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.