in the USA.  Driving is probably the thing that is the most dramatically different between Lilongwe and home.  In Malawi we drive a big old diesel truck with no air-conditioning and a driver’s door that doesn’t open from the outside. It rumbles loudly as we bounce over unpaved roads littered with potholes and rocks.  Most people do not drive, so the roadsides are lined with people walking and biking. I don’t believe there are any two-lane roads in the country, and emissions control is definitely not a priority. Because gas is so expensive, the roads are so bad, and our vehicle is inefficient, we pay over $1 per mile to drive in Malawi.  Driving 72 miles per hour on the gorgeous I40 in North Carolina, with my cruise control set on my Prius, we pay about 6 cents per mile for an infinitely more pleasurable experience.
Eating is also a starkly different experience in the two countries.  Someone asked me what food I miss the most, and I realized that there is no one thing.  What I miss most about American food, and America in general, is the variety.  If there is yogurt at the grocery store in Lilongwe (and there often isn’t), then it is available only in one brand.  If it can be found anywhere else in the city at the same time, it will likely be the same brand and in the same flavors.  In America we have the choice between whole fat, low-fat, fat-free, organic, soy, or greek yogurt, in various flavors and brands.  There was more choice in groceries at the first gas station we stopped at in Virginia than there is at the Lilongwe Shop Rite.  And food here is CHEAP.  It may not always feel that way to Americans, but the fact is that eating is much less expensive here than in many places in the world.  I don’t want to belabor my distress at the price of butter in Malawi (I have mentioned it a few hundred times), but it is emblematic of the cost of eating there.  Unless we live on the local nsima (I think it translates into “constipation” in Chichewe), we pay ridiculous amounts of money to feed our family ($400 per week, and we eat a lot of PB and J).  Food is also so easy to get here. Coming home from a friend’s house at 10 pm the other day, Dave, Eamonn, and I felt hungry. 10 minutes later, we had several thousand calories of Sonic milkshake and Taco Bell in our laps.  Had such a craving hit in Lilongwe, we would have been out of luck, unless we wanted to cook something for ourselves with what we might have in the house.   In general, the quality of food is much higher here.  I’m no fan of genetically modified anything, but the fruits and vegetables in the US are beautiful.  Every strawberry is bright pink and huge, and bursting with flavor; every tomato is shiny red and perfectly ripe.  It’s unnatural (and we greedily scarfed it all down). The food has been so plentiful and delicious and inexpensive, that we have all gained weight.   My Aine has consumed more calories on any given day this month than she would normally eat in a week in Malawi.  Tonight she ate a snack of Reese peanut butter cups and pickles (simultaneously, not combined, but still gross). 
When I was in my “transitional phase” in the first few weeks after coming back, and was so despondant about the prospect of leaving home again, each of the kids expressed anxiety and sadness at the thought of returning to Africa.  “Life is so much better here!” Aine aptly summarized through tears one day.  “I don’t want to go back!”  Finding false platitudes difficult, as I shared her dismay, I counseled her the best I could.  I told her that being home, surrounded by the people we love, and sharing in the joy of family and friends in a place that is comfortable and familiar, is an exercise in truly living in the moment.  We know that our time together in this relative paradise is limited and finite, and we know that we have to leave at the end.  The trick has been, as it should always be, to take deep breaths and take close notice of all that we have in each moment.  I have tried to follow my own advice. Despite the chaos that seems to envelope us wherever we go, I have tried to savor the minutes and hours I have spent talking to my little nephews and swimming at the pool with my kids. I have tried to memorize the sweet crunch of the warm blueberry scone from Starbucks, and the satisfaction of filling my gas tank, at a moment’s notice, with my credit card, for $35. The problem is that even when you savor these moments, they are fleeting, and they pass.  And so tomorrow the Fitzgerald clan leaves again for Malawi (we actually leave Greensboro today).  We will carry the memories of these moments with us in our hearts, and when we miss the familiar faces of friends and family we will recall them, as we wait to return home again. 

Tuesday, June 19, 2012

Going home.

