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| A view of Vanga Hospital's tin rooftops on the left, the Kwilu River on the right, with fields and rainforest inbetween |
It starts becoming light around 5am. Since I’m pregnant and
am up frequently at night, I should know. Shortly after the light comes, there
is a stirring in the community. As there are no competing sounds of cars or
electricity (other than our own fans which run off our batteries), the sounds
of birds singing, a baby goat protesting his mama, middle school girls
bantering as they walk down to get water from the source, and the intrusive
BANG of a mango falling on a tin roof fill the air. Around 5:45, only my fourth
trip to the bathroom this night, I hear the first of the church bells go off that
keep time in this village. I hear my daughter stirring, talking, singing her
two-yr-old language. 30 more minutes until my alarm goes off. I crawl back
under the mosquito net and try to find a spot in the foam mattress that hasn’t
sunken flat from a night of body weight smashing it.
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| Mosquito netting over the bed |
My phone alarm goes off. I hit the snooze. My daughter is
still contentedly playing this morning. I wake a few minutes later and decide
to get up. Another trip to the bathroom and I hear my sweet daughter call to
me. “Mama. Awake!” I open her door and she stands up tall, all smiles, partly
wrapped in the mosquito net she has pulled into her crib with her. “Mango,
crash,” pointing to the window. “Baby, blankie, sleep,” putting her doll down
on the bed. “Bonk! I fall,
giggle”
purposely running into the side of her crib and finding the result. She doesn’t
seem to be in a hurry to get out of bed either. I put on my make-up as she
decides. The 6:30am church bell rings.
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| The over 100 yr mission church, founded in 1912, still ringing its bell to tell the village the time |
“Want to wake up Daddy?” I ask as I finally pick her up.
“Yeah, daddy!” nodding her head. “Book! More more more, baby,” citing the name
of a book. We go to the living room and retrieve the book. “Goose,”referring to
another book about Petunia. We go back with the two books, and I plop her,
heavy, on the bed. She jumps, slides, crawls over and says, “Daddy! Awake! More
more more,” and I get my scrubs on and medical pocket reference books, fill my
water bottle, and set my bag and white coat by the door. I contemplate a bowl
of cereal. Nope, hypoglycemia. I
decide on a glass of milk and a spoonful of peanut butter. I peek in on my
family. They are both reading, separately, because that is what she asked for,
I suppose—he’s reading about a silly goose, and she’s jabbering about a baby
wanting more. I wave to him. Usually she opens the door for me and yells after
me through the window, “Bye-o. Later. Mama,” but today I’m running late and she
is happy. The 7 o’clock church bell rings as I brush my teeth. Yep, late again.
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| Sydney opening the door, saying "Bye-o! Later. Mama." |
I walk down the sidewalk between the rows of purple tropical
plant leaves, the sunflowers staked upright because their strength didn’t match
their height during a recent rainstorm. Our sentinel opens our front gate with
a familiar metal clang, saying, “Bon travail,” (Have a good work day, in
French). I check my pocket- phone is there. My other pocket- my scrub hat is
there. My bag feels light.
Oh my water
bottle. I trudge back up the sidewalk which seems steeper than normal
today. I am always forgetting at least one thing, but I cannot survive the heat
and humidity without extra water.
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| Our front sidewalk lined with flowering plants, a view from our gate |
I pass the sentinel again as I depart and wave, a bit
sheepishly. A family sits outside our fence, shaded by a large tree in the open
watershed area ahead of me. A baby plays in the sandy dirt, tracing motion with
a stick. A young man sits, waiting for someone to buy cell phone minutes. A
mama arranges her bags of peanuts and a couple of pineapples that are for sale.
A chicken picks up a peanut bag when she is not looking and scuttles off with
it, making an impressive run as an 8 yr old throws available sticks and an old
plastic bottle towards the chicken, who finally gives up her treasure as a
stick makes a direct hit. She is almost proud as she kicks her chicken feet off
and gets out of harm’s way. I’m halfway down the hill.
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| The nursing school just opposite our house |
I pass nursing students, just in front of the male nursing
student house, some are also selling cell phone minutes, to earn money for
notebooks or pens, no doubt, but just a mere 20 yards from the first Vodacom
rep. I cross a small landbridge that is successively being washed away in the rain—a
culvert would work great right here, I think for the 20
th time. The
nursing school is on my right. The red flowering tree is quite beautiful, as
are the tall palms that line one side of the school. The ground slopes away,
down toward the Kwilu. I can see the other side rising up with its own set of
palms today, no clouds, no haze, just raw beauty. Hospital staff and nursing
school staff housing is on my left. The fruit tree, of which type of fruit I am
clueless, has left a minefield of slippery apricot sized balls to keep my
attention on the path in front of me. A goat follows its fellow goat through an
opening in the natural bamboo fence—I suppose to see if the grass is really
better on the other side of the nursing school fence.
