Stories about children...
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Today's Heartbreak, Julius
When I first saw him I wondered how he could look so ill, be so thin and yet still be alive. He had these eyes, these beautiful soulful eyes. His skin had almost yellowed and his hair was no longer curled or maybe it never curled. Each breath was an effort, but he made the effort. I looked at his mother almost with contempt because she must have let him get that way. So fragile, so tiny, another African baby with Marasmus, a slow starvation.
He had long fingers that didn’t have the strength to hold onto his mother when she carried him on her back. I would have hated her if she hadn't been so thin and ill looking herself. When they first passed my office I couldn’t stand to look at them--to see a baby so sure to die soon. His eyes stole into my heart however, and touched me in a way I still can't understand. Since he was admitted to the hospital, I saw him and her everyday. He patiently held onto life day after day. She patiently fed him, carried him and waited with him. She spoke only Chichewa and I spoke broken Chichewa. I asked his name. "Julius." Julius with soulful eyes was way beyond his 1½ years. He weighed about 7½ kg and was on full TB treatment. His tiny arms were so long and thin and his little ribs raised and fell as he coughed. Every rib was defined protruding, pushing and stretching his skin. His navel was swollen and protruded two inches, a common occurrence in malnourished children.
I had developed a rash on my arms from mango sap and almost went crazy with the silly itch. I put calamine lotion on the rash and sat in front of a fan for relieve. On that day, I walked past Julius and his mother and was horrified to see Julius' skin. He had a terrible reaction to the TB treatment and his entire body had broken out. He listlessly scratched his arms and belly. This poor child didn't have the energy to scratch an itch. I checked his chart to find what had been prescribed. A calamine lotion alternative had been prescribed but he had not been given any yet. The pharmacist had not had the time to mix the mankwala (medicine) together. I told the woman to bring her child to my office. I gave her my bottle of calamine lotion and had a nurse explain how to use it.
The next day I was happy to see Julius doused in pink stuff, looking as though he had some relief. He was taken off the TB treatment in order to fight the rash. For 3 days Julius’s little body was pink. It healed slowly and his parents decided to bring him home for his mother had other children and fields to tend to. At that point I couldn’t understand why they would leave. The rash was subsiding but he still had TB and was terribly malnourished. His mother didn’t have adequate breast milk. His mother didn’t have adequate food. A deal was struck between Julius’s mother and the hospital. They would release him if she would promise to come daily for treatment and phala–a porridge given to malnourished children. I spoke to one of the clinical officers about Julius. I asked, "Do you think Julius is HIV+? Do you think he will die? How can we help him? What can I do?"
Mr. Joseph Matengere, the Senior Clinical Officer, was the first person to welcome me to Nkhotakota. He was the finest doctor I had ever seen in any country. His compassion ran deep when he communicated with patients of all ages, although he particularly loved children. He was extremely knowledgeable and impeccably thorough, although limited by pathetic resources. He was fiercely adored and respected in Nkhotokota. Mr. Matengere said, "No, he probably isn’t HIV+, although he hasn’t been tested. His mother is illiterate and does not understand the connection between good nutrition and good health. His father does not work. They are from the village. They are completely uneducated. They have no money and no resources."
He told me that Julius's best treatment would be a high protein diet. He should eat plenty of eggs. Eggs in Nkhotakota cost 2Kwacha a piece. Villagers could never afford eggs. The average wage in Malawi was 322Kwacha a month and Julius's family probably wasn't making that much. But I could afford eggs. I told Mr. Matengere that I would buy Julius eggs.
My quest for eggs was long and cumbersome. For an unknown reason, eggs were scarce. The local market had none. I walked past 100 chickens a day but there were no eggs in town. After two weeks of vigilant egg-hunting, I bought six eggs at the grocery store more than 200 kilometers away. Unfortunately, the only transportation home was a series of bus rides. In Malawi, there is always room for one more on a bus. I sat squeezed in an 11 passenger vehicle with 15 adults, 3 children and two chickens. We also were surrounded by a lot of luggage. I cradled the eggs on my lap–sitting backwards on a stump in the vehicle. We hit every pothole that tarmac had. The ride lasted 2½ hours. When I got off the bus I inspected the eggs. One broke, five survived. I gathered my eggs, got on another bus and hoped for the best. Three hours and a bumpy overcrowded bus ride later, I arrived home. One more egg casualty--four survived.
The next day I brought the eggs to the hospital and gave them to Mr. Matengere to give to Julius at his next visit. The next week I found eggs locally. I gave the eggs again to Mr. Matengere who gave them to the nurse on late duty. Julius’s mother came to the hospital at 6 am every morning to avoid the heat. The temperature during the day exceeded 105 degrees according to some estimates. She had left before I arrived at 7:30 am. Julius was also brought to the hospital Friday mornings for the Under 5 clinics, during which they weighted the babies and monitored their overall health. By this time Julius’s mother had brought me a dish of rice to thank me for the eggs. Here eyes were bright as she knelt at my feet and handed me her gift, which I painfully accepted.
I continued to buy the eggs and pass them on to Mr. Matengere who passed them to the nurse who gave them to Julius. The next Friday a local volunteer group was performing a play about AIDS. All the mothers who brought their children to the Under 5 clinic watched the play as they waited their turn to see a medical officer. There were about 150 people in the audience. Since one in ten people in Malawi are HIV+, I wondered how many of these mothers were HIV+. Malawian women who are poor and powerless are the largest group killed by AIDS. During the play I sat and held Julius. He didn’t squirm. He didn’t cry. He sat quietly and patiently as he always did. I knew he was still ill but the color had returned to his cheeks. I thought to myself – "This kid is going to live!"