Circumstances have conspired to leave me alone in front of the computer, with no access to internet and little excuse for not writing.  It is, of course, not unusual to be without the internet.  That happens every night.  It is the fact that I am alone.  All 5 kids are sleeping, and Dave is out at his clinic seeing a patient (rare).  So many times this year I have written blogs in my head, or even started them on the computer, but our lives are so chaotic and full that only occasionally do I finish and post anything.  There have been so many emotions this year that I know have gone undocumented.  There have been so many changes that I have not taken the time to reflect on. 
                For the last several months I have been in a better place.  I think it is the sad but inevitable result of being surrounded by poverty and illness:  eventually you don’t cry over every death.  The patients and the people are always affecting, and there are still some that put me over the emotional edge, but I have been more able to go on with my life, without being thrown into a major depression with every bad outcome.  Similarly, the hassles of life here have become routine, and we have learned both short cuts for and to have patience with the idiosincracies of Malawi.  It has also helped that the former president, who many believed bordered on dictatorial, had a heart attack, and was replaced by one of his rivals, a woman named Joyce Banda.  Fuel lines have been better, and there are less scary-looking police thugs roaming the streets with guns, although the store shelves remain half-empty, and the value of the kwacha just dropped 40%.  I also think it really helped my outlook that I knew I was going home soon.  There appeared to be a light at the end of the tunnel of our life here.
 Unfortunately, my glow of tolerance has dimmed.  It began to fade when I realized that this trip is no “light at the end of the tunnel “.   It is a window, letting some liver of light into a dark, somewhat claustrophobic tunnel that we have only half-way traversed.  I don’t mean to sound melodramatic (well maybe I do), but when it dawned on me that we would be returning to Malawi after our vacation, with a renewed sense of all that we are sacrificing and missing, and without the sheen of novelty to ease the transition, I started to get depressed.   As the date of our voyage has loomed nearer, my funk has grown.   
The hole that the absence of my family has left in my heart is huge.   I am almost afraid to see them again.  I’m afraid of having to try to distill two years’ worth of experience and growth and change and love into just a few days.  I’m afraid to remember what it is like to spend time with them, to watch our children run around my yard again, to laugh and reminisce and hug, I’m afraid that every family dinner, every shared joke and shared beer will be tinged with sadness, because it will be the last for another year, and it has already been so long.  I’m afraid of saying good-bye again.
And, the truth be told, I’m tired of life here sometimes, and the thought of coming back to the same stressors make me anxious and sad.  We are going broke; it is ridiculously expensive here, and is only getting more so.  The economy has gone through so much since our arrival that the price of most foods has literally doubled in the last year, and in some cases it has tripled.  We are now spending $170 USD to fill our gas tank.  We have had to give our nannies 40% raises, to compensate for the devaluation of the kwacha.  Electricity is through the roof.  We have been living off of the money that we saved before we came, and we have gone through it at a startling rate.  I am worried we won’t survive financially for another year, and I’m terrified of going back penniless and with huge credit card debt. 
There’s a side to living in a place like this that I think you don’t appreciate unless you experience it, which can be uncomfortable to explain.   I know that I am blessed to be in the position of giver, and it can also be frustrating and overwhelming.  Sometimes I feel like an ATM.  There are so many people, and they need so much.  My measure of poverty is this:  if another human being will eat the discarded food from your plate, then they are poor.  There are literally scores of children, kids the same age as my own, who live on the streets and eagerly accept our scraps.  And I know that I should be (and I am) so very, very grateful to be the one giving, but sometimes, especially in light of our own financial concerns,  I wish people would stop asking for so much.  I wish I wasn’t such an obvious target.  By virtue of my color, I cannot walk 2 feet without being offered something for sale, asked for money, or asked for a job.  I try to understand.  I am walking opportunity.  But being an Azungu in Malawi can be like being a giant dollar sign with appendages.  I long for anonymity.
Tomorrow we go home.  Once again I will see my family, laugh on my porch deck with my brothers, watch our kids run around on the front lawn together, hug my mom and my little brother and sister.  Once again I will have good food to eat, and tons of it.  I am going to eat ice cream or frozen yogurt every single day.  I am going to eat Thai food, go to salad bars, drink fountain soda, and eat Twizzlers until I vomit.  I am going to drink Starbucks twice a day.  Once again, I will have entertainment, and exposure to American culture.  I will go to the movies at least twice per week. I will take my kids to the Life Science Museum, and the beach, and to see friends and swim in the pool.  I will go to the air-conditioned gym EVERY DAY.  I am going to live a life of convenience and consumerism and comfort, and I am going to try to love every single minute of it.
And then I’ll come back. 

