This past weekend presented me with two incredibly weighty
and humbling life experiences. The first: I chanced to help save my Mozambican
friend’s leg (and possibly, life). The second: I spent a full day watching the
great Humpback whale migration from the prow of a catamaran. And while the
former reminded me of the huge power a small act of human courage can have in changing
the course of another's life, the latter dwarfed any suspicion of
self-importance with the feeling that with every crest and fall of ocean waves,
we were a tiny spec teetering on the surface of a much greater and mysterious
world below. Least to say, it was an
intense few days.
Friday afternoon I popped into the library for a quick look,
and took some measurements for the mural that we’ll start painting next week.
It was there I ran into Raulina, a teacher at the primary school and my new
library counterpart. As usual we chatted
about the weather, our families, her chique new hair style, school gossip, and
our plans for the weekend. It wasn’t until I was on my way out however that she
caught me by the arm, and told me that “by the way, mana Joana is very sick”
and “could we go visit her now?”
Being in a hurrying mood, I’m ashamed to say that I felt a
bit annoyed. Mozambicans are always complaining dramatically of some malady or
another. Teeeecha. Estou suferir. Estou
com fome. Estou doente. Estou com dor de cabeça, ou barriga, ou pé. Estou com
constipação. The list goes on. They’ll
have a pain in their stomach and say they have cancer. If they’re sick, they
say they’ve gotten it from the dust in the air, from the trash in their
neighbors yard, or that a witchdoctor has cursed them. I’ve never met a nation of
people so poorly educated about the transmission and general cause of disease,
let alone a complete lack of taking personal responsibility for disease prevention
and treatment. Even Joana, a very well educated matriarch of the primary school,
had been sick for weeks already with a swollen foot… I’d seen it the month
before. Yet she had just been tolerating it, expecting it to get better.
Perhaps the only thing equal to Mozambicans ignorance of disease is their
tolerance and patience with pain. Since I hadn’t heard anything from her, I
guess I’d just figured she’d recovered and gotten busy again. Still, a little voice in the back of my
head argued, you should go and see her to
make sure she’s ok. Sighing I wheeled my bike back around, away from home
and towards the huts behind school grounds. “Sure, Raulina. Vamos.” I said, now walking at her side.
“Thanks for inviting me.”
While I’m quite conscientious about listening to my inner little voice, I’ve rarely felt more
fortunate for having heeded it than I did in visiting Joana that day.
Immediately as I ducked into the darkness of her hut, I knew
something was horribly wrong. A mound of
blankets erupted from the cold cement floor a foot from the doorway. I knew
Joana was under that huge plaid mountain of felt, but I couldn’t see any hint
of her. “Mana Joana,” I called softly
into the darkness, my eyes adjusting to the dim, my toes slowly picking their
way around hidden obstacles, moving closer to where her face should be.
Finally, kneeling down, I waited as her son (one of my best students) Adelson,
worked to rouse her. “Mãe, Teacher
Karina and Teacher Raulina are here to visit you.” Moments pass. Again. “MAMA. Teacher Karina e profesora Raulina
estao aqui. Levanta mama!” Finally the pile began to stir and grumble and a
hand reached out, grasping. So I took it. It was burning. As the blankets
peeled away from the top, I finally found Joana’s face and gasped. It was a feverish face, a bleary-eyed, leathery brown face aged and etched
by pain. “Joana,” I breathed, scared and shaken now. “What’s happened?” She
began to cry.
The next 20 minutes were a blur, a whirling of action and
response. Trying to keep my voice calm and positive, I sent Adelson and his
little brother for buckets of cold water, a wet cloth on the forehead, and
juice from the market. Joana was shivering uncontrollably and was so weak she
couldn’t prop herself up. Meanwhile, I knew I had to take another look at that
swollen foot of hers she’d told me about the month before. What I saw when I rolled back the blankets
took my breath away. The slight swelling that had been in her foot before, had
spread all the way up her leg and into her groin leaving clustered, dark,
almost pustule-like, spotting along her entire inner thigh. I was looking at an elephant leg.
 |
| Part of Joana's freakishly large and swollen leg. The foot (not pictured) looked like a massive club. |
So, within a few texts and graphic photos exchanged with my
mom, who’s a Nurse Practitioner with nearly 40 years of experience, back home,
we had a diagnosis. Because I’d first seen the swelling in her foot a few weeks
before, we realized just how aggressively the infection had spread up her leg. Joana was suffering from an advanced stage
of septicemia, or blood poisoning.
