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Monday, September 25, 2006

There were 29 in 12 beds . . .

And the little one said, scoot over (or in Lubwisi, mwesike ) to make room for one more.  

We’ve had to limit our internet use this month but when Scott is traveling he hopes to post some pictures of the pediatric ward construction project.  Today I found 29 patients overflowing our current grungy 12-bed ward.  Two of the beds did have two patients each (sets of twins) and all contain both the patient and the mother.  But to squeeze in 29 means that many are on mats on the floor, between beds, in the aisle, out the door, in the hall.  IV bottles hang from nails in the wall or rickety moveable wooden poles.  I squat down on the floor to examine a dehydrated 3 month old, trying not to be judgmental and angry that a traditional practitioner has charged two-days’ wages to take a razor blade and slice open this baby’s gums in order to remove the “false tooth” that is causing his diarrhea.  Or that a dwindling twin with anemia and heart failure is getting no help from her father because he has four wives and too many children to take care of.  Or that the nurse who was on duty for the weekend failed to show up so that most children missed an entire two days of antibiotics.  I want to be compassionate and wise and think clearly through each child’s presentation and needs, respond carefully.   But by the 29th challenge I’m feeling completely at the end of patience (and patients) . . I’m almost out to the door when I realize there are five more outpatient referrals waiting dutifully on the bench.  

Just as I could be feeling sorry for myself and very weary . . I get to the last lady.  She had twins a week ago and has brought both tiny babies in, because she’s concerned about the leg of one which seems to curve a bit.  This is her focus, but from her book I learn that she tested HIV positive in this pregnancy.  Scott had ultrasounded her and noted that Kato, twin B, was breech.  So I ask about the delivery, a breech presentation being a reasonable explanation for his mild curvature.  She answers my questions and I gradually piece together that she did not deliver in the hospital but at home, it was in the night and she had no help at all, and has no idea which part of which baby came out first because it was too dark to see.  Even her husband seems to have disappeared during the critical moment.  So here she is laughing as she relates the story, a lady with a fatal disease and undersized vulnerable twins a week out from delivering them all by her lonsesome in a dirt house at night.  Puts life into perspective.  

But I’m still looking forward to a more spacious and clean ward!

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