Monday, May 14, 2012

Mayhem after Midnight

It is incredibly hard to find time to write, despite my best intentions and the numerous adventures that occur on a regular basis, which I promise myself I will commit to paper. Or keyboard. In my defense, I am getting over a recent bought of influenza, followed closely by my first pneumonia. One of the sequelae of working in a place that does not have a lot of soap or hand sanitizer, where I spend my time in an over-crowded hospital ward, filled with coughing, vomiting, sweating, and urinating children, is that I am exposed to a variety of illnesses.  In spite of my best efforts, I have found myself almost constantly ill with some form of gastrointestinal or respiratory illness from the month we arrived.  Our lives are so busy and so filled with children and work that each illness seems to take forever to recover from.  My exercise tolerance has plummeted; my energy level has hit rock-bottom. It doesn’t help that no matter how hard we try, Dave and I are unable to get a good night’s sleep.  Sleep has become the Holy Grail in our lives.  So desperate are we for a night of uninterrupted slumber, that we stay in a hotel once a month in order to catch up on our REMs (we call it “date-night”, and pretend that we do grown-up things like go out to dinner, but no parent would be shocked that the prospect of sleep is sometimes more exciting to us than that of romance).
Last month ended with a safari trip to Zambia, with my good friend Tamika (another blog entry I intend to write), where our entourage passed influenza from one to the other, for the duration of the very expensive trip. I had it first, and recovered pretty quickly, but then started a week in the wards when we returned home, and my health rapidly deteriorated.  I did not realize that the malaise and cough and chest pain that I was developing was pneumonia until I came home from my weekly ER shift with a fever.  The next day at work I had a nurse in the clinic give me IV Ceftriaxone, and I went home that afternoon, resolved to get a restful night’s sleep.  I slugged a shot of a magical tonic that Dave bought, over-the-counter, for cough.  A potent combination of Benadryl and Codeine, I think it’s mechanism of action is pure sedation, with possible suppression of the respiratory drive.  (No FDA here- it has children’s dosing on the label down to 2 years old).  I chased this with a handful of Ibuprofen, put soft jammies on, and curled up in my bed with my earplugs in.  I drifted off into peaceful sleep.  To give you some indication of the recent state of my subconscious:  I was having a delightful dream about grocery shopping in a magical, air-conditioned supermarket, with shelves actually full of food, and aisles bursting with variety and color.  In this idyllic wonderland (which could have been any store in the US), I was able to buy every ingredient I needed for dinner in one place, and was even given choices between different brands for many items.
Suddenly, a shrill, screaming sound filled the air, and I was startled awake.  Dave sat up in bed next to me.
“What is that?”
The sound was incredibly loud, and appeared to be coming from our attic crawl-space.  We quickly determined that it had to be our alarm system going off.  Here in Lilongwe, there is not really a 911 that can be called.  The government is so broke that if you call the emergency number and ask for help, they ask you to please send someone to pick them up. This is in a country where people are desperate for “Forex”, or American dollars, and where being an Azungu means being obviously, noticeably different and presumably well-off.  Therefore many foreigners, including ourselves, opt to hire local security companies to protect them.  Our apartment complex has a big metal gate and 24 hour guards, and we have a panic-button installed in our house.  It looks like a doorbell, is in the corners of several rooms and the hallways, and if pushed will summon a crew of goons who show up in full-battle gear with helmets and batons to fight whatever bad guys might be hassling you.
Dave pushed the mosquito net aside and stumbled over the children, who had camped out on our floor for “Family Night”, pulling pants and a shirt on and heading for the door.  Eamonn sat up as he left the bedroom.
“What’s that noise, mom?” he asked groggily.   Determined to go back to my grocery store paradise, and committed to my night’s sleep, I refused to allow myself to completely regain consciousness.
“It’s just the alarm system going crazy. Daddy will fix it. Go back to sleep.” 
But a few minutes passed and the shrill sound continued unabated.  Aine and Malawi sat up, and Aine (who has been going through a “sensitive” phase) immediately began to hyperventilate and cry in panic.  Malawi, who does whatever her sister does, followed suit.  Amid the escalating wails of my children I went outside to find Dave, hunched over the computer, desperately trying to find the number of our security company.  I looked at the time: 3:45 am.  Although we were unsuccessful in our search for the number I was not especially worried, as I was expecting that the goons would arrive momentarily in response to the alarm.  15 minutes passed, during which time both my anxiety and that of my near-frantic children increased, as no security team arrived and no number was found and the deafening siren sound continued. The twins began to cry from their room.  My friend Tamika came in from the guest room, rubbing her eyes.  We began to get texts from the neighbors, making sure we were alright.  And still, the horrible screeching sound persisted.  Unsure why the goon squad had not come, and unable to contact the company by phone, we pushed the alarm button in the hallway repeatedly, while trying to maintain a forced cheerfulness to soothe our wailing girls.
I took the babies out of their cribs and changed them, as Dave climbed onto a chair and tried to reach the system in the crawl space above our second floor.  Using a broom handle, he attempted to rip the wires from the wall.  The electricity went out.  The piercing noise persisted. The big kids continued crying as the babies crawled merrily around the living room, apparently awake for the day and ready for business.  It was now about 5 am. 
Suddenly, a covered vehicle with about 10 men dressed in combat gear, with helmets and batons, arrived at our door, ready to fight.  They traipsed into our house in procession and examined the situation. Several phone calls were made to the home office (using our phone, because none of our hired thugs had a functional phone). Dave demanded that a technician be sent immediately, as the sound was unbearable, and we were all in need of sleep. Further discussions ensued until, at about 5:30 am, we were told by the technician in the home office that we did not have an alarm with sound.  Ours was a silent alarm.  My genius husband investigated further, after apologetically dismissing our personal army and requesting that the company send someone during the week to repair the system we had unwittingly destroyed with our broom, and discovered that our plumbing system was responsible for the caucophony.  The pressure in the pipes had built to such a point that it was causing them to vibrate against one another, resulting in the horrific sound.  The solution, after 2 hours of sleeplessness and much distress, was simply to run the water.  He left a faucet running (a phenomenon which usually causes me much angst), we gave the children some Melatonin and the babies a bottle, and we all went back to bed.
I’m not sure what the “moral” of this story is…perhaps it is that I am destined to never have a good night’s sleep.  Or maybe it is that sometimes life here is surreal.  As I watched the crew of armed guards track mud from their combat boots on my carpeted stairs, a twin on each of my hips at the crack of dawn, it occurred to me, once again, that life in Malawi is never, ever boring. It is unpredictable, frustrating, rewarding, heartbreaking, and challenging, but it is never boring.  

