OBSERVATION

When an old, emaciated man, dressed in tattered American donations and leaning heavily on a wooden cane for support, approaches you with a solemn story of diseased dependents and no job, what do you do? What about a widowed mother of six, requesting money for food? Or an orphan, living with her blind grandmother, appealing for primary school funds? Even a first year nursing student understands the futility of placing a band aid on a gangrenous wound with the expectation of a cure. So do you give money, and propagate the expectation of a rich foreign savior with Schwarzenegger on speed dial? How about to the next 500 equally sorrowful eyes and tormenting tales?

Think about a community with no restaurants, malls, shops, taxi cabs, banks or movie theaters. Aside from the few lucky teachers, nurses or fisherman, there are no jobs to be had. Prostitution at $6/visit is undoubtably an appealing career option. It is a village in a century-late unsuccessful transition from agrarianism to capitalism. With a late-starting rainy season and a complete petrol shortage, even the crop production is scarce, leaving an old woman roadside, with a paltry pyramid of 9 tomatoes, in a space built for a feast.

Malawi is Malarious: Under 5's Clinic

Collapsing off my bicycle, we have reached the weekly rotating under 5's clinic. Approaching, there are approximately 100 women with their children receiving a lecture in family planning. Lecture is followed by a beautiful harmonious song, intermittently lead by different mothers under the shade of the banana tree. I ask Fletcher, the local health officer and leader of the clinics, the meaning behind the lyrics, and he states that the women are singing about family planning, the dangers of childbirth, and overpopulation. Now, making that sound good, takes talent! Over the next three hours we weigh, measure, and vaccinate over 100 children. The scale is designed to hang from a tree, and each mother undresses her child, wraps them in a sarong, and precariously balances them from the scale. The older children think that they are flying and the younger ones flail and scream as they attempt to determine what wrong they have done to deserve this torture. Every detail gets recorded in the child's health book and trended on a growth chart. In Malawi, each person at birth is given a health book or "passport" which will be a dynamic written record of vaccinations, illness, assessments, diagnosis, lab results and medications. Those determined to be underweight will be referred to the malnutrition program.

Sitting in red dirt, surrounded by man-eating ants, spiders and wasps, I am the recipient of all 100+ passports, pages falling out, and as I attempt surgical resuscitation, I can't help but notice that every third child has the same surname. And then I recall, that each man is allowed multiple wives (and girlfriends), therefore may be the proud father of an entire football team. In fact, if the girlfriend dies, one of the wives is expected to, and does, take in the child as her own, without any Jerry Springer drama.

Children are screaming, crying, playing, pushing and peeing everywhere, and it is a blessing when we finally finish. I stand and fight the first ominous signs of my own dehydration. As the blackness clears from my periphery, I see that about two dozen women have remained. Fletcher approaches me and informs me that these are the women with sick children who wish to be be seen by me- nooooooo! With resignation I grab my stethoscope, thermometer, and the first passport waving closest to my face. With minimal pediatric experience (emphasis on minimal, not experience), I have aggressively tried to absorb the "sick child" chapter in my tropical medicine book, and can only recall that a child is NOT just a small adult (ugh, news to me!). Being taught that white people are in fact ghosts who will eat the child if they misbehave, listening to lung sounds translates to protecting my ears from severe eardrum damage. It is the screaming children that made me happy, the worrisome ones are the listless children that allow limb manipulation, hydration assessment and temperature-taking, without protest. As I assess and dictate, I "diagnosis" multiple cases of malaria, a couple upper respiratory infections, a severe case of kwashiorkor, and a possible strangulated hernia vs. intussusception vs. belly full of worms?!?! At my disposal I had Oral Rehydration Salts (ORS), Tylenol, malaria mediation, and one type of antibiotic. Per protocol, any child with increased respirations gets five days of antibiotics plus three days of Tylenol; fever= Tylenol; fever + diarrhea= Tylenol, ORS, and malaria medication. Of course all we have are adult dosing, and the mothers are instructed to break the Tylenol tablets in quarters. Unfortunately, a common requested fall-back medication, when I refuse to give Tylenol to one mother whose child is completely healthy, a scene is created. I question the medical ethics- liver damage for cultural sensitivity? Two I refer to the district hospital, and seriously contemplate a self-referral as I consider my 10K bicycle ride back, in the blazing African afternoon sun.