I smile at the old and young women who line the path nearest
to the hospital gate, selling peanuts and pineapple and green vegetables I
still don’t know the names of. Yet another small stall sells cell phone
minutes. That’s 3 Vodacom representatives in a 5 minute walk, and I know there
are usually at least two inside the hospital property as well. I think about
their meager prospects for making a profit, and also the lack of good jobs for
young men. Quickly my mind turns to the women as I pass by the maternity ward,
listening for babies crying, for the rare shout of a woman in labor, and
searching the doorway to see if a nurse is anxiously looking out of it for physician
instruction for a critical patient. Not today. I cross the sidewalk, pass the
women sitting on steps—women in waiting. They are waiting for labor to start,
or waiting for a loved one to be discharged, or waiting for a follow-up
appointment. But all have come from a distance; otherwise they would not be
paying to stay in a rudimentary cement room, lying on straw mattresses, and
cooking food over a charcoal fire under a pavilion with 20 other women and
children. Some days they stare or try to get their children to wave at the
mundele (white person), but today they smile and wave, no doubt remembering my
daughter’s bouncy red curls and shouts of “mbote,” (hope you are doing well! In
the local language) the night before as we walked back from our daily swim in
the Kwilu.
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| Just one of the pavilions where families of patients cook food, wash clothes, bathe, and live |
I walk into morning report. A row of medical students who
have been on overnight duty lines the front wall, 2 per service: OB/GYN,
pediatrics, internal medicine, and surgery. The staff doctors and residents are
in the front row, with 5 rows of medical students behind them. Each pair of
students is called to give their detailed report of just one of the patients
that they took care of overnight. Questions are posed by the staff, diagnoses
and treatment discussed. Occasionally there is a disagreement and lively though
friendly argument that breaks out among the staff. A student is sent to chase
off the goat that is yelling for its mama right outside the open windows. I
speak up and ask a few questions, clarifying a few points when OB/GYN is in
front. I remain mostly silent for the rest, scouring my brain for the answers
to questions in medical disciplines I haven’t studied since medical school.
Unfortunately, for today, both OB/GYN and pediatrics share
the same mother-child dyad. A woman came in during labor at term, having
faithfully attended her prenatal care visits (more rare than not). She has 2
living children, after which she had 6 newborns that died in the first day of
life. Yesterday I had seen her when she was in early labor, trying desperately
to find a cause through a good series of questions about her past history,
through laboratory tests (of which we have few) and through an anatomy
ultrasound to look for problems. I found nothing. And now I’m hearing in
morning report that the child was born last night, full term, but didn’t
breathe well. They ordered lab tests overnight which haven’t been done yet. The
baby is doing poorly despite the oxygen given in pediatrics, oxygen saturation
remains in 50’s (normal is 92+). I know I need to find this child right away,
examine him for myself, and perhaps do an ultrasound to look for anomalies.
Morning report ends, and I walk out into the already bright
sunlight. I talk briefly to the OB/GYN students, telling them I’ll see them
shortly for rounds. I search out the pediatrics team, only to find out the
child in question died while we were doing morning report. Not sure what is
culturally acceptable, I ask another staff doctor if it would be appropriate to
do an ultrasound on an already dead infant. I surely hope that some of the labs
ordered had been done before the infant’s death. I search for the child, but
they mention that he was no longer in the pediatrics ward. Neither had the lab
work been done. Rats! I walk quickly over to the maternity, hoping to be able
to at least examine the child. When I arrive, I am told that they have already
come to get the child to bring him back to the village for burial. With how
slow some things are, this one rapid act is extremely frustrating. I now have
no more information for this mama than she already knew before—all of her
babies are dying of something, even with good pediatric care available
immediately.
I return home quickly to use the internet to write an email.
Maybe my high risk maternal-fetal medicine professors from residency can give
me something to go on, something to tell this poor sad mama. I drink more water
while waiting for the wheel of death, that circle that keeps going round and
round on the computer with slow internet—a fitting name for today. I prepare
mentally for the rounding on maternity. I don’t have anything to say to that
mama yet.
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| A view of the maternity, with covered sidewalk connecting the rooms |
I make the 5 minute walk back down to the hospital quickly.
