Realizations

Sometimes there are small moments in life when you realize, this is a turning point. Whatever decision I make right now I'm going to remember for the rest of my life and either look back on it with regret or knowing I did everything I could. After hearing some terrible stories from an ex-volunteer about the polygamy and incest that was going on in his village I was terrified to have one of these moments in village. I knew if a child came to me and told me her father was sexually abusing her there is no way I could let that child return to her father. I would do everything I could to get her out. I would have to. Thankfully I've found no polygamy or incest in my village. But the dark whoas of a place can take a while for a new-comer to realize. Last week, 5 months into the program, I realized the true length and breath of my village's whoas with childhood malnutrition.

Emily is the SPW volunteer in Igelehedza, the village 25 min walk from mine. Her and I were walking home from the Ilembula secondary school last Monday when we came upon a Mama with a baby strapped to her back. She was on the verge of tears and she told us her baby was sick. She showed us the baby's red swollen feet. She was frantically saying she needed a letter from the Mwenye Kiti and the police. We took her to the Igelehedza Mwenye Kiti's house, but he is in jail in Makambako for stealing the pots and pans from his brother's widows house. He's a huge Ulanzi, the local moonshine, enthusiast and doesn't get much work done. We told the Mama we would take her to the hospital ourselves because we thought she didn't have money to pay and the hospital was asking for a letter from the Mwenye Kiti to have the hospital fees waived.

Upon entering the hospital the Mama was asked by the receptionist where the blue card with the baby's information was. The Mama said she left it at home. The receptionist was going to make the Mama walk all the way back home and get the blue card with a sick child on her back. I stepped in and said this baby is very sick he needs to see a doctor immediately and we will get the blue card for you later. The receptionist grudgingly gave the Mama an admittance card and we sat down with the 20 other mama's and baby's waiting to be seen at the family clinic. The nurse took the baby's temperature and weighed him. This hospital is notorious for it's slow service, bureaucracy and its staff's lack of curtousy with patients. Devota hates going there. She went to get a quick test for Malaria once and she came back 5 hours later furious at how rude the nurses where. The funny thing is Emily had a completely different experience when she visited the hospital to get tested for Malaria back in March. She said she was seen right away and that the nurses were very polite. I had a suspicion the Mazunguu (white person) factor is to blame for the difference of experience. Sure enough because we were with this Mama and her sick baby we were seen by Doctor with in a half an hour. We cut in front of at least 50 other people. I even heard the Doctor say send in the Wazunguu (white people) next.

Emily and I sat in for the examination and the child was in far worse condition that we thought. He was severely dehydrated. When the doctor pinched the skin on his stomach it stuck together and took a long time to return to place. He was under weight. A healthy 1 year 2 month old weighs 7 - 9 kg. This child weighed 5.5kg. When his mother lifted him up by the armpits you could see all his ribs down his back. He had been vomiting and had watery diarrhea. The doctor said he was severely malnourished. His feet were swollen and red from a lack of protein. The doctor said the child needed to be admitted into the hospital immediately. We asked the Doctor to ask the Mama why she needed a letter from the Mwenye Kiti and the police. She said her husband refused to let her take the child to the hospital and she wanted a letter from the Mwenye Kiti telling her husband to bring the child to the hospital and getting the police to make him do it. When we heard that we decided to pay for the child to be admitted into the hospital because we knew the Mama had no money and her husband wouldn't pay. We saw the Mama into the Children's ward. I stroked the baby on the head and we left.

A few days later Devota and I were passing the hospital and I thought it would be a good idea to go and check on the baby. We entered the children's ward just at the Mama and baby were coming back from home. Normally the hospital does not let an admitted patient out of the hospital until he is discharged, but they made an exception with this Mama. What we didn't know before hand is that the hospital does not provide food for it's patients. Even in the malnutrition center were Mama's stay with their malnourished children for months learning to cook more nutritious meals and getting their children well, their families are expected to bring all the food for the Mama and baby. Our Mama's husband would not even left her take the baby to the hospital let alone bring food for her and baby. The second day they were there a nurse gave our Mama and baby some milk and flour. Our Mama's mother-in-law visited that day and took the milk and flour from the Mama and sick baby and took it home. The Mama was let out of the hospital with the sick baby to try and get the food back. She returned empty handed.