No meds, No doc, No problem

My drug-induced sleep prior to my first day at Chintechi Rural Hospital, is laced with dreams of emaciated children and my glaring inadequacies in caring for them. For once, my 5:30AM alarm is a pleasant reprieve. With trepidation I arrive, toting gloves, a stethoscope, a pen, hand sanitizer and a thermometer- a modern day Florence Nightingale? As I pass the dreaded pediatric ward, my breakfast of tea and peanut butter (that's right), threatens a re-visit. I am greeted by the medical officer, who tells me- "I am a Practitioner, you are a Nurse, today you will be with them." Never has such arrogance sounded so musical to my ears! With relief, I follow one of the nurses to triage- an environment that finally instills more comfort than terror. The nurses, all fully trained as midwives, with no reliance of doctors (closest one is over 40km away), are the image of poise and self-sufficiency. Among others, within two hours, we have seen, referred, drawn blood and medicated multiple malaria cases, a child with marasmus, two post-partum women with retained products, a dramatic case of cellulitis, a child with a fractured arm, and a man with a human bite to the chest wall (further details unclear). A second nurse soon beckons me, advising me that a woman is currently in labor, and questioning whether I was ready for delivery. Was this a joke? I hoped so!
Side note: Child birth in Malawi is simple, quick, and quiet. To scream is an embarrassment. The woman checks herself in when she feels contractions. She arrives alone, and is received in the L&D ward, which houses three steel cots separated by makeshift curtains, and an ancient infant-warming contraption. She brings her own sheets and materials for laboring and baby clothes. A female family member may come in and bring her food at any part of the birthing process. The nurse midwife assesses position and station of the fetus. First time breech delivery gets referred to the district hospital, an hour away. Multi-para breech gets delivered here, more often than not, successfully. The woman delivers naked, on her back, hands grabbing the bed railing behind her head. No medication aside from a post-partum intramuscular shot of pitocin to induce uterine contraction to help stop bleeding. No blood pressure monitoring available secondary to supply shortage. No mandatory antenatal rapid HIV screening available secondary to supply shortage.
But back to me! The midwife asks me to preform the “V” test. I'm sorry, what? Ah- insert your fingers into the vagina, spread them to a V, and estimate how dilated the cervix is. Ahhhh! Ummmm, ok. I tell her I feel something hard, and she states, “that is the baby's head, she is ready.” OMG! She is ready, but I am not! The midwife teaches me how to listen for the baby's heart rate and how to feel for contractions, sans technical assistance. I scream “PUSH” every times I feel her contracting, most likely NOT negating the stereotype of the loud American. I start pacing, doning the role of the absent father. After about 20 min, a head emerges. For the next several minutes, an eternity to me, the body fails to follow. I am panicky, and perhaps more diaphoretic than the mother at this point. I am staring at the bodiless head, believing that the baby, who has failed to take a breath yet, must be rapidly approaching brain death. OMG- why am I the only one panicking?! As my mental fog clears, I realize that until the cord is clamped, the baby is still receiving oxygen from the mother. PHEW! Within seconds the body follows, and I place him directly on his mom's chest. No crying. OMG! Has he swallowed meconium? What his APGAR score? Who has a watch? Should I initiate resuscitation?! PANIC! The midwife rubs down the infant, who then produces the worlds most beautiful cry (the baby, not the midwife)! With bloody gusto, the mother delivers the placenta (which will be protected and later burned out back with all the others of the day), and breast feeding is immediately encouraged. Still bubbling with adrenaline, I peel off my gloves, carefully avoiding the gaze of the young woman in the adjacent bed, who has just suffered a late-term miscarriage, and is awaiting manual, bedside evacuation.

Going Batty

Every morning I awake to a pile of insect wings in a heap on the wooden floor. No bodies- just wings of various sizes and colors. Malawian Santa or tooth fairy, I think you have it wrong…As it turns out, as the sun sets, another nocturnal friend has been out and feasting- on the bodies of insects, discarding the unwanted fibrous waste. Which, by the way, in some tribes, is collected nightly in a bowl of water to be fried and enjoyed the next day (souvenirs- done!). Like an old man fixed in his ways, once a location has been chosen, a bat tends to feed in the same spot nightly. Lucky me! It also explains the terrifying flapping noise I hear, as I lay wrapped up and sweating in layers of sheets and blankets, pretending that my mosquito net is impenetrable shield.