Doing some research on it later, septicemia is actually one
of the biggest killers in the underdeveloped world. Infection and the lack of
access to basic antibiotics and controlled treatment plagues the poor across
the world. As WorldSepsisDay.org explains:
"Sepsis arises when the body’s response to an infection damages its own tissues and organs. It can lead to shock, multiple organ failure, and death, especially if it is not recognized early and treated promptly. Between one-third and one-half of all sepsis patients die. In developing countries, sepsis accounts for 60-80% of all deaths."
Perhaps the greatest tragedy of it is that infections like Joana’s are
some of the easiest to control and treat if caught early.
Yet with the lack of education and understanding of disease
transmission and control, coupled with the fact that most of the world’s poor
can’t afford treatment or even have access to a medical provider, most people
with very treatable injuries or diseases just sit, rest, and wait, hoping their
malady will pass and thus instead allow the infection to set in and take over.
They don’t even have a fighting chance.
Anyway, we finally
had a diagnosis thanks to mom. So I hopped on my bike and shot out of that barrio like a bullet, pedaling for home
and the extra stash of kick-ass antibiotics my mom had brought me from home a
few months before (I’ve always loved being a Nurse Practitioners daughter!!).
With a new flurry of texts, Mom and I settled on a 1000mg / 12 hours pusher
dose of Amoxcycilin for the first 36 hours, then a switch to 500mg / 8 hours of
Erithromyacin. I threw in a pack of dehydration salts and Ibuprofen for good
measure. Then I hopped on my bike and shot off again through the sand and onto
the main road. Fenda must have thought I’d gone crazy. His wagging tail quickly
drifted back only a few steps into his pursuit.
On the bike ride back to Joana’s, I prepped myself on how I
was going to explain treatment. One of the things we’ve learned through
teaching about HIV and malaria prevention is that you can’t make assumptions
about what people “already know” because most likely they actually don’t but
say they do. What I had going for me was
that I knew Adelson, the son, was a super diligent student of mine – the rare
kind of kid that copies every word on the board and asks clarifying questions
in class. So I crafted a list of detailed, descriptive instructions. Pacote branco, I wrote, referring to the
silver packaged Amoxcycilin, Adelson perched religiously on my shoulder. 1 pacote cada 12 horas para 2 dias. Aleve. 1
medicamento cada 6 horas quando tem febre. I had him describe back to me
the treatment until he could do it from memory. Then in an attempt to push
program adherence I told Adelson I’d count each empty packet he had the next
day. Then I had to tell him to push fluids into his mom despite her resistance.
“Have her drink 4-5 cups of water or juice every hour,” I explained him,
guessing we’d be lucky if he could get even half of that. “The medicine needs
fluid to work,” I clarified, giving a very abridged reference to the horrors of
dehydration. I didn’t really know how to describe kidney failure.
And with that, my lesson was done, the immediate crises of
deciding what course of action to take, over.
I watched Adelson administer the antibiotics and Aleve to his mom and
felt really proud. But I knew we weren’t out of trouble yet. Joana now just
needed time to let the antibiotics work. And while later that night I still
felt really self-assured in the decisions I’d made earlier that afternoon, I
couldn’t sleep. While we didn’t really talk about it, I knew that my sitemate
Maria, who had done pre-med at university thought I was out of line for helping
the way I did. That, for one, I was putting myself at risk with the community
if Joana didn’t make it and I’d been the last person seen with her giving her mystery
pills, and for two, she thought that I was in absolutely no way qualified to
make the judgment calls I’d made that day, even with my Mom’s help.
Both were valid points. It’s true there could have been
backlashes from Joana’s family if things had gone badly. Because I’m white.
Because people don’t understand how medicine and disease work. Because I’d make
a convenient scapegoat for a mourning community, and that I was trying to treat
an infection that was too far along. It’s the sad side to medicine in a
developing country that the odds are against you. And as to the second point,
sure, I wasn’t qualified at all, but with 40 years’ experience my mom is. And
with technology these days, essentially I got to present to my mom the symptoms
with photos and descriptions with real time accuracy. It was truly amazing,
honestly. Without the power of WhatsApp and GoogleVoice calls, my story would
have been different. I would have tried to take Joana to a second rate hospital
by public chapa, where we would have been forced to wait for hours to be seen
by a doctor, and for what? To be told to go home again? No. Way.