We start in the post-cesarean section room that has 9 beds in it. Today most of
them are doing well. One hasn’t bought any medications yet, antibiotics nor
pain medicines, and she has a high heart rate and fever. I have lost patients
to overwhelming infections treated to late because of inability/unwillingness
to pay—or because they flee in the middle of the night and return with an
infected wound, sutures still in place. I know I’ll pay for her antibiotics and
whisper to the nurse to bring me her bill after rounds. It’s only $10 out of a
$120 bill for the surgery and hospitalization. Turning back to the medical
students, I ask questions about the indications for cesarean sections, their
risks. We move on to the next room where there are some women who have had
hysterectomies, then onto a room full of women still pregnant, hospitalized for
malaria or typhoid fever or kidney infections. I prescribe a few antibiotics,
change a few plans. Walking out of doors (imagine an old-school motel where
doors to rooms open to the outside with a covered sidewalk between), a woman
comes up to me with a paper and asking to see me. Yes, around lunchtime after
the medical student activities, I assure her. Then it’s on to the postpartum
room with 12 beds in it, mostly full of mamas who delivered vaginally without
problems, babies in arms or nursing, but one doesn’t have a baby and I know
why. I can’t talk to her today. I have nothing to say. Tomorrow, I think. I
hope tomorrow I have something, though I doubt it.
The group of students, tired of standing, trudge into the
meeting room where one of them has prepared a presentation on bleeding in
pregnancy. A nurse pulls me aside as I’m walking into the meeting room. Her
brother is in the emergency room and needs surgery. Can I help? Oh, and there
is another patient who wants to see you after the presentation. Too many people
need me. I feel like a mom with toddlers pulling on her ankles while she is
trying to make dinner. I tell them all I need to finish up with the medical
students first. I escape. The medical student is talking already. I follow most
of the French, though some words I have to clarify still. Medical terminology
wasn’t emphasized in language school. Critique, however, was emphasized.
Immediately after the presentation, the staff doctors (me included) evaluate
aloud the presentation. The other doctor states, “Well, that was poorly
presented. You need to organize it better, look how many people were sleeping
during it.” And instead of being dejected as I would have been in his shoes, he
takes notes on what to do better next time. This is definitely a French system.
I begin, “Thank you for the presentation. Next time, if you look at the
audience and don’t read off the computer screen as much, it will be better. But
the content was good.” Yes I’m American. I have to sandwich the bad comments
between something positive.
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| The group of medical students and residents working in OB/GYN |
It’s noon. The students scatter, as do most of the nursing
staff. They take lunch break seriously here, for 2.5 hours. I’m hungry, but
since I don’t have regular consultation hours, I take patients as they come to
see me in the maternity. The nurse waiting for an answer on whether I’ll pay
for part of her brother’s surgery looks at me. Not now. I call a nurse who is
on call over the lunch hour to come in to help with translation. Surprisingly,
now there are 3 patients waiting. We start with the first. Pain. Menopause.
Irregular periods. I’m happy I can give them instructions on how to improve
their health that don’t require surgery or expensive medications. Soy beans,
palm oil, reassurance. All three are similar cases. I finish fairly quickly, as
documentation here is not as necessary nor do I always have the proper French
words to explain my findings. Finally, I finish, and as I head out the door, I
turn to the nurse still waiting on my answer and hedge, “Come up to my house
after lunch. I have to discuss this with my husband.”
I walk up the hill, which at times seems like a mountain.
Halfway there, I make a detour and walk through the nursing school. I’m looking
for the academic dean, because I’ve been given a few donated computers for the
nursing school and need to distribute them. He has already gone home, so I
continue through the field, past the new building for training nurses in a
practical hands-on way. A nursing student stops and asks me to give her money
for books. Ah, the requests don’t stop. Unhindered, culturally-appropriate
here, the requests wear on me. I try to think of a good way to banter back, as
I sometimes say to people asking for food on the road that I’m not a cook, but
I’m tired. I just say no.
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| The path back up to our house, nursing school on the right, our house at the very end of the path, top of the "mountain" |
I’m late for lunch, so Ryan and Sydney have already
finished. Sydney is taking a nap. I sit at the table, grateful to sit, grateful
for food already prepared for me and mostly still warm, always tasty, and
grateful that I can turn a 12 volt fan on as afternoons can be stifling without
wind. I overhear our house help talking in more energetic than normal tones. I
look over and they come out of the kitchen. The gardener has just returned from
the market with eggs for dinner. He overheard on the road that there had been
an accident this afternoon. The details trickle out. My cook’s neighbor, a
motorcycle chauffeur, was killed in a head-on accident with a vehicle. Not only
that, MY neighbor’s 10 yr old boy was also killed, and his mother sustained
significant injuries but is alive and being treated now at the hospital. Oh
death, you are so frequent and near here.