Burns and Bravery

Wednesday afternoons, following Mphatso, we visit a girl named Naomi. Two months prior, Naomi suffered from an epileptic seizure while holding her infant, and rolled into an open fire. Her infant was spared- her arm was not. A skin graft was attempted to repair the third degree burns covering her left arm, but has left both her thigh and arm open, raw and vulnerable. Kneeling in dirt, swatting chickens, I attempt to make a sterile field with an old ziplock bag and clean gloves. The smell of cassava soaking in the sun is a pleasant odor of vomit mixed with gangrene, and I briefly wonder if it could be marketed as a potent weight-loss scheme back in the states? Back to Naomi! Today is my first time providing wound care alone, and as I unwrap her dressings, I brace myself. Her left arm is completely blackened, with areas of peeling skin and oozing flesh. She screams as I attempt to clean her open wounds with soap and water, and I am forced to have her brother and mother hold her down. My apologizes sound weak, and it is with urgency that I attempt to redress her arm without trapping one of the carnivorous flies beneath.
It is 5:30, and hour before darkness, before I make it back to the tarmac where I might catch transportation back to the roadblock. From the roadblock, I still have a 35 minute walk down to Mwaya Beach, where I stay. As if a lifelong fear of the dark is not enough to send me into a fit of tachycardia, it is also much more difficult to see (avoid) snakes, past nightfall. For 30 minutes I walk, and wait, yet not a SINGLE vehicle drives past. With the petrol shortage, and the increasing black market prices, I am not surprised. Still 10.5 kilometers from my destination, I start to panic, and flag down the first vehicle to pass me- a 16 wheeler truck. As I sheepishly ask them for a ride, the driver jumps out and hoists me up, from with point I have to climb across the labs of the six men who are occupying the cabin. As they grin at me and offer me Chakula, a white substance in a white carton (milk?), it is with increasing panic that I realize that not only does the passenger door have no handle, I have no local cell phone and dusk is falling. I quickly plan my escape, and wonder if I could survive the 10ft jump out of the window of a moving vehicle, if I aimed for patches of grass lining the road, with obvious care to avoid the crocodile-laden river. Can I fight off 7 men who are currently and actively being fortified with milk? As we reach the police roadblock of Matete I breath a sigh of relief, and thank the driver, who proceeds to tell me that he can not let me out yet, for fear of fine, and must past the bend, out of the site of the police, before I disembark. I feel yet another flutter of panic, my new close acquaintance, and envision a life of sex slavery in Lilongwe. I shout out that the police are my friend (I did meet them earlier that morning), and that they would have no cause the fine them (which is when I realized that the “milk” is really a disguised form of distilled beer), and that they are expecting my immediate and punctual arrival! With that, I climbed back across the men, paid double the expected fare, and vigorously waved to the police officers (who had changed their shift since morning), who peered at my dirt-encrusted body, and flushed face, with mild consternation.

When the pedicurist gasps: arriving to MPHATSO

After five hours of walking today, my blisters have run out of space, and now are developing blisters of their own. I have travelled to an organization called Mphatso- initially developed by a single Australian woman 9 years ago, Mphatso is now the largest children’s organization in the area. Through Mphatso and its generous donors, 9 pre-schools have been built and fully supported while previously there were none, select and qualified school children are sponsored to continue their primary and secondary education, a widespread malnutrition feeding program has been developed and sustained, and every Wednesday, up to 100 local children are entertained for porridge and play time. The organization is currently run by an Australian couple, Mark and Lena, who reside there with their two children. One’s pre-conceived notion of a ruggedly handsome man and a beautiful, fearless woman, are only augmented by their tall sun-kissed blond teens, who have traded in sleepovers and high school dances, for composting toilets and communal living. Aside from their standard Australian Akubra, Lena and Mark wear many hats, and in the past week have been summoned to care for both a midnight breech home delivery and a child with a poisoness (or non-poisoness dependent on the witness) snake bite.
Here, on Wednesdays as well, the couple holds a lakeside clinic. Our job will to be evaluate any sick children or locals that arrive. As I look up, a silent line has formed of mothers with babies on their backs, children, and even the village chief. Again I am struck with the faith they have in us, and panic as I realize just how insufficient my skills are. A mother brings in a small child covered with circular sores with dark black centers. Can a child have Kaposi sarcoma? Can leishmaniasis look like this even if it does not match the exemplar photo in my tropical medicine book? A farmer arrives with pain and weakness in his forearm. After a lifetime of repetitive slashing and hoeing, it appears that his tendon might have ruptured. Surgery is not an option. We immobilize, prescribe rest, dole out ibuprofen, and hope for the best. He wants to know, how can he work without strength and mobility in his arm? Good question. Next is a fifteen year old boy. He lives and breathes soccer. He dreams of playing professionally, and is said to be one the best goal keepers in the area. He has dislocated his middle finger on his right hand. It has been two weeks, and fibrous scar tissue is developing around the misaligned joint. He complains of continued pain with any impact, and is only seeking help because his coach has banned him from playing. It is too late to re-align, and we must tell him that it is possible that he will never play goal keeper again. At least not as well. His face remains expressionless, but his eyes betray him, as I see his dreams evaporate, replacing hope with dull resignation. We teach him how to buddy tape, provide him ibuprofen for before and after practice, and excuse him from the bench, because the line is continuing. Lena hands us a cold bottle of coke, and as I look at her family, I know for a fact that angels reside on earth.