Thursday, March 15, 2012

Primates on the Playground

For most of my life my mother has been afraid of flying.  She is a homebody by nature, whose idea of traveling is going to the Durham Super Target.  She is happiest when she is in snuggly pajamas, in her beautiful living room, with her protein milkshakes and a good book.  For decades she has supported but never truly understood my wanderlust or my desire to live and work in Africa.  And yet, over the age of 60, she recently boarded a flight that took her into the air for over 12 hours, across an ocean, to a foreign place with a blazing sun and perpetual shortages of petrol, electricity, and water.  I think that God recognized her effort, because the heavens rewarded her courage with unseasonably cool weather, and a plethora of petrol for the duration of her visit. The ONLY time that I have ever driven up to a gas station and filled my tank without waiting was shortly after her arrival.   By comparison, since she left we were without a car for more than a week, because no one could find fuel and our tank was empty.
My mother and Kennedy fell instantly in love, and she carried him everywhere, which seemed sweet at the time, but has left us all with a 23 lb baby who thinks he needs to be held constantly.  She was the hit of the party when we visited the boys’ village, and was surrounded by a crowd of jostling children eager to have their picture taken with her camera. We have an entire series now of village children, including several with my mom seen grinning in the middle of a crowd of 30 kids. She was affected greatly when we visited Chrissy at PIH, where she had been admitted again for likely TB in her abdomen. My mom was heartbroken when we visited Chrissy’s home to check on the her motherless children, where the 12 year old brother is the breadwinner and the 10 year old sister the surrogate mother. She cheerfully survived power outages, water shortages, and long hours of crying babies and a house full of kids. I am extremely proud of her.
As my mother quickly learned, one of the greater challenges when living abroad in the developing world is, believe it or not, boredom. Petrol is a constant issue, and the ordeal that one has to go through in order to fill the tank makes us reluctant to use fuel for recreational purposes. We pay someone to wait on line for gas for our truck while we are at work, and he recently waited for three days on different petrol queues but was unable to get more than ½ gallon. People start lining the streets with cars outside the petrol stations at the merest rumor that gas might be arriving, and traffic builds up, often to the point of blocking the roads in both directions. The gas stations are volatile places, where fights break out over the order of the jerry cans, and who has been waiting longest.  The police and army often patrol in order to maintain peace and order, but the crowds can sometimes be intimidating.  So we try not to do a lot more driving than necessary. 
Home is also definitely the easiest place to be for a family of seven. The energy required to leave the home is enormous.  Getting all 5 children and two adults dressed, with shoes on, with full bellies and empty bladders, strapped into their car seats or seatbelts and off on an adventure is an operation requiring careful coordination, and not to be undertaken lightly. Even if we had fuel and were motivated enough to wrestle the children into the car, there is really nowhere to go.  There are no parks or playgrounds, certainly no museums or movie theaters, and definitely no arcades or adventure centers. Over the months we have lived here we have discovered a very few places that we can take the children.
And yet, my patient mother had to get out of the house once in a while.  And, miraculously, the fuel crisis had temporarily eased, leaving us with a full tank.  So, feeling generous and anxious to entertain my housebound mom, I planned a trip to the Lilongwe Wildlife Center.
This is a beautiful preserve in the middle of Lilongwe, where they have one of the best (and only) playgrounds in the city. It has a wooden fort with stairs and balance beams and swings, and there is a gigantic hill of dirt with a climbing rope anchored to the top. There are large swinging benches on a wooden platform, surrounded by a small picnic area.  Just past the playground is a path that leads for several kilometers in a circle, where crocodiles, lions, and monkeys are kept, often after rehabilitation. It is a great place, where we held the girls’ birthday party in December. The employees played “Musical Chairs” and other games with the children, painted their faces, and took them on a short tour of the park to see some animals. 