I continue to eat, mulling over thoughts of how prevalent
death is here—so IN YOUR FACE. What if that had been Sydney? Or Ryan? My
empathy strength seems like a curse now. Soon, we hear it… the inevitable
wailing and mourning coming from the direction of the hospital. It happens at
least weekly, with the mourning friends and family passing by our house. This
time it is during daylight. I follow our house-help to the front gate to watch.
And I regret it. It is children. A lot of children, lamenting their friend.
There are a few adults too, that look like mamas. A couple of men carry a
stretcher. I want to look away, but I can’t. It is my neighbor boy, all of 10
yrs old, a surgical wrap seems to keep his head on his shoulders. Still. Silent.
Tears come unbidden. The procession is now at our house and passing by. I turn
and walk back inside. It’s just too much. This suffering. He is too young.
I finish eating. A sentinel who works for a missionary currently
out of town comes to get money for his sister’s hospitalization for malaria. I
give it. He asks if I’ve heard the news of the accident. He gives unsolicited
new information. It was a missionary vehicle. My heart sinks, thinking of which
missionary is in the town nearby. Relief washes over as the sentinel explains
that there was only a chauffeur in the vehicle at the time, and he is now at
the police station for protection. At least there will be no cross-cultural
interrogations. Nothing is simple here. I receive a phone call from the owner
of the vehicle leant out this week. She wants to know details, and I give her
what I’ve heard. When I mention that the chauffeur had gone to the police,
afraid of retaliation, this seasoned missionary replied, “and with good
reason!” I’m feeling the gravity of cultural differences.
On the heels of that phone conversation, the maternity nurse
comes once again, asking for money for her brother’s surgery. I’ve looked it up
over lunch—probably not an indicated surgery. I have had time to wrestle over
this persistence. I don’t have money designated for the sick other than for
patients I’m treating in the maternity. But this is like a family member asking
for money. She is persistent. She is desperate. I finally decide I’ll give $30
as a gesture of friendship. I also explain that although I’m no expert, I think
they could avoid surgery and act conservatively. She thanks me, then asks if
I’ve heard of the accident. Yes. Too many times.
I am no sooner in the door when I receive a text to come to
the maternity for an urgent patient bleeding after a vaginal delivery. I send a
message that I’m on my way, telling them to give cytotec intrarectally to stop
the bleeding. I quickly finish my glass of water, thankful that I don’t have to
worry about cleaning off the table or washing dishes. I walk back to the
maternity ward, being told about the moto accident two more times en route. No
need for TV news here, I think. This is how word travels fast. At the labor
room, the nurse has just finished placing the cytotec. I do an exam, and I’m
thankful that the bleeding is currently much less than what the floor gives
evidence to. I remove a few clots, and determine she doesn’t need anything
further.
There is another patient waiting to be seen. I walk to an
open room, sit down with her and another nurse, and go over her options for
fertility treatment here. I tell her I’ll need to see her tomorrow in
ultrasound to see what her ovaries and uterus look like. She is satisfied.
Thunder rolls, and a rainstorm begins. But I need to go see a colleague who is
past her due date. She is waiting for me at her house, wanting to discuss
induction options. I decide the rain will not deter me. It is the rainy season
after all. If I let the rain keep me from going out, I’d be stuck either in my
house or at the hospital, potentially for hours. But a great protest breaks out
as I’m leaving the maternity. First from the nurses, who laugh a bit at me
after realizing I’m seriously going to walk out in the downpour like this. Then
the patients and family members lining the covered sidewalk outside the
maternity object. Some speak to me in broken French, others only the local
language. Some are sitting against the wall, others filling containers, taking
advantage of water flowing off the roof, others standing and just watching the
deluge. I insist that I’m walking out into it and I’ll be fine. I’ll simply be
walking through God’s shower, just as they fill their buckets with water to
bathe their children in later.
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| The path down to the hospital becomes a small stream during rainstorms |
Like a gentle caress, the water comes. It tries to find its
way through my white coat and scrubs. My eyebrows drip. But it’s warm, and
there is no lightening threatening my steps. The bricked walkway leading out of
the hospital is now a stream, always carrying the sandy soil further downward
and toward the Kwilu River just on the opposite end of the hospital. I turn
right just after the gate instead of continuing up that mountain stream. I
arrive for the home visit, my too-pregnant friend is surprised but happy to see
me. We discuss options, pros and cons. We decide that Friday is the day, though
both of us hope she has the baby by then.
It is still raining, though lighter still as I walk out of
her house and on home, past the giant palms, the papaya tree that’s leaning too
far over the already narrow path. There are still pieces of the afternoon left.