OBSERVATION

One can not walk down the path without being greeted by the local villagers, children and elders alike. You will most definitely exchange a five part greeting, dependent only on the time of day. Following, you will be asked, in order, where you are going, where you are coming from, and your name. While a nuisance initially, because a 30 minute journey is expanded two-fold, I do find comfort with the knowledge that if I were to be lost, and entire village will know where I am, and where I should be.

When the milk runs dry and the honey sours: Chintechi Hospital

When asked at interviews about my most challenging experience, I will no longer struggle for an answer that doesn't include surviving my mothers cooking...Today was my first day at Chintechi Rural Hospital. Run by nurses and a medical officer, it is the largest clinic within an hours drive. While void of a doctor, the medical officer is trained to deal with anything that walks through, or is carried through, the doors. One can imagine the outcomes in a country with tragically limited resources, ridden with communicable disease, poisoness reptiles, and fast vehicles on narrow unmanned roads.
The hospital is made up of two female wards, a labor and delivery ward, one men's ward, a pediatric ward, and an operating theater for the occasional rotating surgeon. Each ward is lined with cots and non-absorbent mattresses on dirt floors. Medications are extremely limited, and glucometers, urinalysis, or xrays are not available. When supplies allow, the lab can check for malaria, HIV and hemoglobin levels. My duty will be to round with Rose, and Australian nurse volunteering for 6 months, and the medical officer, to assess the patients, write medication and lab orders and re-evalute discharge plans.
I feel desperately inadequate for this position, and to the best of my ability squelched back fear and anxiety as we started in the women’s ward. How do you tell a woman with a hip fracture, that because she can not afford surgery, she will never walk again? Progressing to the pediatric ward, my heart stopped. Grouped 3 to a bed, each mother patiently waited with her child. The children here are sicker than any I have seen in my life. Some halfheartedly attempt to breastfeed. The rest lay listless, to weak to cry, with eyes that reflect a short life of sorrow and starvation. The first child was a 2 yr old, inhabiting the body of and reflecting the physical milestones of a 6 month old. While she could sit, she could not walk or speak. Her skin struggled to stretch over her protruding ribs and swollen abdomen. With sores lining her mouth, this child was fighting a loosing battle with malnutrition and AIDS. She no longer ate and had stopped producing wet diapers. Her eyes were dull and her spirit was dying. Her body followed 24 hours later. And it continued like this, on and on. I was hit with waves of nausea, frequently stepping out because the gravity of the illness in these children rendered me useless. What do you do when the milk runs dry and the honey sours?

Naughty Knees and Naked Boobies: City girl meets Malawi

Malawi Post One
Week One, Monday:

For a girl who is terrified of insects, frightened of the dark, and who has a healthy distrust of venomous snakes and man-eating crocodiles, coming to Malawi is akin to exposure therapy extreme enough to make even the most sadistic psychotherapist cringe. For the record, it is not ALL types of bugs that send me into full blown panic, mainly spiders, cockroaches, grasshoppers, locusts, large ants, and any insect that flies with erratic and unpredictable motions. Loaded with 6 cans of bug spray, malaria prophylaxis, 2 massive suitcases filled with medical supplies, knives of various sizes, emergency power bars and iodine tablets, I felt armed and ready! Of course that was only until the plane touched down in Ethiopia, at which point realized that I was in a continent where I did not know a soul, did not speak the language, and had been foolishly tricked by AT&Ts promises of international phone reception. My first night passed uneventfully, in that I was lucky enough to be picked up by Dr. Kim, the head of the (only) nursing school in the capital city Lilongwe, in an ambulance, which disposed of its hopefully not-so-sick patients in honor of my arrival. I would stay one night with a local volunteer doctor and and his wife, and the next morning start my bus ride to a rural village up north, forgotten on most maps.
In addition to my aforementioned obstacles, I am also plagued by severe motion sickness, which is very unfortunately aggravated by oppressive heat and pungent smells. Further complicating the journey, in which I am attempting to lug over 150lbs of luggage, there will be a complete absence of bathrooms stops. While many of my fearless friends offered foley insertion, or adult diapers in come cases, I figured having a bag of urine attached to my leg would only add to the unwanted weight I would have to carry. So based on further suggestions, I was now bravely equipped with a "you go girl," female, compact able, reusable, urinal, of a feminine lavender color, whose package boasts utilization during camping trips, while canoeing and at concerts!! So those of you accompanying me to my next Backstreet Boys performance- watch out- I plan on zealously chugging down rum and cokes (joking mom, orange juice) no longer constrained by the nuisance of bathroom lines!
Because buses here are overcrowded, with no discernible schedules, I arrived to the central bus station at 630 AM, only to sit in the baking vehicle for two and a half hours before it was decided that they were full enough to depart. With no organized waste management in the country, I was surrounded by a pool of discarded plastics, rotting foods, decaying animal carcases, and feasting flies. As the smells wafted in, I was already off to a bad start, and might be the first person alive to become motion sick in a completely stationary vehicle. A woman with a young child on her back, chose to sit next to me. While the child was a little angel sleeping, the minute she awoke, all hell broke loose. Like other mothers on board, the woman pulls out a breast in attempts to appease the child (although showing knees are forbidden), and yanks and pulls for a few minutes before she looses interest. Tired of her kicks and wails, this mother thought it would be most suitable to lay this child across both of our laps for the remainder of the journey, and give her a whole mango, which she preceded to consume with voracity. Having also a fear of sticky children, my mind was attempting to reconcile the mothers plan of cleaning her mango-laden offspring. Luckily for me, she chose to let her child remain covered in pulp and juice, now the new epicenter for all the flies in the area. Now, covered in mango, flies, and coca-cola that the mother had ingeniously spilled across both my shirt and pants, my already-peaked anxiety level (so I thought) was only augmented by the now sputtering engine. As I gazed out the window for distraction, I noted that vendors selling samosas and eggs have been replaced by lush green foliage dotted with bursts of color as women dressed in blues, yellows and purples, walked along the side of the tarmac with jugs of water balanced on their heads, and sleeping babies on their backs. Now if only my lap child would do the same...
As we pull off the road in one of our many stops, on a particularly desolate part of the road, the engine succumbs to heat and exhaustion, and refuses to restart. Four hours into the journey, just as I breathed a sigh of relief at the halfway mark, all one hundred of us, plus luggage, are forced to disembark in the midday sun. Efforts to repair the engine dissolve into workers napping in the shade of the engine block. The promised 20 minutes turns into two hours, and as sweat pours off of me, I revisit my four-sips-an-hour rule, and decide that passing out form heat stroke, tropes having to use the go-girl, but barely...Digging through my luggage I withdrew my mom-approved sun safety items, and sitting on a pile of suitcases with my Fendi sunglasses and wide-brimmed floppy hat, I am sure I was a site to be seen.
As promised, a replacement bus did arrive. However, it was already filled with people, without a seat to spare. As people with sacks of rice and chickens balanced on backs and heads, crowded to climb into the bus, I succumb to the realization that me, my wide hat, and my obscene amount of luggage, would never fit. Amazingly, 45 min later, all of us refuges had been successfully crammed into the now heavily weighed-down bus. Laps are piled with briefcases, small animals and children. Packed so tightly in the isle, I have no ability or reason to hold on. As famous Nigerian author Chinua Achebe is fond of saying when describing crowded market places, "if one were to throw a grain of rice in the air, it would never touch the ground."
I arrived at sun-down, and much to my relief, found one of the employees, Dan, waiting for me at the police roadblock, as he had been, for the past four hours. Together, with my luggage, we trudged the 2.5km over dirt, rocks and sand (and environment on which I would later be hilariously and painfully learning how to ride a bike), to my final destination. Never had my arms been more numbly tired, never had I been more thoroughly exhausted, never had I been happier to have a group of people call out my name, sequester my load, and hand me a cold beer.

