I MISS MALARIA

Who in her right mind would miss a disease that ranks as one of the number one killers of children in the world? Me. I shouldn't, I feel guilty about it, but I confess that I do.

Malaria is deadly. But it is also quite concrete. It can be seen under the microscope. It has a known course, and a cure. A child with malaria can look like death and in a few hours look pretty normal. Malaria is an enemy one can grapple with. We aren't always successful, but we often are. Patients and parents understand it, and want the treatment. You don't have to convince or cajole. The drugs are available, relatively cheaply, and the turn-around is quick.

Which is in contrast to the average Kijabe Paediatric patient, who is complicated and for whom we seem to do little that is dramatic. When I heard that our new admission yesterday was "a 15 month old with diarrhea and dehydration" I thought, great, something we can treat. But of course he had that on top of a progressive depressing divergence from normal developmental milestones, a history of TB with a pericardial effusion, a Rickets-related cardiomyopathy, overall marginal nutrition. This morning he was barely moving, just this side of coma, and we re-checked his potassium level which had fallen from 5 to 2.2 since admission (bad) from his copious stool. The one patient on our service who may have actually come with malaria (from a distant low-lying town) was only here because he also has spina bifida, a VP shunt, a deep pressure ulcer awaiting plastic surgical repair. One of our patients was missing this morning, a darling little 4-year-old girl in a pink headscarf (already) who had come from ICU after being stabilized for new-onset insulin-dependent diabetes. Not the easiest place in the world to raise a diabetic child, but thanks to Mardi's contacts we had a donor who was willing to fund her glucometer and care. Only it seems her father and his relatives did not deem her worth the effort, because about an hour after a long conference convincing them to stay, they ran away with her, and left the bill.

Because we're a referral hospital, and because we have excellent surgeons who are game for attempting the impossible and taking on desperate cases, and because simple things can be treated more cheaply in government health centers, Kijabe is a magnet for the complicated. And often a place where we fail to substantially alter the course of a disease or disability. A place where we bump (crash) right up against our limits.

Which is my real problem, I know. I like to see cures. I like to fix, restore, redeem. It is more appealing to deal with problems we can label, to engage in battles where we can fight back.

Jesus had compassion on the poor, the blind, the lame. I suspect that most of my patients are not so different from those that thronged to Jesus. He healed many, but I don't think he "fixed" everything. The final putting-all-things right still eludes us. The people of the Kingdom are tough cases, complicated, marginal, hungry, lagging, peripheral. Being at Kijabe immersed in these very people should be a taste of Heaven. In fact it just reveals to me that I don't particularly love the needy so much as I love being able to do something about their need.

So pray for people like me, who miss the curable malaria cases, and resent the sense of ineffective futility when confronting our daily stream of those who will never be particularly healthy or smart or strong. Pray for compassion to trump frustration.