I can be productive. But upon arrival, I discover via text that we’ve been
asked by the hospital administrator to use our internet, computer, and printer
to print out a document sent from Kinshasa for the official traffic report. I
sit down at the computer, and realize quickly that it is impossible. The
internet has been disconnected to protect the equipment from all-too-frequent
lightening strikes. I relay the message of this problem to Ryan, who then walks
from the house he is installing solar panels on to the internet room to
reconnect to the satellite for this urgent need. The task eats my afternoon.
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| Our normal evening activity is swimming in the Kwilu just after work, just before dark |
Having lost motivation, I decide to wash away the sweat of the
morning with a bath. It’s SO cold. The water just drips. Our solar camp shower
has given in to the harsh sun and frequent use, and now is obsolete with a few
holes near a herniated pouch. Jumping in the Kwilu is much preferred over this,
but with the threat of lightening and continued storms, this will have to
suffice. Sydney is more than ready to hang out after I’m clean, and I take her
from her best friend and nanny, Nancy (known as nounou). We read books while
going, “rocky rocky” in the wonderful over 100 yr old chair in the corner of
our living room. It isn’t long before Ryan comes in, followed by Tim and Kathy.
Ever since we went to language school together in France and lived across the
hall from one another, we’ve had the tradition of eating most dinners together.
So even with the 15 minute walk now that’s between us, we’ve continued the
habit. I turn on the stove to reheat the pork tomato sauce and the rice that
the househelp have left for us. I’m grateful. For food, for not having to cook,
and for a gas stove, although I miss a microwave.
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| Sydney reading to her monkey in the 100 yr old rocking chair |
It gets dark during mealtime, as usual, though it’s only 6
pm. The geckos come out, and Sydney is too distracted to keep eating. “Gecko!
Mommy. Daddy. Kat-y. Gecko, look! Baby, cute!” Soon after, “I done. Wash.” She
climbs down off the stool and onto the chair, then putting her hands together,
she runs off toward the bathroom. Ryan finishes eating sooner than he’d like to
help wash her hands. Sydney takes the cushions off the couch, one by one. She
then gets on the bare board, says, “One, two, three,
Sautez! (French for Jump!)” She steps off
the couch after rising up on her tiptoes. It’s close enough. Several times I
think she’s going to fall when she reaches the unstable cushions, but she doesn’t,
smiles, and does it again.
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| Sydney pointing out the geckos |
The roar of the hospital generator alerts us that it is just
after 6:30pm. The nearby Congolese houses and the nursing school study rooms
light up like a Christmas tree without color. It is the start of our 3 hours of
electricity in this village by generator power. Otherwise, we are dependent on
solar energy or battery power, and most of the village does not have money for
that. Thankfully, there are solar panels in many areas of the hospital which
provide light when needed. As it is the time when we have the most access to
electricity, I run to grab the laundry basket. I plug in the small European
sized front-loading washer that is located in our back covered entryway. I load
it full of scrubs and towels, and start it. It usually takes 2 hours, after
which our sentinel will hang the clothes to dry in the entryway as well. I remember
to take in the cup I’ve used to pour in the laundry powder. If not, with the
humidity here, it will be partially filled with water by morning.
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| The back of our house, with covered entryway (the door you see) where we do laundry and hang clothes at night |
The Rices head back to their house as we get Sydney to bed.
It’s nearly the same every night. Sometime around 7pm, we brush teeth, change
her diaper, and sing “Jesus Loves Me” as we put her under her mosquito net and
into the pack n play. She rarely protests. After all, it’s been dark over an
hour. I walk out to the living room and tidy up the cushions, put away
yesterday’s clean laundry. Ryan has already put all the dishes in the kitchen.
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Playing with Daddy at the end of the day |
It’s now time to use the internet for the remaining 2 hours
that it is available to us. With satellite internet, an electrical system prone
to damage from lightening, and with living in the lightening capital of the
world, the internet is disconnected from all electricity around 9pm. So I
hurriedly try to catch up on emails, send out requests for medical advice, chat
with friends on Facebook, learn about world news, and I write this blog. It’s
been a good day. I thank the Lord for all He’s given us and provided for. And I
pray for all the patients in the hospital that are suffering, the mama who’s
lying in the hospital bed, mourning the loss of her son and hurting from
injuries herself. I pray for the large group of friends and family gathered at
the nearby church to mourn the loss of the motorcycle chauffeur and the little
boy. They will be there all night, sitting, singing, just being together in
solidarity. This is life and death. This is Congo.
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| A malnourished child, just outside the pediatrics ward |
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| The Kwilu River at morning light |