So off we went, arriving after work one Tuesday afternoon, and accompanied by Aine’s bestfriendClaire (as she says it) and our nanny Laura.  We had packed carefully, and planned on feeding pb and j sandwiches to the twins while the big kids played.  Immediately upon arrival the children raced to the mound of dirt and began climbing, as the adults wrangled the babies out of their car seats and into their strollers, then maneuvered them down an embankment to the playground.  After settling down on the swing, we took our food out of the plastic shopping bags and began chatting.  A few minutes later Laura interrupted the conversation to say, “I didn’t know there were monkeys roaming free here,” and I turned my head.  A group of 5 or 6 monkeys, each about the size of a toddler, was approaching the hill where the children were climbing.  The children noticed when I did, and began scrambling down quickly, sliding in the dirt and running toward me in a near-panic.   Having traveled and lived in Africa and India, I am not too afraid of monkeys. Just the previous weekend we had taken my mom to the Zomba Plateau, and a baboon mama, with a baby clinging to her belly, had stolen a croissant off of Malawi’s plate at breakfast. So I found the sight of my children fleeing from the monkeys with arms flailing and mouths open in screams of terror funny, and began to laugh.  My mom, also amused, took pictures of the primates approaching her panicked grandchildren, while Laura continued to feed the babies bits of sandwich.  I stopped laughing when I realized that the monkeys were also descending the hill, and were heading down the embankment toward the playground. I made a hissing sound and raised my hand, then feigned brandishing a weapon as I scanned the ground looking for an actual stick to wave in the air.  This is a technique which I had seen many Africans use, and which usually seemed to frighten animals off.  Yet these monkeys were indifferent to my display, and continued to advance.  The biggest one, who led the approach, bared his considerably sharp teeth at me and returned a hiss. The children began to panic in earnest behind me.  Although I was still (mostly) certain that nothing would happen, this pack of monkeys was not acting as they should act when confronted by humans. In fact, the leader jumped up on the top of one of the swinging benches, looked down at us and hissed again as we scurried out of his way.  My children began to scream. My mom, apparently oblivious to the escalating danger, continued to take pictures.  I began to yell for help.
 I was trying to shout, in Chichewa, in a way that would capture the attention of the park employees, but not contribute to the anxiety levels of my whimpering, crying, and occasionally screaming children.  There was a group of Malawian gardeners pulling weeds about 50 feet from us, but they did not look up. “Excuse me,” I yelled in my faltering Chichewa. “Monkeys coming.”
No response.  Meanwhile, the leader monkey advanced, still growling, and my children screamed louder and tried to hide between me and the wall behind me.  My heart rate increased, and I began to yell again, louder this time, and less concerned about how I sounded.
“Monkeys coming. Please! Excuse me! Excuse me!” I repeated, my voice growing hoarse. Finally one of the men looked up from his work and noticed the cowering, frantically gesturing Azungus down the hill.  He clearly did not understand us, however, and was somehow unclear about our need for help.  Apparently he did not see the menacing pack of primates that was openly threatening us. He turned to his friend for a second opinion about what, exactly, we might be saying, as the fanged monkey leered at us and crouched as though he was about to leap.  I tried to be courageous, and put my kids (and mother, who had finally stopped taking pictures) behind me, readying myself for the oncoming assault.  At that moment, however, the manager appeared, having been summoned by another one of the gardeners who found our bizarre behavior disturbing enough to seek help.  The manager, thank God, immediately deciphered the situation, and walked down the embankment toward us, scattering monkeys as he approached. The pack scampered to the forest and climbed the nearby trees, then looked down at us in disdain.
My heart still pounding and my throat sore from my barely muted shouts of panic, I quickly realized that if I did not convince my children to stay at the playground for a few minutes now that safety had been restored, they would never again return to the Lilongwe Wildlife Center.  And that would be a shame, because it is a great place. And we had just spent 14,000 Malawi Kwacha for a family membership.  I tried to point out that we had been attacked because we were feeding the twins their lunch, which the animals wanted.  It was also very deserted that day, as Tuesdays are apparently a day that the park is short-staffed.  I attempted to convince them to take a walk with a park ranger, with whom we would be perfectly safe, so they could see that it is a great place to hike and enjoy nature and the enclosed animals, but they would have nothing of it.  They were truly traumatized by the event, and they cried and begged me to take them home with such looks of desperation and such fear in their voices that I had to comply.  Even Claire, who is South African and pretty tough, was terrorized.  They clung to me as we walked to the car, staring with wide eyes up into the trees as they held my elbow, searching for monkeys, then dove into the car and slammed the doors. It wasn’t until we were all comfortably inside, windows closed and doors locked, that the story became funny.
Who needs museums and zoos when you live in Africa?

