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.