I sit on the steps to the hospital entrance sipping a warm
Pepsi. People amble around me, chatting, laughing, and singing. Three old men
are perched on a tree trunk, smartly dressed in suits, clutching bamboo canes
and swinging their bare-feet in the dust. Two girls walk past with huge golden
papayas balanced skilfully on their heads. A Masai tribesman draped in deep red
robes paces under an acacia tree talking fervently into a mobile phone. Welcome
to Berega.
I reflect on this week’s highlights. Unexpectedly I have
found myself overseeing the paediatric ward. Two children were admitted over
the weekend with soaring temperatures, bright yellow, and in deep deep comas.
Every year, 18 million Tanzanians get malaria, and of these 60,000 die. Nearly
all deaths are children aged under 5. The environment is just the right (or
wrong) combination of warm climate and poor housing, leading to maximum biting
from parasite filled mosquitoes. Children suffer the most as they have not had
the years of exposure to the disease and ultimate resistance which that brings.
The children we admitted had the most severe form possible, cerebral malaria,
with involvement of the brain. Without treatment it almost always results in
death. The team treated them diligently, we crossed our fingers, and watched
anxiously on the first, second, and third days as they slowly improved but failed
to revive from their comas. Then miraculously on the fourth day they were
eating breakfast, and on the fifth day they both walked home.
Not all has gone well. I saw a two year old girl last week
with Kwashiorkor, the most extreme form of malnutrition, whose parents refused
to allow her to be treated in hospital. This is a life-threatening condition
where the whole body starts to shut down, the most obvious manifestation being
generalised body swelling, thin brittle hair, and a lethargic demeanour. This
poor, tiny girl was so weak she was unable to cry, managing only a few muffled
sobs. The mother, without an extended family to care for her remaining children,
found it impossible to remain in hospital and fled overnight with her little
girl. She has not returned and there is no way to trace her. The mortality of
Kwashiorkor is high, and without specialist treatment and intensive feeding it
is difficult to be optimistic. As a team we are deeply upset. We struggle to
find some meaning or lesson to take from this. We muse on the huge social and
economic pressure that illness puts on society, and especially on women.
Mothers, daughters and aunts are relied upon not only to provide the most basic
elements necessary for life (water, firewood, maize from the farms), but also
to remain in hospital providing the majority of nursing care for sick
relatives. This mother was forced to choose between the health of her daughter,
and the feeding, warmth and security of her entire family. Perhaps without her
presence at home another child, deprived a few bowls of maize porridge, would
drop a few calories closer to malnutrition. Akin to Sophie’s choice, no one can
hold her responsible for her disappearance from hospital. Unfortunately, the
problem is not as simple as sending money, or food. Something, somewhere in the
great antiquated systems driving economic and gender inequality is to blame. We
must strive to fix this. We must think. We must learn. And in the meantime, we
must do our best with the remaining patients.
I spend the evenings attempting to learn Swahili. On the
whole my speaking is unintelligible, with occasional flashes of fluent idiocy.
Thankfully, instead of demanding my immediate resignation, the patients have
the grace to laugh. A ward round begins as I ask a giggling mother whether her
baby has been doing much cooking the past few days. At the next bed the
impeccably polite nursing staff cannot hide their grins as I enquire how
beautiful a boy’s stools have been. Finally, as I leave the bedside of
particularly terrified looking six year old girl I’m informed that I’ve just
told her that a goat will be along to weigh her.
So as the sun sets over the dusty, green valley, my solar
powered computer battery slowly dies. I hope to write again soon. Even during
the past few days I’ve accrued a year’s worth of stories- hope, sadness and
futility thrive here. Thank you for reading.