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…