Wednesday, February 15, 2012

The wet season: A tribute to love and drool

I am sitting on our bed, under a gently undulating sheer white mosquito net, my feet entangled with Dave’s, and the house uncharacteristically quiet. It sounds romantic, but in reality the %$& mosquito net is flecked with the smeared bodies of flattened mosquitoes, and is perpetually getting wrapped around my head or draped across my face and obscuring my vision as I write.  The big kids are in a room down the hall together. My mother, who is visiting, is in the room that Martha and the twins usually share. Right now she is downstairs with Laura, who often spends her evenings wrestling with the internet, trying to Skype or use Facebook. The twins are asleep in the playroom while my mom is visiting, which is a little less than ideal because it is right in the front of the house, is filled with toys, and has no door. Nonetheless, they have settled into slumber. It is the time of day when Dave and I fall into our beds breathing a collective sigh of relief and try very hard to stay awake long enough to have a conversation (usually about the logistics of the next day) or do work on the computer. Our days are filled to capacity with love and noise and work, and the riotous chaos of five growing children. When night hits the house like a stone (with the help of an occasional Melatonin) Dave and I have an hour or two before we, too, collapse beneath the weight of our busy lives and sleep.  I believe we are happy.
The babies are growing so fast it is astonishing, and the size difference between the two of them is becoming more apparent. Shaney (I call him Shaney because, to me, Shane will always be my brilliant, sarcastic bald-headed little brother) is a peanut, and Kennedy grows more massive every day. For a while feeding him was a challenge, as it could not be done fast enough to meet his demands; he would shriek if we paused even momentarily.  At one point he was actively choking on some food, and simultaneously attempting to scream and reach for the fork we had put down in preparation for performing the Heimlich on him.   We joke that he will soon be the first human being to go from severe acute malnutrition to morbid obesity in less than 6 months. Their development has been miraculous. They have both hurdled several milestones in just the last few weeks: they clap, crawl, and Shane can wave bye-bye and shake his head “no”. In fact, he has developed an entertaining but somewhat disconcerting habit of shaking his head rapidly back and forth until he gets dizzy and dazed. Until recently Kennedy could not crawl because he was just too fat, so he would roll from place to place, but they are now both proficient crawlers; they have even recently successfully attempted to climb the first two stairs to the second floor.  Our whole lives are changing, as they have become mobile and willful, driven by the insatiable desire to put the most disgusting, hair-raising objects into their mouths after digging them up from the tracks of the screen door. (And yet, offered a banana, Shane emphatically shakes his head “no” until his eyes roll).  They are so loving and so sweet.  When I walk in the house after work it is a race across the room on dimpled knees to be picked up first, then giant open-mouthed, drool-laden kisses on my chin and face.  The big kids truly love the babies, and are remarkably tolerant and doting.  Together our family applauded as they waved for the first time, and together we cheered the first time they crawled.  Our little twins are constantly smothered with kisses and entertained and carried and tickled.   I believe they are happy.
Eamonn has matured so much since we arrived in Malawi.  He remains a shy, somewhat introverted boy, happy to stay in the library reading a book with a few friends during free time at school.  Although he has recently developed the dry, know-it-all attitude of the pre-teen, he has also revealed himself to be a patient and genuinely loving big brother, especially to the twins.  Today, on his way home from karate (which Malawi calls “Ninja”)  he even commented on the fact that he is fortunate to be living in Africa, and that he recognizes that his life is an adventure that few kids his age ever experience.  I believe he is happy.
Malawi, who still insists on wearing thick fleece hoodies in the stifling African heat, has also grown taller and more mature.  She is probably the most self-sufficient of my children, and is fiercely independent.  For the first few months she treated the twins like her baby dolls, frequently changing their outfits and force-feeding them bottles. Her career as a surrogate mother ended when it was discovered that she had left the house with a baby in her arms and walked down the cobblestone driveway with him to the neighbor’s house.  She is relentlessly chatty, from the moment she awakens in the pre-dawn hours, and is a tough little survivor who challenges even her big brother, who is several times her size. I believe she is happy.
It has not all been roses and butterflies.  I had my conferences for the kids’ school, and was told by Aine’s concerned teacher that she has been needier recently, and (while happy), she is not as well-behaved as she had been, and seems to be craving attention.  I, too, had noticed a difference in Aine’s behavior, as she has lately been very dramatic and prone to meltdowns.  I have also witnessed a time or two when she has been a little rougher than necessary with the babies, or given them a little tweak as she passed, which has made me worry.  Aine has typically been a bright, silly little girl filled with giggles and curiosity.   She slept in my bed and breastfed until she was 2 ½, when I reluctantly stopped because she had started to wrestle with me for access to my breasts in public.  Since that time, she has always needed a certain amount of physical contact with me.  She has told me a several in the last few weeks that she needed more “Mama-Aine time”, once handing me a note on pink construction paper that said, in crayon, “Mama, I need Snuggle. Aine”.   I worry that she is not happy.
After that conference I felt disconnected from my childrens’ lives and incompetent as a mother.  For the previous two years at home I had been a part-time physician, working only 3 days per week.  I spent days in the children’s classroom each month, and tried to go on their class field trips.  In Malawi, I work fulltime and often have to wait for transport or walk home, so that I rarely return before 5.  Plus, now we have two adorable, drooling, time-consuming, babies to take care of, and life here is logistically a lot more complicated.  Grocery shopping routinely takes 3 hours, paying rent requires changing money on the black market then waiting in line at the bank with 759,000 Kwacha in a knapsack to be deposited.  My heart was heavy with guilt and resolve, to be a better mother, to buy a bike so that I could get home earlier, to try even harder to spend quality time with each and every one of them. 
Luckily, I have Dave, and he is my hero.  When I have a nervous breakdown over having to spend the 1 ½ hours I have at home with the kids making dinner, he says, “I’ll make Mexican.”  When it is Martha’s night off and I am bleary-eyed with fatigue he says, “I’ll get up with the babies tonight.”  And when we are hit with the overwhelming scent of a “Code Brown”, he says, “I’ll change his diaper.”  Living and working here, with all of our children, requires a degree of unity and teamwork that I didn’t previously imagine we were capable of.  I thank God for him and for my marriage every day.  I believe he is happy.

