She Made My Day

I have been sick here since Sunday. A nagging hacking wet cough. Yes, it is something that I can’t help but wonder if it’s TB being that about 3 children at any given time have TB on the malnutrition ward. No isolation precautions. No masks. But everyone seems to go ahead and just work away. And so do I. Well, one girl, an adorable 11 year old who has HIV and TB was coughing straight on me the other day as I was examining her. I was with another doc. She hadn’t started receiving TB meds yet but we were pretty sure she had TB being that she was coughing like a champ with no remittance, spiking fevers every night with night sweats. The other doc, Dr. Bob, as he is referred to here, or Dr. Bobo as he is also called because they sometimes think Bob sounds like Bobo, was trying to teach her to cover her mouth when she coughs, and instead she coughs as if demonstrating for him - a drift of coughed wind hits us. But I don’t have the other symptoms of TB: fevers, night sweats, fatigue and instead I have an unstoppable runny nose and am sort of achy with some mild fatigue.

So maybe I have what all the other children have on the wards who have coughs right now and accompanying colds, and no TB. The hospital staff say this is the season for it. So many of the kids just have these wet productive coughs that we don’t do anything about at this point because it’s probably viral. Being so hands on with all the sick kids though, it is no surprise to me that I have caught something. Good thing is is that I took some Azithromycin that I had because a nurse gave it to me before I left to Africa and she had taken it with her to India and upon suggestion of Dr. Sara, the pediatrician here, I am now taking it and am feeling better already this morning. So maybe it is not something viral, and maybe it is bacterial, and maybe I will be better in a few days.

Anyway, sickness in tow, I was starting to get that defeated feeling yesterday. A feeling of…is what I’m doing here making any difference at all? Am I using my time well here? I don’t feel like it. One child I really took a lot of time caring for last week in the malnutrition ward died right there behind my back as I was putting an NG tube in another child late in the evening. All the mothers grabbed me when he had what I think must have been a cardiac arrest. I tried CPR, to no avail. He had no pulse, no heart rate, his extremities were already cold, many days prior to this night of his death. I had no ambu bag to deliver oxygen. I did chest compressions. I didn't do mouth to mouth. He had vomit all over his mouth and his eyes were rolled back. I was the only medical person there. He just was so dead to me. So dead. I could not believe it. A dead 4 year old right there in front of me. Me feeeling all alone. With no doctor to call. Just the mom's looking at me, for what I was going to do next which was yell for Jean-Baptiste who was the nurse in the room next to come help me. And when he saw the child, he didn't even rush to grab an ambu bag or do any emergency anything, he just said, "Il est mort." And he closed the eyelids of the child and put gauze over the mouth and taped it shut. Then he started to wash the body. So I started to wash the child too. Wash all the zinc off his body that I had lathered over him earlier in the day because his skin was peeling so badly from his malnutrition. I really had to wash hard to get all the zinc off, it was so sticky, it was my doing all that sticky zinc on him, it just seemed like I needed to get it all off before he was taken away. I washed up while his lifeless limbs flopped around like a rag doll and I wrapped him up with the help of Jean-Baptiste in the mom’s African sheet to be taken to the morgue. Like a mummy. He was like I rag doll was all I kept thinking, he was just like a rag doll. And I was crying.

Does it matter if I’m here or not? I don’t think so. I think things would go ahead status quo with or without me. I haven’t had any effect on the nursing side of the pediatric ward. It is a run by a very firm tough young woman who does not take suggestions pleasantly. In addition, there are two nurses for 50 patients and the last thing they care about is strategies for improvement – they’re not even able to deliver all the meds. So I end up focusing on the malnutrition ward. Which has been great because I have really gotten to learn that ward much better and the protocols and made efforts to make sure everything is done according to ascribed rules. WHO guidelines, MSF guidelines. And I have visited all the other health centers at this point and am putting in motion, along with Dorothee, our malnutrition educator, the ambulatory malnutrition food distribution at all these places, and I really do enjoy teaching the Animateurs de Sante so far. Yesterday I gave a lecture on nutrition and a balanced diet. Afterwards Dorothee, really my main partner here, we’re like good cop good cop, told me that I need to give that lecture at all the health centers to all the Animateurs de Sante and she was very enthusiastic about my teaching session, so that made me feel good. I gave a powerpoint lecture and projected it up on our cafeteria wall, and about 20-25 Animateurs de Sante watched and I had a translator translating everything named Grace. Which turned out, Grace studied nutrition in school, so she said that she enjoyed translating this material since it is her field of study and she knew the vocabulary of this particular context which was very helpful. And I did have an influence on the start of this garden we are making, I got an agronomist who is going to be in charge of it and it is going to be a garden to teach moms better growing techniques for their home gardening. Cultivating vegetables in sacs and the like. The field for this is being tilled as we speak.

All this aside, around 5PM yesterday I was starting to feel a bit down about being here, like maybe I’m just not making good use of myself and I don’t know if anything would be any different if I weren’t here, and I was just going through the malnutrition ward to do a quick check on all the kids. See which looked the sickest –keep a mental list of the top 3 worst. Keep extra close tabs on those ones, although this week, they all are looking pretty good, and I was standing out in the back yard of the malnutrition ward and out of no where in the bright day light I get this huge hug around my thighs that almost knocked me over and it was this little girl, that I put an NG Tube in last week and ended up pulling it out because it wasn’t flushing right. And then I left it out because the mom and child really made some valiant efforts to start drinking more and they HATE the NG tubes so I held off on it. And slowly, slowly, each day she has been looking better, always lying in bed, but more alert, more wide eyed, skinny as skinny can be, without dying. Peeling sloughing skin all over her body, including her genitals, because this is what happens with severe malnutrition, and I had massaged her skin with zinc oxide on a number of occasions. I had only seen her sit up in bed on a few occasions, propped up by the strength of her mother, and the rest of the time she stayed under the covers seemingly close to lifeless for several days. Like the previous kid who died. Then out of nowhere a little girl wraps her arms around my legs for a huge hug and I look down and it’s her. My sickest friend in the ward is now up and walking around outside and literally came up to give me a huge hug. I was shocked. That she had her strength back. That she chose to give me a hug. That she was able to do this or muster the enthusiasm, or that she recognized me, she seemed so out of it when I was helping her. Still with her spindly arms and skinny legs, and she looked up at me with this gigantic smile, the first one I’ve seen her make ever and I kneeled down to her level and gave her a huge hug and said with excitement “Amakuru!?” Which is How are you?! in Kinyrwanda and she said with equal excitement and a huge smile back, “Ni meza!” which is “Good!” as she kept on hugging me and at that moment, my feeling that I’m not doing enough quick enough completely lifted, made me so happy her hug, unbelievably happy, and at that split second I had no black clouds in my mind and I thought, “Wow. That made my day. Wow. Can't believe how much that made my day.”