"Yes, I guess."
"When you saw this you must have thought, 'This is not a hospital'".
There were a total of 11 tiny preemies today in the nursery. Five lay spooning in a single incubator as they waited for a second to be cleaned. They were so incredibly small that it was hard to believe they were actually humans who would grow to be mature adults someday.
The student intern I've been working with, whom I will call Mwanafunzi (student in Kiswahili), explained to me how the babies are fed. He cupped his nonexistent breast with his right hand as he told me the mothers must first "express" or breastfeed before the formula can be prepared. One part formula is mixed with one part breast milk and babies are fed depending on their weight. Preemies are characterized as weighing less than 1 kg (2.2 lbs) or being born before a 9 month gestation period. Seeing so many preemies today made me think that this was a common occurrence, but Mwanafunzi guessed that only about 10-20% of babies born in the hospital are premature. (According to the March of Dimes website, about 1 in every 8 babies in the US are born prematurely. That's about 13%.)
In the adjacent room were three babies sharing a crib. They had originally been classified as premature but had gained enough weight to be moved out of the incubators. One of the abandoned babies had found a home, but the other adorable boy who we saw last time was still there. He giggled as Mwanafunzi picked him up and tickled his belly. Turns out the nurses have named him Obama!
Walking into the critical room of the PEM ward I braced myself for what I was about to see. Two mothers shared a bed lying head to foot as their malnourished babies lay nestled against them. This time there was no crying mother who had lost her son sitting next to them. We were met with a much happier sight.
The severely malnourished girl was actually sitting up in bed today and talking. It was really incredible and gave me hope that she will get better. Flies gathered on the taught skin of her forehead as she stroked her legs. I couldn't quite put the look on her face, but she seemed to know that something was wrong with her and that her legs didn't look as they should.
I'm a little worried about her because she weighed 10 kgs on August 4th when she first arrived and she still only weighs 9.9 kgs. She only consumes formula and I asked Mwanafunzi whether that was substantive enough for a five year old. He told me that it had all the nutrients and vitamins she needed. When I repeated my question, worded slightly differently, he repeated the same answer. I obviously have no expertise in this area, but it seems like she should be eating some normal food by now instead of solely surviving on formula.
Three more malnourished children had arrived at the hospital in the past three days, one having arrived just yesterday. We talked to her 20 year old mother and received many of the same answers we had from the other mothers. She too brought her child to the hospital for coughing, not knowing that she was malnourished.
With the three new children in the ward, that brings the total to 13 mothers and 13 children and still only 6 beds. Five of the children have been discharged, one over two months ago, but their mothers remain, unable to pay the hospital bills. Mwanafunzi said the women were "ignorant" and saw their time there as a kind of "vacation" where they had food delivered to them, could use the wash rooms, had a TV to watch, and beds to sleep in. He made it sound almost like the women want to be there. I'm not so sure I agree with that statement especially because many of the women have other kids back home.
The little abandoned girl, who I will call Udadisi (curious in Kiswahili), sat in a yellow bucket tub as she got a bath. One of the mothers cleaned her with a child's wet long sleeve shirt she was using as a rag. They dressed her in a halter dress with fabric fruit slices sewn on it then put her back in her crib. I found out today that she is two years old and had been found left behind the hospital's pharmacy.
Mwanafunzi left for a while to check on some things, so I amused myself taking notes. It wasn't long before I heard some babbling and when I turned around Udadisi was pointing at me from across the room. She continued to stand in her crib and point, making some of the mothers in the ward laugh. I walked over to her and she looked at my buttons and explored the contents of my jacket pockets. She beckoned me over again later after she'd eaten and waved her blue plastic mug at me, splashing drops of porridge all over my jacket. I was covered in porridge by the time I left. We played peek-a-boo and she giggled and hugged me. Mwanafunzi came back and saw us playing together. Looking at us he said, "She is so in love with you." I hope they find her a home soon, but I'll be sad to see her leave.
