. . and when the last admission of the afternoon is a 6-day-old vigorous baby with a bilirubin of 27. That's high. That's the level of jaundice that edges into the brain-damage range (and lest we forget that the risk is real, we have another child on the ward who is neurologically impaired, which made sense when I saw his old chart and his admission as a newborn for a bili of 39). So the nursery is gearing up tonight for the second exchange transfusion in a week, a procedure that is almost unheard of in the USA. Why? The baby was seen at two days of age and sent to the lab for the bili test, but it took the family 4 days to come up with the funds. So a problem that could have been resolved by light therapy (pretty cool, there is a blue wavelength that changes the toxic bilirubin into an excretable form, so the nursery glows an arctic blue in the steamy heat as infants wiggle under the eerie lights, like so many roasting chickens) now becomes a problem that will require a time-consuming and dangerous process of removing the baby's blood and infusing donor blood, a few cc's at a time, until twice his estimated blood volume has been exchanged. Stoic and inefficient and sacrificial all at the same time, Africa.
. . and when I notice one more mom with two kids in the ER at midnight, a fussy one on her back whom I assume to be the sick one, and a 4-ish year old passive little boy standing in front of her. I ask what the problem is, and she lifts the standing boy's shirt to reveal a fleshy lump protruding over his lower spine. A big one, soft and spongy. In fact it looks like a meningomyelocele, but those are usually fatal if not repaired as a newborn. But it must be, because she has an appointment slip for the neurosurgery clinic, and explains through staff that she lives in an IDP camp at some long distance and though she left home this morning to come to the hospital, she did not arrive until the clinic was closed. She had no nearby relatives or friends, so there she sat. The nurse in charge of "Casualty" matter-of-factly said "we must accommodate her so she can see the doctor tomorrow." Once again, that stoicism, not making any fuss, just sitting there in the midst of the emergently ill, because it was the only place open by the time she could drag her two kids here.
. . and when dinner preparation includes an evening brisk walk to the nearby town where a half-dozen ladies sit in a shed-like enclosure, each with her own table of exactly the same fruits and vegetables set out for sale. I am almost always the only customer when I enter, and so far my strategy has been to try and buy at least something from each table, keeping everyone happy. I try to use my Swahili, which only confuses them, they are quite used to white people and English being this close to the mission station. I take my cloth bag and fill it with 5 avacados, 3 mangos, a squash, broccoli, two tiny heads of very dirty lettuce, a cluster of cilantro (!), a dozen or so tomatoes, a few potatoes and carrots, two zucchini, and two apples (!), spending about seven dollars I guess. Walk ten minutes back home and put a chicken I bought from a local lady into the oven (dead and plucked though!), then the sliced vegetables. Feel semi-competent with my Alice Water's Art of Simple Food meal until 45 minutes later I realize the propane tank is finished, and my oven is barely lukewarm. We locate a spare tank, start the dinner cooking again, as kids hover starving. I have one little end of a loaf of bread left and decide to toast the five pieces to accompany the chicken and veggies. I slide them under the broiler, get distracted, until I notice the entire apartment filling with smoke. Panic. I open the broiler and there are five flaming balls of charcoal. Jack is so impressed with the fire he does not even feel bad about the lack of bread now. Finally we sit down to eat, and I realize how even a simple meal is not simple when everything is still unfamiliar and uncertain. and involves languages and interactions and equipment and disasters.
. . and when I sit down now at 9 pm and try for about half an hour to send this post, without success, give up for the night, and think, there is no place I'd rather be, than Africa.