I am sorry for not putting up any blog entries sooner. I have found it very hard to put into words my experiences. I almost feel as if the words capture very little of what I see, hear, and feel. But I will try.
As a social worker in the hospital I have been privileged enough to work in many of the wards and build relationships with numerous patients, nurses, interns and doctors. When I first started at the hospital I found myself with a list of 7 ‘clients’, which may be the patients him/herself, or the patient and their caretaker. In the paediatric ward I had 3 clients, 2 boys aged 5 years and 18 months, and a little girl aged 5 years. Both the 5 year old children came in with severe malnourishment, malaria, anaemia, and de-hydration. The 5 year old boy was being taken care of by his mother. After spending some time with his mother I found out that the little boy was staying with his father and step-mother. This is common here. Polygamy is common. I am told that step-mothers may be neglectful of children that are not their own. This was the case with this 5 year old boy. Though he was 5, to me he looked about 2.5-3 years old. Malnourishment stunts development psychologically and physically. His mother was unaware of his condition, but when she came to know of it she brought him to the hospital. This little boy was quite swollen when he first got to the hospital. He was irritable and unresponsive but his mother was very caring and attentive to his needs. As the days went on and this boy felt a bit better, it was beautiful to see his mother play with him. She would tickle him and he would laugh. She would make faces that he found funny. She followed the regimen given to her by the nurses and intern doctors. This again is rare. There are many barriers to following the ‘doctors orders’, lack of money and a difference in beliefs being the two most prevalent. The nurses would tell me that this mother and the way she cared for her child was rare and was the reason this little boy was getting better. My heart would smile when I would see the relationship between the two.
None of this was true for the 5 year old little girl. Her caretaker was her father and her older sister. Malnourishment brings with it many other problems, one of which is anaemia. Severe anaemia results in a scab like peeling of the skin. This little girl’s body was not able to heel itself internally or externally, she did not have the nourishment to do so. When I first met this little girl and her father, there was a Nutritionist speaking to the father. In Lugandan he was telling the father what this little girl needed to get better in terms of nutrition. He was also asking the father why he was so distant from his daughter. The little girl’s head was just hanging to the side. She did not have the strength to hold her head up. The Nutritionist asked the father to hold his daughter close to him so that she could rest her head on him. The father pulled his daughter closer, her head fell onto his arm. To me, an observer, though I could see that there was no distance between father and daughter, I felt a large void between the two, there didn’t seem to be any sort of attachment. As soon as the Nutritionist and I left this girl’s bedside, the father walked away as well. The girl sat there, again, with her head hanging to a side. An intern doctor walked over and helped her lie down.
I visited this girl every day that I was at the hospital. I would ask the father how she was doing. One day an intern nurse and I spent some time talking to the father about what he could afford in terms of nutritious food. I realized that at times parents are told what to provide for their child but they are not asked whether or not they have the means to do so. This father did not. So we worked with him to figure out what he could afford in terms of nutritious food which would meet the needs of his daughter. As I continued to visit and speak to the intern doctors about this little girl, I was told that she was not making much improvement, she was actually getting worse. She had caught another infection on top of what she already had. For the most part this little girl was alone, she had no one by her side. She would lie in her bed alone, hooked up to IVs. One time I saw her trying to walk. She took one step and fell. Her legs didn’t even have the strength for a single step forward. Her sister, who was about 9 years of age, was washing clothes nearby. The little girl, collapsed on the ground, just lied there crying until her sister came to pick her up. She put her in a cotton sling, threw her over her back and went back to washing the clothes.
