Wednesday, February 17, 2010

Moments of tragedy

Sometimes I feel like I could sum up my Malawian experience as "general hilarity and punctuated by moments of extreme tragedy."

Working with children is inspiring, annoying, hilarious, exhausting, unpredictable, uplifting, messy and wonderful all at once. Despite the fact that we treat seriously ill children, I find myself laughing through most of clinic. The babies are always doing something to make me smile and despite the fact the some of the kids are in pretty bad shape- most of them are doing OK and will probably be just fine after treatment. That is why I find clinic enjoyable and end the day satisfied and content.

Sometimes, however, I see things that make my stomach turn. I mentioned HIV positive kids and I'll say again that this never ceases to be tragic even though its sadly very common.

Older children also especially tug at my heart because they are fully cognizant of their issues. We had two kids today that stuck with me. The first was a child who was seven years old and myrasmic. I sat down with her and her mother and, with the aid of an HSA (for translation), I tried to figure out what was going on. Severe malnutrition is most common between 6 months and 5 years so older children (who can find food for themselves and are physiologically stronger) generally have other issues (TB, HIV, cancer, congenital problems) that lead to malnutrition. Turns out that the mother is HIV-positive and the little girl had yet to be tested. My guess is that the test won't bring good news. Sitting there with her and knowing that she is probably positive was particularly painful for some reason. She just looked so dissociated. 

The second child was a 9 year old with severe myrasmic kwash (meaning they were very skinny/wasted and also had extreme swelling) who couldn't even walk. In order to put him on the height board I had to get him out of his mothers arms and lay him down. He clung to me like a baby monkey. He was very cooperative and just lay there with a blank expression as we measured him and squeezed his feet to assess swelling. Then I leaned down and he reached up and put his arms around my neck and I returned him to his mother. Something about his somber forbearance and total reliance on me in that moment when I picked him up nearly broke my heart.

We also witnessed a horrific event yesterday that may have been coloring my perceptions. When we arrived at the health center, our nurses told us that something was amiss. I'm not sure how they knew because it looked like a normal crowd of people but it turned out that a 4 or 5 year old child has passed away the previous night. Apparently the mother had brought the child to the health center at 3 in the morning but the clinical officer was asleep and could not be roused (the details of this are sort of unclear). The child died during the night and the community was outraged.

In the middle of clinic I felt a silence descend and looked up to see the tiny shrouded body being wheeled away from the health center on a cart. Following the body was the child's father, moaning and crying and, a few steps behind him, the child's mother, also crying. This is apparently typical: grief is expressed intensely and publicly and then largely put aside as life goes on.

We lapsed into respectful silence as the body was wheeled past us. Clinic went on as usual and my life went on as usual but I am sure that the image of that funeral procession will stay with me forever. And I sincerely hope that no amount of exposure to tragedy, poverty and sickness will make the death of a child any easier for me to stomach.

Happy Update: I saw the mother who had the premature baby (we took both mother and baby to the hospital- see earlier post) and the baby is alive and mom is doing very well and managed to bring her other child to clinic while dad stayed with the baby at home. 

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