Hmm, what about me?  My life at work has its rewards and challenges.  I have managed to maintain (what’s left of) my sanity recently because I have not been in the wards since just after Christmas.  It is there that the mortality rate is high and the conditions are abhorrent.  In the Baylor clinic most of our patients are well, albeit HIV-infected.  We see starving and TB ravaged kids every day, but the numbers are smaller and therefore not so overwhelming. I recently had a Baylor professor liken what we are doing to being on the front lines of a war, where the enemy is poverty and the bullets are disease and hunger, and I find that analogy to be really fitting.
In addition to seeing patients in clinic, I have recently started giving lectures at the hospital and in nearby health centers, to Malawian nurses, medical students, and clinical officers.  I have been so gratified by their interest and enthusiasm. I have loved sharing information with these clinicians, who are the backbone of the Malawian heathcare system (which has about 30 practicing physicians, including myself, serving a country of 15 million).   In 2 years I will not be here, but hopefully the knowledge that I have helped them to acquire will survive when we Azungu have returned to the comforts of our first-world lives.
My home life is my salvation.  Although I did not miss the days of oatmeal in my hair and dirty diapers in my garbage pail, I had forgotten how sweet it is to smell my babies’ heads, and to feel the weight of their bodies against my chest when I hold them. I am so in love with my children, so fortunate to hold their hands as we walk, so awestruck as I watch them grow into little people. Our family, while far from perfect, has grown closer in this land where we look strange and are witnesses to such struggles.  The gift that is my life has never been so starkly apparent, and I have never been so grateful. So yes, I am happy.

