Wednesday, December 06, 2006
Maria, "little one of God"
Maria Kabaruhanga is an 18 year old whose life has been teetering on the balance for the last 10 days. Like her namesake in the Bible she was pregnant with her first child and far from home, which in this case is Congo, with nowhere to stay and little to live on. She arrived at Nyahuka Health Center, which is about as clean as a first century stable, to deliver her baby. After long hours of labor the midwives noted that the baby’s heart beat was not stable and alerted Dr. Jonah, who decided to do a C section to save the life of the child. Pamela happened to be in the right place at the right time and was invited to observe. The midwives labored for half an hour or more to stimulate and revive the baby while Dr. Jonah attended to the mother. That was Sunday a week ago. That Monday the baby’s grandmother sat waiting for me, hoping for baby formula to sustain the child because the mother was not doing well post-operatively. I asked the baby’s name, which threw the grandmother into confusion. She looked around helplessly, upon which cue the lady sitting next to her in line (who was no relation and had never even seen her before) suggested rather firmly “Nightie”. Lots of girls get named this in reference to being born at night (which on the equator is about a 50-50 likelihood year round). This baby, however, I knew was delivered in broad daylight because I’d heard the story from Pamela. No matter, no one listened to my logic, once the name Nightie was suggested, Nightie it was. Over the next several days of antibiotics and milk Nightie began to improve. Maria, however, slipped further and further from life. By Wednesday she was in terrible condition, breathing rapidly, unconscious, full of pus. While we were at the airstrip dealing with the plane-stuck-in-the-mud, Scott got an emergency call to come and attend to her since he had agreed to cover Jonah’s patients. Jonah however was unable to fly out so he borrowed Michael’s motorcycle to zip back to the hospital and took Maria back into the operating room to re-open her wounds and clean out the infections. We feel pretty sure she would have died that evening if the plane had not been delayed. Over the weekend Scott kept her alive with antibiotics and blood transfusions. He came home every day shaking his head that even in an ICU he was not sure she could live, but in Nyahuka Health Center what were her chances? Now she’s propped up in bed, awake, still in pain and still very ill. I saw her this morning and had to walk out before I cried. Ten days ago she was a robust teenager; now she is gaunt, with bony cheeks and drooping breasts, drained of vitality, clinging on weakly to life. Her parents seem to be trying but barely manage to keep her clean. They often lay Nightie on the bed between her mother’s feet. I have not seen Maria hold the child, I doubt she could even manage to lift her arms yet. I want to have hope for her. If she dies, we will continue to supply Nightie with as much milk as we can manage to get, but it won’t be easy. Without a breast-feeding mother her chances of survival are greatly diminished. I suppose it is the way Maria’s cheeks have melted away leaving only her large eyes, or perhaps it is her name, or the knowledge of how much struggle has been put into her survival by Jonah, the midwives, Scott. The book I’m reading says that sadness is the purest response to evil. Not anger this time, only the pure sadness of watching a young teenage mother whose life has been sapped for that of her child. Watching her parents who are in a foreign place try to cope with her care and that of their new grandchild. Sadness that the risk and struggle of Mary of Nazareth has not yet erased the risk and struggle of Maria of Congo. NOTE on Wednesday: I sent this post last night (Tuesday). This morning as I was seeing patients I heard the characteristic death wail emerge from the female ward, not very loud or intense, only one woman crying. Maria died at about 9:30 this morning, only her mother was there to mourn. We hired a truck to help get her body to the border. Maria died giving life to her child; in a reversal Jesus was born to die to give life to his mother and all other laboring women. It is a bleak and rainy day again here and the promise of no more tears seems far off.