Slaughtering a goat is all part of the fun

What a breath of fresh air. And I mean that only figuratively. Actually I am still trying to wash out the pervasive stench of smoke, dung and goat blood from my hair. We spent all weekend at a Massai Village on the Tanzanian/Kenyan boarder. The Massai are a pastoral warrior tribe, nomadic in nature. They subside on less than little, and follow the rains. Visually they are easily distinguishable by their tradition dress, exaggerated facial piercings and distinct Ma language. The village employes traditional hot and cold remedies from the surrounding foliage that treats both human and animal ailments. To this day, a boy becomes a warrior only if he can withstand, without flinching, his group circumcision during adolescence. Female circumcision is still practiced, along with polygamy. Each wife does get her own home for her and her children. Of course, it is the women of the village who are responsible for building the houses, called bomas, made of cow dug, ash, dirt and water.

Circular and with poor ventilation, inside the boma is very dark, and when I tentatively stepped inside, I bumped into something soft, which in the light of my camera flash, I found to be a calf!

The children of the village are absolutely adorable, although sadly only about 20% of them get to go to school. The closest school to this particular village is a Christian Missionary school on the Kenyan border. The children who attend there, free of charge, have a two hour walk in each direction, every day!

The rest of the village is rarely exposed to outside culture, including medicine, electronics and western influence as a whole. When night fell, we found that we were in absolutely complete darkness and we didn't hesitate to switch on our flashlights. You could imagine our surprise when the children started chasing the spots of light in fear and intrigue. When we switched them off, they would be searching all over for the beam. On--Off--On--Off the magic never ceased!

Earlier that day a crowd formed around me when the children noticed that my finger nails were not the same color as theirs. The girls would at first, shyly, and the more aggressively so, rub my nails to see if the color would come off, and then check their own finger for color transfer. And then they would look amazed when their fingers didn't show any evidence of my color. Nail polish! I am not sure if I am more shocked at their surprise, or at the fact that we fail to notice the magic of our every day that gets masked in with the quotidian.

One of the most memorable and startling parts of the weekend was the ritual goat slaughter that was presented in our honor. It took 4 men to hold down this tiny goat, while they suffocated him to death in order to preserve any loss of blood. Once the goat stopped squirming they slid their machete down his stomach in effort to begin the skinning process. Unfortunately for the goat, he was not exactly dead, and awoke in a screech and the suffocation process had to begin anew. In the Massai culture, no part of the animal goes to waste, and sfter the skinning, the organs were carefully removed and all of the blood preserved. And although I lost my appetite over the smell of roasting hooves, the locals enjoyed their feast, washing down the tasty intestines with scoopfuls of fresh, although slightly congealed blood.

Not for the faint of heart, but I have AMAZING photos to post, once I figure out how to do that...

POEM

We live in a world of dichotomies
the rich and the poor
the hungry and the satiated
the blossoming and the trampled

U and Me. Right now. Let's discuss the tragedy of devastatingly widespread poverty, over brunch.
You try the omelet. I'll have the crepes.

And after, U and Me, let's discuss the rampant spread of disease and the unaffordable medications, on the way to the pool.
If we hurry, we can catch the midday sun and even out these embarrassing tan lines.

A brother and a sister.
One with eyes so deep and pure I am quite sure I could describe the colours of her soul.
The other, with eyes of blank steel, deflecting light, as if to say please, don't waste your energy on me.
Both orphaned years ago, but not before their parents bestowed upon them the legacy of their bloodline.
Please believe me when I tell you that they can not yet feel this supposed virus multiplying and mutilating their blood cells.
I am told they have no friends.
This isolation is thick and palpable.
And this pain overflows in a way they could only imagine a banquet would.

But never have I witnessed such devout faith as I see here
amongst the flies and the dust and the garbage and the rumbling stomachs.

While he finishes the mortar to a hotel he will never afford to enter
and she scrubs the toilet of another when she herself has none
they praise their Lord for the strength to work
and kindly step aside as I hurry past to the sound of the dinner bell.

My Work at St. Lucia

St. Lucia, my placement, presents me with challenges that are only surpassed by those that I am confronted with the following day. Calling life here, a daily struggle, is an understatement. But ironically, those who live here know no alternative. In fact, while there are about a dozen different greetings, the only acceptable responses are those of the positive nature.