On another occasion when I had gone to visit her I had asked the father if he had fed her. He sat on the edge of his child’s bed at her feet as she lied there barely moving. Her skin was getting worse. She seemed to have less strength than 3 weeks prior when she had arrived. Her eyes would open, she would make a sound, which to my ears was a painful scream for love, affection and care. She didn’t seem to be doing well. At this time it was about 1130am. He had said that she hadn’t eaten anything that day. I asked why not. He told me that she refused to eat, she was not hungry. “How does that make sense? How can one say that a child that is malnourished is not hungry and therefore I did not feed him/her? The child is malnourished! She needs to eat whether or not she feels the need to. Is that not obvious?” I stood there for a minute, dumfounded. I felt myself getting frustrated with this man that sat before me. I could here my mind questioning whether he cares for his daughter. “Does he feel her pain? Does he not see her lying there in front of him?” Sometimes it is hard to place our biases aside and just ‘be’. Sometimes we have to quiet our minds before we try to hear what the other person is saying. I took a deep breath, told myself that I know next to nothing about this father and his daughter, therefore how can I place any judgements on him according to mere assumptions, and what good am I to anyone if I don’t try to understand the other’s perspective. I explained to him that she may not be hungry because she is ill, but in order for her to get better she is in desperate need of nutrition. At this time, a mother sitting at her son’s side on the bed beside this little girl spoke something in Lugandan to the girl. The girl quietly uttered some words back. The mother placed a passion fruit in the little girl’s hand. She looked at it, still lying on her side, and let it fall out of her hand. I picked it up off of her bed and placed it in her hand again. She again let it slide out of her little hand and let it fall beside her. I picked it back up and placed it in her hand. She slowly lifted her other hand and scratched at the passion fruit. She dropped it again. The intern nurse standing beside me took the passion fruit, squeezed it to break it in half, and handed it to the little girl. She put it to her mouth and began eating it. We sat her up. She ate 2 passion fruits and then some bread. She was hungry. She was very hungry. She just didn’t have the strength to eat, and the father may not have the means of care or communication to know so. It was nice to see her eat.
I visited her for the rest of the week, she was still not doing very well. When I came back to see her and the other patients on the following Monday morning I found her bed empty. There were no sheets, no suitcase, no bags or food to be seen. The bed was completely bare. My heart sunk. I hesitated to ask the intern doctor. I walked further into the ward, the intern doctor greeted me and then said, “Your little girl didn’t make it. She died this morning at 5am.”
‘Malnourishment did this? Her sister was fine, she was healthy, even had fat on her body. Neglect maybe?’ My thoughts run quick. I find myself getting frustrated with the father for not taking care of his daughter, for depriving her of love, affection and any sort of attachment. I feel a sense of loss and emptiness inside. I feel my eyes fill with water. My mind tells me that this isn’t the time to process this and that I still have a full day ahead of me. I’m quite good at turning my emotions off, throwing up my wall and carrying on. So I did. I looked forward.
At the other end of the ward I see the mother of the 5 year old boy whose bed was beside the little girl’s. The mother looks very sad. I walk over and ask her how she is doing. She says well. She was not well. Looking into her eyes you could see her mind racing. I tell her I’m sorry about the little girl. She makes a sound of acknowledgment. She then says that she is afraid the same will happen to her son. She is afraid he will die as well. She had lost hope. I tell her that her son is doing quite well and that the little girl had gotten other infections. I ask her to continue taking care of her son and not to lose hope. Hope and faith seem to be this nation’s fuel. When one loses hope the others can see it and feel it from a distance, it is like an ever consuming vacuum. Her son would feel it. Her eyes had lost hope. I asked the intern doctor to speak to her, and discuss her son’s health with her so that she understands that the health of her son was very promising. A week later the little 5 year old boy, who was once irritable, unable to move, swollen and very ill, was discharged. His mother was very happy, and he was healthy and playful when he left. He would even giggle when I would try my broken Lugandan with him.
Every experience is bitter sweet. These two little children came into the ward the same day. One walked out, while the other lost the battle fighting until her last breath. She was fighting a battle that almost seemed to have an end result written for her before she started. She had nothing but her own strength fighting something that had consumed her entire body. I watched her die, slowly. I watched her strength whither away, slowly. I think of what I feel inside when I write about her, and then I think about what her last thoughts may have been when she had the strength to think. I remember her.
