the weight of a Wednesday

Esther, floppy as a fish, dressed in blue, with sparkling brown eyes that follow our movements, a babbling tongue.  She's a normal 1 year old mentally, trapped in a body that barely moves.  Her mother died giving birth, so her stout and steady, coarse-featured competent grandmother stepped in to rescue her.  For a year she's been feeding, bathing, carrying this child, who grew in size and responsiveness but never managed to hold up her head, to sit, to play, to crawl.  As a last ditch effort, her grandmother accepted money from a friend to travel across the country to Kijabe, determined to hope.  Instead she ended up with me, hand on her shoulder, as she wiped the tears subtly with a blanket edge, then broke down in sobs.  Esther seems to have a form of muscular dystrophy, and is unlikely to survive very long here.  She will never do very much.  I hated watching this dignified older Kenyan lady sob, hated being the one to bring her dream of cure to an end.  But I stood there and talked and then prayed, because it is important for the family to understand the truth.  

An hour later, a hyper little two-year-old flitted around the outpatient exam area.  Who would have guessed that she was brought here to rule out rape?  I couldn't find any definitive signs, and as time went on it became clear that the mother and father were separated , and the rape accusation was actually directed from her to him.  We could not untangle the truth.  In the end we called in the police-based child welfare officer to ascertain the safety of sending this little girl home.  I'm afraid this country will not protect her, or the many children like her.  That she'll be abused by those whom she should be able to count on for sustenance.  

Same room, another hour or so later, I was called by our clinical officer for help.  As soon as I opened the door the stench almost knocked me over.  Incontinence of stool and urine, chronic and powerful.  I tried to breathe shallowly and appear unaffected.  The 3-year-old little boy smiled at me, disarming, charming.  He has been having seizures for the last couple of months, getting more and more frequent, and now has a staggering gate, loss of speech, and inability to control his excretions.  We fear a brain tumor, and arranged for a head CT.  When I examined him his pants were chock full of pasty overwhelming stool, and soaked with urine.  His mom was dressed poorly and I suspect just too overwhelmed to keep him cleaned up.  I'm sure Jesus would have put this sweet little boy on his lap.  

Back to the ward, where baby Mercy waited for the results of her bone marrow biopsy.  She is a diminutive 4 1/2 pounds at age 2 months, tiny, curly dark hair and huge eyes.  She has many anomalies, at least two of which could use immediate surgery . . only she has very few platelets, so no one wants to take her to the operating theatre for fear of bleeding her to death.  I was pretty nervous about poking a needle into her bone as well, but she survived that.  For someone with a long list of problems (cleft palate, heart defect, ano-rectal malformation, microcephaly, not to mention anemia and low platelets) she looks pretty cute and cuddly wrapped in her blankets.

All of these children have potentially disastrous, lethal prognoses.  All are oblivious, mentally intact, eyes seeking out contact, face ready to brighten and smile.  And when they do, all give my heart a tinge of grief, a sigh under the weight of this world's sorrow.

We have plenty of other kids too, malnourished and dehydrated, oozing pus from a huge scalp incision, incessantly convulsing, breathing too fast, languishing with fever.  This week however I feel the burden of those who trust, who look me in the eyes, who try to connect.  Who hope for help in this world.  And who probably won't linger long.