Essentially to me it all came down to this: I could play it
safe, stand by, do nothing but try and make her comfortable and watch Joana lose
her leg or die from a treatable infection. Or I take a risk on both our parts,
make my best judgment based on expertise from someone I trust, and try to save
a friend’s life.
I stand by my decision to this day. I couldn’t have lived
with myself or looked Adelson in the eye ever again if I’d knowingly made him
and his brother orphans.
So, I let time take its course and kept myself busy. I had a
new roof on my hut installed that next day. I later sent myself to Vilanculos
with Maria, Sarah and Victor to relax and go whale watching for the weekend. It
was splendid to have my worries juxtaposed to the magnificence of the humpback
whales. Any anxiety suddenly seemed miniscule and was forgotten in the scheme
of things. For nearly an hour, a pod of four young males circled our catamaran
and put on a show, splashing, fluking, and diving. Dolphins played at our bow.
Witnessing these creatures felt more sacred than probably anything I’ve ever
experienced (besides wild elephants). They were letting us into their lives and
engaging us, and when they were done, they just flipped their flukes and dove.
Here we were bobbing on top, hundreds of meters above them, yet the whales came
to us not because we wanted them too, but because they did. The magnificence of the whales was awe-inspiring. And it
reminded me of the importance of perspective.
Yet I called and checked in on Joana twice a day, even from
the boat, and we started seeing signs of progress. After the first 24 hours,
Joana rated her pain level a 5, down from a 9 the day before. And it was on the
third day, when I got back to Mapinhane, that we rejoiced to see that the
swelling had started to finally go down too. The skin on her foot and ankle
that had been once taunt and stretched to bursting had begun sloughing into
flappy layers of loose skin.
This time at my visit she had her church lady friends
sitting around her bed, and Joana had propped herself up to receive them all.
What made me happiest though was that Joana was once again smiling that huge,
toothy grin of hers. She was herself again. “You saved my life,” she said, in
front of everyone, taking my hand, hers healthfully cool again. “I only did what
I knew I could do,” I said, suddenly embarrassed. “It was nothing.” I then told
her she wasn’t allowed to get sick again. Right on cue, all the ladies cackled,
then proceeded to overwhelm me with their own medical worries. A woman with a
lump on her eye, another’s swollen foot, another complaining of chronic stomach
pain. I waved them all off. “I’m not a doctor,” I said. “I’m a teacher. And
anyways, mana Joana isn’t even on her feet yet.” Thankfully, they all chuckled
again and I left in a wave of “obrigadas” and “gracas a deus” also escaping any
further inquiries by stepping out into the winter rain.
As a kid, and still even now, my mom and I have a little
thing where when I ask her how her day went after working at the clinic or running hospital rounds, and she’ll sigh
dramatically with a grin and go, “Oh you know, just saved a few lives honey. No
big deal.” It’s played off as a joke. Because how else can you talk about
everything inbetween the lines? The people you can help versus the people you
can’t. It’s easier to have a punchline instead.
On my path to becoming a nurse, hopefully one day with Médecins Sans Frontières (MSF), it honestly feels like I’m doing everything out of
order. I’ve had to confront and will confront a lot more of these harsh
realities of third world health care next year with my volunteer position at
the hospital without formal medical training or knowledge. Yet I know that the
type of work M.S.F does is the type that works in similar or
even worse conditions of stressful, undersupplied, impoverished, undeveloped or
war-torn nations than Mozambique. I actually met an ex-M.S.F employee on the
whale watching trip and he said that getting posted to Mozambique is almost
like a holiday compared to the majority of other M.S.F posts. I’d like to think that it will help me a lot
in the future to be able to think back to the amazing people here in Mozambique
that only needed a little education and guidance to turn a serious illness or
complication like what killed Hermenigilda only a few months ago, into a
survivable one like Joana’s. I expect the people we preserve in our hearts, we
find again in future chapters of our lives, and what better way than to have a real skill to offer, and a real, tangible way to help.