As Devota and I discussed with the nurses what we could do to help this woman the Mama sat quietly on a bench with the baby strapped to her. Then suddenly her face began to twitch. Then she began to shake and say gibberish. Then she began to shake more violently. I was afraid she would fall on the floor and crush the baby. A nurse came around the side of her and loosened the knot of the cloth holding the baby to her. Then an orderly scooped up the baby from her lap and brought it to another room. She promptly fell on the floor and began flailing and rolling around. She knocked over a water basin and rolled around in the puddle of water. She wailed and began saying her husband doesn't love her, that he won't give her money for the baby and he doesn't take care of her. All the Mamas in the ward gathered to look at her. People from the ward next door crowded the door to see what was going on. Nurses and Doctors stepped around her to do their work. All the Mamas began to talk about how her mother-in-law had taken the milk for the baby. Finally she stopped wailing and just layed on the floor on her belly weeping quietly into her arms. It had been at least 10 minutes since the episode started and no one had gone up to her. Finally I went and put my hand on her shoulder. I said Pole sana Mama. Simma Mama. Karibu kiti. (I'm so sorry Mama, stand up Mama, please sit in this chair) And she did. Her arms were shaking but she got to her feet and sat down on the bench and did not say another word.

The nurses said the baby needed milk, eggs, high protein porridge and two thermoses to put the porridge and milk in. The Mama needed corn flour and beans. Devota I and went to the market bought a months worth of corn flour and beans and two thermoses. The hospital had milk and porridge and the ward matron said we could pay for the the milk and porridge at discharge. The next day I came back to the hospital to pay one of the nurses for a months worth of eggs and I talked extensively with the Matron and tried to get more information from her. I wanted to know if there was a social worker at the hospital I could talk to about the obvious unstable family situation at this child's home. I wanted to know if the mother could be examined by a psychiatrist. I wanted to know how the hospital could help to make sure that this child did not become so severely malnourished again. But mostly I wanted to know if the baby was going to recover. I wanted some reassurance. I got none. What I got was a bleak reminder that even though there is a hospital in my village I'm still in a desperately poor part of the world and the simplest things kill people here everyday. The hospital has no social worker. The Matron said the nurses would give the Mama a daily amount of the food I bought so it wouldn't get stolen again from her mother-in-law but that after the baby was discharged there is nothing they could do. The Matron had talked to the hospital psychiatrist about the Mama. He suggested the fit she had in the children's ward was an epileptic ceasure and wanted to put her on epileptic medicine with out even examining her. All of this was frustrating to listen to. But then I asked the Matron will the baby recover. She smiled at me, put her hand on my shoulder and said "Sure, why not". That was the end of our conversation.

A few days later Emily, Devota and I were walking down the road in Igelehedza. The Matron came up behind us and said started speaking in Swahili. I thought she said "You did a good job helping that child. Did you pay for the eggs yet?" Then she said in English do you understand what I'm saying? I said "Yes". Then she walked away. We walked on and then Devota turned to me and said "Did you understand Amanda? She said the baby died". I immediately turned and ran toward the Marton she was already in her office at the hospital. She said she didn't know the details all she knew is that the baby died just a few hours after I came to pay for the eggs and talk to her. I went to the hospital and talked to the doctor who treated the child. I wanted an explanation. I wanted to know what the complication was that killed him. I wanted to know how a child could be brought to the hospital be rehydrated, given medicine and food and then just die. The doctor had no explanation. There were no complications. The baby was just too weak and he passed quietly.

I'm still trying to come to terms with what happened. All I know is I still have questions. I asked one of the nurse how many children she had seen die of malnutrition in the hospital. She said "5". I said "5 this year"? She laughed and said "No, 5 last month and many of the children who die of malnutrition are also HIV positive". There is a problem in Ilembula, of great misfortune and immense sorrow. This problem is solvable by educating mothers on how to feed their babies , on how to prevent mother-to-child transmission and on how to prevent themselves from having a baby you can't afford to feed in the first place. I plan to do everything I can in the next few months to spread that education to every house in my village. When that Mama came up to us in the road I knew it was a turning point. We could have walked on but we stopped and listened and now we truly know our village from its beautiful sprawling pastures to its darkest whoas.