St. Lucia is a orphanage/nursing home for children and invalid adults living with HIV or AIDS. There are 6 full time nurses and the number of patients fluctuate between around 15-20. As volunteers we do a combination of in patient and out patient care every day as well as the education of health workers who are then integrated into the community.

My Week!

Monday, after greeting the children and participating in daily prayer, I began my morning by sweeping a dirt floor for just over an hour. Let me reiterate that I dont mean a "dirty" floor, but in fact a floor literally made of dirt. The irony of this task, however, is lost on the nurses who routinely assign me this futile but apparently crucial morning job. I like to think that perhaps I am superb with a broom, and the underlying layer of dirt is much less dirty than the level I swept aside.

Following, like most days, we were asked to do the laundry. I have never been thrilled with domestic chores at home, but washing machines are now no longer a pleasantry I will take for granted. Laundry is done here completely by hand in outside tubs of diluted and increasingly filthy water that only gets changes when dropping the soap into the bottom instills the same type of sheer panic one might experience in a prison shower. And, it is not just the clothes that we launder my hand, but also the dirty nappies of both adult and baby patients alike! I usually let those marinate and cross my fingers that time will run out before I have a chance to finish...

As a break, I aided one of the nurses in the kitchen snap off the heads of some 600 dried up sardine-like fish. The stench was overwhelming and sadly fish has joined chicken in my list of African avoidances.

Afterwards I got to bathe the children, which was surprisingly a blast! We have a little plastic tub outside that they take turns jumping in and out of while I chase them down with soap (incidentally the same above referenced bar). While I am not sure how effectively I cleaned them, considering it was my first time washing any child, much less 7, I myself quite enjoyed the thorough yet unintended shower they provided me!

Tuesday we planted maize and I will no longer take popcorn for granted. They handed us not hand shovels, but pieced-together hoes and after the 6th hole I was exhausted! It blows my mind every time I consider how labor intensive the everyday work is here! The two local men we were working with would finish 4 rows for every 1 we completed. Ironically I had my hair braided this weekend and I couldnt help but think-- here I am digging rows of corn with corn rows in my hair (said with a southern accent it is a palindrome!).

We had about an hour walk back just when school was letting out. There children here are beyond adorable. They stand so proudly in their uniforms, oblivious to the tears, rips and patches that mar the fronts and backs. All the girls wear long blue or green skirts, blouses, and black and white striped knee socks. The boys match in socks with trousers, ties and wool sweaters. Sadly, some children are prevented from attending school simply because they cant afford the mandatory school uniform--a price of three American dollars. So, with their huge eyes, torn seems and broken book sacks they quietly trail behind us. Fascinated and excited, until, like always, we spin around and yell AHHHHH which sends them squealing and scattering in every direction. But then the brave one of the group reveals himself as leader when he emerges daringly to tap one of us on the back. And then it is game on, until the ill-dressed, underfed Tanzanian children break us with exhaustion!

Wednesday I was asked to accompany one the nurses to the clinic with three children and one of the adult patients. We were there for 6 hours. Half of that time the nurse left me alone with the three children, running, like a chicken without a head, between waiting areas, doctor offices, x-ray, lab and pharmacy. All the while, counting of 9-yr-old David to act as my competent interpreter.

And I introduce the above image with purpose. Last week we were told that one of the volunteers would have to slaughter a chicken for the children's dinner. My partner Shahin boasted he could complete the task, but when push came to shove, he squealed louder than me, freaked out on the first slice and accidentally released the startled chicken, nicked at the neck, draining blood, squawking and flapping for his life. The job was finally finished, but not by poor Shahin, who remained light-headed, quivering and repeating "Oh dear Lord," over and over. Incidentally, I am ten dollars wealthier for predicting the unfavorable outcome...

Thursday morning one of our patients died. Her name is Bernadetta and she was 24 years old. We visited her mother's house several hours later to pay respects, and the following day attended her funeral. It was a colorful, loud, vibrant and startling event- the ceremony and open casket reflecting the spirit of Africa in life and in death.

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Some side notes!!
--> When I say "nurses," I mean women who wear uniform and call themselves "nursi"
--> When I say "broom," I mean dried plant leaves bundled together sans handle
--> David was diagnosed with full blown AIDS and recurrent pneumonia
--> The chicken mishap was captured on video and we are considering if it is UTube worthy!