Tuesday, January 10, 2012

Hope changes everything

Thank God today was a better day.
 I spent yesterday in the Treatment room, which is like an acute care room, where sick kids and kids that require admission go for evaluation and treatment. The clinicians rotate through about weekly, and (as anyone who knows me can imagine), it is my favorite place to be.  It’s like my very own little ED: I have my own stash of meds to give, and have become more proficient with procedures, having even given ketamine a few times.  The day was busy, and I was in the middle of consulting with a colleague about a puzzling clinical case when a nurse approached me and said that there was a baby who was not doing well who had just arrived.  I rushed to the Treatment room and saw a woman with a 2 ½ year old on her lap. The child was fully dressed and wrapped up to his chest in a blanket and chitenge. He was staring straight ahead. I put my hand on his chest to rub it, put my finger on his pulse, and looked in his eyes simultaneously. He was warm, but I did not feel a pulse, nor did he react when I moved in front of him.  I put my stethoscope on his chest, expecting the worst, and heard nothing. It was a very odd sensation. I have put my stethoscope on the chests of a hundred children a week for eleven years (give or take), and only very rarely do I hear silence.
“Annie,” I said quietly to the nurse, “this child is not alive. You need to tell this mom that her baby is not alive anymore.”
The woman must have suspected, for she did not wail as is the custom, but cried to herself. I spent last night in a flat mood, refusing to find any joy in a day that consisted of examining a dead toddler.
But, oh thank God, today was better. Since leaving little Thokozani feverish and vomiting at the beginning of my vacation, I had been without phone access for a few days in the mountains. While at the beach later I texted and called Mwawi (too) frequently, and when she answered my calls she assured me that the baby was doing fine. Experience had proven, however, that our definitions of “fine” differ, and I was anxious and afraid to hope. The baby’s mother had been doing well at PIH, and was reportedly eating and had had no fevers or diarrhea for days.  They were ready to start her on anti-retrovirals and send her home, but I delayed them, waiting for our social worker, Mrs. Chisale, to return from vacation. Unfortunately, I learned today that she would be extending her vacation until next week. Chrissy’s older three children were already supposed to have been removed from the transitional orphanage where we had  begged to keep them, and Chrissy could not keep staying in the wards. So today I drove to PIH to meet with her myself, and discuss her discharge options with her.
When I walked into the ward she sat up in bed, shirtless as most of the women were, due to the oppressive heat. She smiled at me, and it was one of the most beautiful things I have seen in a long time. She has gained about 5 lbs, and proudly showed me her lunch plate, empty of nsima. She is still so terribly thin, and when I awkwardly attempted to touch her shoulder during conversation I felt its sharp edge, and it startled me. Poor Chrissy has no family, which is the safety net of the impoverished Malawian mothers and children, especially those with HIV. Most of these women have never been to school (Chrissy finished 3rd grade), and have no employment options unless they sell a few vegetables, find a few pieces of laundry to do, or occasionally turn to prostitution.  That hovel that she lived in cost about $5 per month (which I consider overpriced), and she struggled to pay that and feed her children. I told her that she needed to find a suitable, watertight home to bring her children to, and advised that she organize herself for a day or two before she brought the older children home. We also agreed to have Thokozani stay in the nursery for a few weeks.
So Chrissy will be discharged tomorrow, and I will retrieve her children from the orphanage on Friday. The family literally had nothing but a few metal bowls and a handful of tattered clothes, so together we will get some outfits for the children from a nearby orphanage and buy some plastic dishes and metal pots for her to use. Dave and I agreed that, in order to help her get on her feet, we will buy some chickens and maize and soy for the family and hope that she can, as she assured me, “manage”.  I considered buying her seeds and fertilizer, but planting season has passed, and she has no land. I asked her to promise to send her children to school, and to take her medicines and to eat. Again, she smiled, and my heart nearly broke with happiness.
Buoyed by Chrissy’s improvement, I went to the nursery to see the baby. I entered nervously, and was shown which room he was in. On the floor, propped up with pillows, were three tiny babies, two of them smiling up at me, and one crying. None looked like Thokozani.  Then one of the smilers caught my eye. Was that him? But this child’s cheekbones did not protrude. This baby was grinning. I lifted his head off the pillow and examined his occiput. Thokozani had a very unusual, distinctive head shape, and so did this baby, who grabbed at my nose as I examined him.  It was him. For the second time that day my eyes filled with tears. He has gained about 1 ½ pounds (about 20% of his body weight) in the 10 days since I had last seen him. His belly was distended with food, and his smile was gummy and enthusiastic. 
As I may have mentioned, and at the risk of alienating many of my friends (most of whom already know this about me), I have a complicated idea of what God is. I do not subscribe to any religion, yet I feel strongly that my entire experience here is intended as a sort of living prayer of gratitude for all that I have been given.  Today, every cell in my body was grateful to that God for the chance to have witnessed these two people transformed from near death to life. What I saw in Chrissy’s eyes (I imagine), was hope. There is a tapestry on the wall of PIH that says “Hope Changes Everything”, and it seemed almost prophetic when I noticed it today. Although I recognize that poverty is unrelenting, and I fear that Chrissy’s family does not have a sustainable means for survival, my belief that I am here for a reason has been repaired, if not entirely restored. I sometimes ask myself…would it be worth all the time and effort and money to have come here if you could only save just one life? Looking at that baby’s sweet smiling face today I believe the answer is yes.