Walk With Me

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

A malnourished child, just outside the pediatrics ward

The Kwilu River at morning light