I stopped and talked with Mr. Matengere all the time, but especially on Sunday mornings after church. He was my neighbor and had two beautiful 3 year-old sons who I frequently played with. I would talk to his wife, but more often, discuss politics with Mr. Matengere who was infatuated with John F. Kennedy. I told Mr. Matengere how well Julius was doing. He smiled and said, "Sure, he will be fine. He may be slow however."
Severely malnourished children have stagnant growth both physically and mentally.
Mr. Matengere smiled a warm smile and said, "But who knows, maybe someday Julius will be president."
The next week Julius’s mother brought me mangos. I caressed Julius's cheek and took a good look at him. I was delighted! Julius looked wonderful. He was gaining weight and his cough had subsided. He was shy and would cling to his mother, but I smiled and played with him. I left Julius that day with a feeling of comfort. Maybe those eggs were helping--maybe I was helping this child to get better.
In the developing world, where medicine is expensive and often out of reach, preventive is essential. If we could prevent children from becoming ill by feeding them a nutritious diet, we wouldn’t need to scramble to treat diarrhea, anemia and severe malnutrition. In most cases the resources are available within the country if they were distributed more fairly.
Weeks passed and I bought eggs. I passed them on and didn’t see Julius for a while. I thought about him often though and hoped he was gaining weight. As I over ate and spent money, I thought about the rest of the Juliuses in the world.
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The next time I saw Julius's mother she brought me a bag filled with pumpkins. I was delighted! Jimson, our cook, made a wonderful pumpkin pie and cooked other marvelous dishes with pumpkins. My diet consisted mainly of rice, beans, tomatoes, mangos and onions, so pumpkins were a wonderful treat. I lugged the bag of pumpkins home that day, but the bag must have weighed 20 pounds! Julius's mother carried Julius on her back, her bag for the day and a 20-pound bag of pumpkins—for me! She told me that she would bring her husband to meet me. She asked when would be a good time. We decided on Friday. I thanked her again for the pumpkins. I told her I'd bring my camera to take a picture of Julius. She smiled and left. She had a 6-mile trek home. The sun was so hot and she would walk the entire 6 miles.
Up until then I had bought the eggs for Julius with strict instructions that the eggs were for him. Often parents eat the food intended for malnourished children, as they themselves are hungry. After I lugged those pumpkins home I decided that I must give Julius’s mother a present. Anyone who lugged pumpkins six miles was special!
I decided to give her a chicken. I asked our cook Jimson how to go about buying a chicken. As a vegetarian, chicken-buying was beyond me. He laughed and said, "No problem! I’ll by the chicken on Thursday and bring it to you on Friday." I was so excited to be giving a chicken to such a sweet family. Thursday afternoon I walked into the house and almost tripped over a chicken! It was tied to a post in the front yard. I had asked Mr. Matengere what, in addition to eggs, could help Julius. He suggested oil to make the mpala (porridge) more digestible. On Friday, I went to the hospital with oil and a chicken.
When Julius's mother came I was delighted to give her a chicken and a liter of cooking oil. She introduced me to her husband who was a friendly looking man. He said, "Zikomo Kwambili" (Thank you, thank you) many times. She gave me more rice and mangos. Big sweet mangos. Julius’s mother was Maraweed Katengeza (Mar-a-wee Ka-teng-gay-za). She couldn’t write her name, so I am unsure of the spelling. Julius was her ninth child. Her first child was 20 but was "mad" or suffered from a mental illness. Three of the children had died and six remained. Julius was the youngest. I introduced Julius and Maraweed to some friends who were touring the hospital (one of these friends was Paul—who I married 18 months later.) I had introduced Julius to many people. I felt some connection—some unknown bond to him and Maraweed. They were poor and so sweet. There were hungry for nutritious food. I had to accept their presents and although I knew that they could not spare them. It felt wonderful to give them presents, now two weeks before Christmas. The rainy season had begun which slowed down the already turtle-paced mail system. I hadn't received mail in 5 weeks but somehow, I touched this family at Christmas when I was far from my own.
That day I began doing rounds in the children's ward with the hospital's only doctor, Dr. Storn Kabaluzi, a soft spoken, young man lucky enough to have been selected to train as a physician in England. He had actually confided in me that he wanted to be an auto mechanic, but had to be a doctor because it was such an honor to be chosen!
In the children’s ward, I looked at one malnourished child after another. My mind started reeling—I was trying to think of some income generating activity to aid some of these mothers. They needed food and some source of steady income to save these children. I thought about selling eggs or fish, raising chickens, communal gardening, basket weaving. I had decided to buy Maraweed a chicken and hen so she could have eggs all the time. First, I'd have to make sure she understood to eat the eggs -- not the chicken or hen! Then I had to make sure that she had sufficient chicken feed.
On January 2, 1996, I sat in the hospital’s morning clinical meeting as I did every day. Eight patients had passed away the day before. Five malnourished children and three adults had passed away. Two of the adults had AIDS. I was deeply saddened and felt helpless hearing about the five children. Food, they just needed food and yet one child after the other, dies of hunger. After the morning meeting, the TB officer stopped me on the way to my office. He said, "That boy that you see is dead." My stomach clenched, my shoulders drooped and my heart sank.
Julius had died.
He was 1 ½ years old. When he looked at me with those soulful eyes, he was asking me to tell his story.
After Julius death, I worked intently with the Mr. Matengere and the Head Nurse to revamp the malnutrition program at the hospital. We revamped the program to decrease mortality dramatically in one month. The program proceeded successfully until April when Mr. Matengere died of AIDS and the Head Nurse became ill. She died several months later from AIDS.
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