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.