Mwanafunzi needed to write down the day's formula measurements, so we went down the hallway to the "acute" ward and sat at a picnic bench. Not finding a ruler, he grabbed a paperback copy of the New Testament and used it as a straight edge. As we left the ward, two men pushing a metal cart with a metal cover walked past. "That is for the dead" Mwanafunzi said walking on.
As we waited in the nutritionist's office we sipped on some sugarless masala tea and Mwanafunzi told me how the cost of living in Kenya has been rising. One kilo of sugar now costs about 200 KSH (about $2), a price which the hospital can no longer afford. When the nutritionists arrived for their afternoon tea, I noticed they took their bread without margarine as they had before. Perhaps that too has gotten too expensive?
Dorcas picked me up and we headed straight to Kaaga Primary to pick up the health textbook and curriculum. As we waited I noticed a sign posted on a bulletin outside. It said the following:
HIV cannot be spread by touching, sneezing, or coughing.
HIV cannot be cured by having sex with a virgin.
HIV is not a by-product of political warfare.
Respond to the facts, ignore the myths, and together we'll reverse the spread of HIV/AIDS.
I'm interested to see if there are any myths the students believe in when I teach the after school health class about HIV/AIDS. I teach my first health class this Wednesday!
In the afternoon we drove to a nearby town to assess one of the schools there for MKMF's feeding program. I couldn't believe how quickly the landscape changed as we left Meru. The land went from lush and green to barren and dry in the span of only a few miles. There were row upon row of crops which never grew for lack of rain. If food doesn't grow, many families go hungry as they cannot afford to buy food.
In the corner was a stack of sacks full of rice, beans, and maize meal to give to the most needy families in the area on Monday. Rwarera encompasses 74 sq km and includes 11 primary schools and 2 secondary schools. He was very grateful for MKMF's feeding program which will provide porridge to around 3 of these schools for all of the students for the full term. He said, "feeding the children, you have fed us all." He predicted that enrollment in the schools would double once word of food got out. Many children stay home to work or look for food and the drought has made the situation especially bad.
Before we left he offered his full support to us saying, "I'm a servant of the people. Anywhere you call me, I'm there." Then we signed his guestbook and were on our way.
One of the board members, who works for the Ministry of Agriculture, accompanied us to Rwarera Primary for the assessment. She pointed out cotton crops along the way which hadn't been harvested in 3 years as a result of the drought.
Enrollment at the school peaked in 2006 with 339 students, but currently only 207 are enrolled. This is almost certainly due to the drought and a lack of food. The headmistress told us that many children leave to find food during lunchtime and never return. Even the kindergartners aren't fed for the entire day. She expects that enrollment will increase once food is provided and we also hope to see a rise in test scores as the children will be better able to concentrate on their studies if they aren't focused on their hunger or finding food.
The other day in the office I read a children's book about Nobel Peace Prize Winner Wangari Maathai and The Green Belt Movement. In the 1970s after returning from her studies in the United States, she noticed that many of the trees in her hometown of Nyeri, Kenya had been cut down. She started the organization by giving poor women seedlings to plant as well as a small wage for the seedlings which survived past 3 months. As a result, over 40 million trees have been planted. There is a great documentary about her and the organization, which I watched on Northeastern's campus. You can watch a short clip here. The book talked about how women had to carry sticks on their backs long distances for firewood. On our way home today I saw a group of three women walking hunched over each with a large bundle of sticks hung from their back. Right down the road from them a boy no older than 8 or 9 watched over a handful of cows. Most children were in school at the time, but he had obviously been out watching the cows .
After dinner Alexia wanted to tell me a story about a mzungu she had once seen. She started with, "When I was a small girl..." Stephen and I burst out laughing. "So you mean yesterday" I said. "Yes, wait, NO!" She's so funny. Later she kissed me on the cheek and said "Clever girl. You know I love you." "I love you more Alexia" I responded as usual.