LITMIR.BIZ

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patient.

      Mama Joe spoke with the infant’s mother for a few minutes. Although Leslie didn’t understand the words, she was struck by the mother’s lack of emotion. Was she, Leslie, more disturbed by the baby’s death than its mother? As the woman watched, Mama Joe carefully rewrapped the child in the cotton cloth. She handed the tiny bundle back to the mother and embraced her. Then the woman shuffled out the door to walk back to her village where she would bury the child.

      When the woman had gone, Mama Joe turned to Leslie. “She told me the baby had been ill with diarrhea for a few days. She went to the local healer at first, and the baby was getting better. But this morning the baby was sick again. She wouldn’t eat at all and only cried a little. That was when the mother decided to bring her here.” Sorrow was evident in her tone, and she rubbed her eyes. “She had to walk about ten miles.... Obviously, she was too late.”

      Leslie remained quiet, and Mama Joe helped her clean the exam table with a strong disinfectant. Noticing Leslie’s silence and shocked expression, she sighed and shook her head. “Sometimes there is nothing we can do to help. But, if she had brought the little one to us yesterday, we probably could have saved her.”

      A tear ran down Leslie’s cheek. “It’s so sad...so unnecessary.”

      Mama Joe gathered her into a comforting hug. “Yes it is. But we have to maintain perspective. We do everything we can to stop the sickness and death, and much of the time we can.” She blinked back her own tears and added, “Leslie, this is something we have to learn to cope with. We don’t accept it, but we do cope with it.” Mama Joe pulled away and headed toward the reception area. “I need to show you what to do in the event of a death.” Together they filled out the forms that were required by the Health Ministry and gave them to Elizabeth to post.

      Leslie wiped away tears as she pondered the day’s lesson. In Kenya, death was common. Give the body to the family and fill out two forms, and that was the end of the process. She desperately wanted to sob, but she followed Mama Joe’s example and went back to care for her next patient, knowing there were many more who needed help.

      * * *

      LATER THAT AFTERNOON, a boy of nine or ten burst through the front door. He had obviously run to the clinic and was panting heavily. Elizabeth called to Mama Joe, and, after talking with the boy for a minute, the older nurse grabbed her bag and motioned for Leslie to follow. “Titus!” she yelled from the front porch. “We need to go to town.” In a very short time the Jeep was at the door, and the two nurses climbed aboard with the young boy.

      “What’s happening?” Leslie asked as they bounced down the unpaved road.

      Mama Joe’s answer was hushed. “The boy’s father has AIDS. He’s been sick for more than two years. The family is very poor and can’t afford for him to go to a hospital. Evidently, he is much sicker, and the boy’s mother sent for me.”

      A short time later, the Jeep pulled in front of a small wood-and-mud dwelling at the edge of the village. Mama Joe entered the home without knocking, and Leslie followed closely behind her. The interior of the hut was dark and overly warm, illuminated and vented by two small windows. The odor was a nauseating mixture of cow dung, human excrement, body odor and decay. Leslie cupped her mouth and swallowed hard to keep from gagging.

      Her eyes adjusted to the scanty light, and she saw an extremely frail man covered by a thin blanket lying on a cot in one corner. An equally frail woman sat on a short stool near the head of the bed. Her jaundiced eyes watched intently as the two women entered the hut.

      Mama Joe whispered a greeting as she approached the cot. She reached out and touched the woman, then the man, on their heads. She asked a few questions, which were answered by the woman in a bare whisper. Mama Joe glanced toward Leslie and motioned for her to come near the cot, and Leslie knelt by the meager bed to assess the dying man. His eyes were closed and sunken, and a wet, rasping noise told them he struggled to breathe.

      Mama Joe knelt beside Leslie. Her voice was barely above a whisper as she said, “This is Mr. Kanjana. His high fever is most likely caused by pneumonia.” They briefly discussed a treatment plan, and Mama Joe drew up medications for inflammation and pain into two syringes. Although Mr. Kanjana did not flinch at the prick of the needles, Leslie cringed as her colleague injected the medications into his skeletal thigh.

      The nurses tried to get the patient to sip some water, but he did not have the energy to swallow. Mama Joe held his fragile hand for a while, and Leslie watched as she said a prayer in Swahili. A few minutes later, Mr. Kanjana’s breathing seemed to ease, and Mama Joe rose and drew the wife away from the cot. Safely out of the husband’s earshot, Mama Joe spoke to Mrs. Kanjana for a moment. With a tiny nod, the woman returned to sit beside her husband.

      “The medications will allow him to breathe a little easier, but, judging by the breathing pattern, he probably won’t live but a few more hours.” She spoke quietly to Leslie, who glanced at the pitifully thin woman seated by the cot. “I told her I would stay with her. Why don’t you go back to the clinic? Titus can take you home and then come back for me.”

      Leslie desperately wanted to go back to the clinic. She desperately wanted to leave the stinking confines of the tiny house filled with death. Instead, she looked into Mama Joe’s calm brown eyes and whispered, “No. I’ll stay.” Tears threatened to fall, but she managed to blink them back. Squaring her shoulders, she said, “Tell me what to do.”

      * * *

      AS MAMA JOE predicted, it was over in less than two hours. The nurses helped Mrs. Kanjana clean the body and cover it with a new cloth. There was nothing left for them to do but fill out the requisite forms when they returned to the clinic.

      The frail woman stopped them as they were leaving. Her yellowed eyes were filled with gratitude, and she whispered something in Swahili. Mama Joe simply nodded, and Leslie did the same. As she waited, she tried to avoid thinking about the loneliness the widow would now have to endure, and she struggled once more to blink back tears.

      Dusk had fallen and, once outside, Leslie gulped in the warm, clean air. She was surprised to see that a number of men and women had surrounded the dwelling, waiting patiently for them to emerge. Those nearest to Mama Joe nodded with apparent respect but gazed at Leslie with curiosity. The young boy who had fetched them stood with two other children near the door. Their expressions were stark.

      On the drive home, Mama Joe explained that the Kanjana family had already lost two children to the scourge of AIDS. “Mrs. Kanjana doesn’t have long. She’s taking antiretrovirals, but they’ve only slowed the disease a little.” She sighed audibly. Her lined face showed fatigue, and she closed her eyes.

      As soon as they arrived at the clinic, Leslie excused herself and rushed to the bathroom where she was violently ill. Afterward, she scrubbed her hands and face and rinsed her mouth, all the while trying to regain her composure. When she finally returned to the kitchen, she found Mama Joe seated at the table drinking a cup of hot tea. A second cup had been prepared for her, and she sat down and sipped it gratefully.

      Leslie interrupted the silence a few minutes later. “How do you do it?”

      Mama Joe smiled sadly. “Just when I think I can’t take it a moment longer, when I can’t bear to see one more child die, or treat one more case of some dreadful, preventable illness, or when I think I can’t face walking into the clinic one more time—something happens. Sometimes it’s something big and impressive, like saving a life or delivering a baby. But it’s usually something little, like a smile from a child or a grateful look from a parent.”

      Laying her roughened hand gently over Leslie’s, she said, “I wish I could tell you it gets easier, but it doesn’t. You just do what you can and leave the rest to God.” She reflected for a moment before adding, “After all of these years, I still find myself asking why? But we can’t expect answers. I’ve learned to try to help whenever I can and to fight death any way I can. We don’t always win, but we can always help ease pain and suffering.”

      Mama Joe gave a tired smile. “Leslie, Dennis Williams told me your story—about

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