I also remember a 60 year old man that I had met in the surgical ward. This man was in a bed at the far end of the ward. One couldn’t even tell that there was someone in the bed. He was a long, thin man. His sheets would be drawn over his head. There were countless flies around his bed. His little area smelled of urine. He had had a surgery for his gut and was continuing to have abdominal pain following his surgery. He had no one to care for him. His wife had run off on him with their son while he was in surgery. She ran off with all of their money. I visited him daily. An intern nurse would translate for me. We wouldn’t talk long. I would ask him how he was doing. He would tell me about his wife, his work, and how he just wanted to get better. He didn’t want anything to do with her. He didn’t want to be upset. He just wanted to get better and go back to his employer to work. I asked how he would transport himself to his work, would he like for me to find him transportation. He said he would walk. I would ask him if I could come back to visit. He would smile and say yes and thank me for visiting him. He would never ask me for anything. He struggled to speak, and spoke very quietly. He would hold his abdomen when he spoke, and grimace in pain, but would always greet me. I spent a few minutes with him every day I was there, and would just wish his pain would go away. On a Friday, I went to the ward to see how he was, he was asleep. I always woke him up to say hello, but this day I thought I’d let him rest. I visited other patients and was on my way. The ladies and I went away for the weekend to Rwanda (an eye opening, heart wrenching experience on its own). As we commuted there I thought of this 60 year old man. I wanted to see him again but something inside told me that I wouldn’t. I thought about him numerous times. I prayed that he would still be there when I got back there on Wednesday. When I went in his bed was occupied by another man. Tears fill my eyes as I write this. He had passed that Monday. I didn’t get to see him again. I didn’t get to look into his eyes and greet him. His eyes revealed a depth and a wise soul. His eyes had a story to tell, maybe a painful one. His eyes seemed to peer into me. His eyes carried warmth of one that had lived and had experienced much. His eyes evoked something within me. His eyes I remember. I remember him.
I hesitate before I carry on with this next experience. I feel overwhelmed with sorrow and yet have not even started to write about a boy that I met, also in the surgical ward. I hesitate still.
I met another 5 year old boy with his 11 year old sister, and his 9 month pregnant mother. This little boy was immobile. His body was stuck in an abnormal position. His legs crossed one another, his arms were pulled tight up against his chest. He did not move anything but his eyes. He did not speak. Instead, he cried. A cry that I still hear. It wasn’t a cry of a child that one would normally hear. It was a cry of pain. His mother told me that a few months prior he was running around and went to school. He was quite bright, the top in his class. One day, she had come home and found him convulsing. Soon after this he lost his ability to move and then speak, his mouth had minimal movement. He was found to have Osteomyelitis, an infection of the bones and the bone marrow. He was in the surgical ward because he and his mother had fallen off of a bike and he was left with a fractured bone in his arm. His bone was protruding out of his arm. He would cry in pain all day and night. His mother did not have the money to purchase pain medication. She did not even have money for food. This little boy was in this ward for weeks waiting for a surgery. An x-ray was taken of his arm and the doctors found that the infection was eating away at his bones. They could not do surgery on his protruding bone because it was very infected and was pussing.
Could you imagine being stuck in your own body? Could you imagine what this little boy was thinking in his head? I wondered this. The thought of being stuck in my body…………I can not even fathom this. Yet here was this little boy, stuck. The infection was eating away his body from the inside-out. His eyes wondered seeming to look for an escape. His mouth cried. His mother and sister carried him around. My mind can not even begin to comprehend what his mother would be going through. I think of what I feel, and can’t imagine what his mother feels, or what he feels. I wonder what goes through his mind and then I stop myself from wondering. It’s painful.
He was being discharged. There was nothing the hospital could do for him. The mother was asked to go to a clinic nearby her home to get dressings for his arm. The nurse and I both knew that wasn’t possible. She had no means to do so. She was 9 months pregnant. She gave birth to her 6 children on her own, in her home. She was going to do the same again. ‘And then what? Then what happens to this little boy? How will she care for a newborn and this boy? She doesn’t have any other support.’ When he was being discharged I went to speak to his mother, and to say goodbye to him. I’m not sure if he understood me because he couldn’t respond. He just cried in his mother’s arms. As I was talking to his mother with the nurse, the mother showed me her son’s leg. My eyes again fill with tears as I write. His little leg had a flesh wound the size of my palm. What once was a blister had developed into a large open wound. There was no skin on it. Just white flesh. His body was truly being eaten from the inside-out. I look into his eyes. His eyes seemed to scream ‘help’. His eyes looked up completely helpless. I wished him freedom. I wished him freedom from him pain. If that is what his heart desires, I wish him absolute liberty. Liberty from this body that had become an infected cage, holding him in. I hope today that he is free. I remember his cries. I remember him.
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