Darkness

One minute I'm eating my Danish tuna pasta salad garnished with circles of fresh green pepper and the next I can't even see my hand in front of my face. Then, silence abruptly descends as the motor driving the generator is shut off. With the increasing silence, the sounds of mourning increases as well. The wails and shrieks and moans that have become all to common and yet still cut deep into my psyche with its piercing hopelessness come from directly behind our house.

It must be our neighbors. It must be the family of Allawaye, the father of "Naked Boy" and "One Armed Boy", our little neighbors with self-explanatory names (although "Naked Boy" has recently transformed himself into "T-shirt and Sometimes Pants Boy"). Allawaye's third wife's little one year old was recently hospitalized for meningitis and treated with a full course of IV Chloramphenicol. At discharge, the fontanel was normal, there was no fever and the child was breastfeeding and otherwise acting cured. Three days later, the child comes back seizing and with a tense fontanel. The H. flu bacteria infecting his little cerebral spinal fluid was resistant. We had no good other alternative but did what we could.

Last night, David comes to talk to me.

"Allawaye's wife came to the gate with the child insisting on going home. I told them to wait until morning."

This morning, I enter the peds ward and see Allawaye with two of his wives including the mother of the child with meningitis. The mother looks down the whole time and has a scowl on her face. The baby is breastfeeding...an improvement from two days ago when I was forced to put in a feeding tube. The fontanel has become less tense. I start to explain to Allawaye that while the baby is still sick and could die, there are some positive signs. Just then the other wife pipes up with a low, vicious voice and an evil glare. The nurse translates her Nangjere. She insists on going home. The child isn't better. Our treatments haven't worked. It's time to consult the witchdoctor.

I make her leave and continue to explain to Allawaye why I think the child should stay in the hospital. He seems to understand and agrees to finish treatment. The mother of the child continues to act like we're trying to torture her child by asking him to stay. I offer to pray for the child and they accept. I'm desperate for God to prove that it's not some witchcraft that is making the child sick (although, I guess one could say all sickness originates with our enemy, the devil). I ask that he continue to heal the child. We've done our best but with the limit in our arsenal of antibiotics we need a miracle.

Now, in the crying, wailing and yelling coming from next door I'm afraid God has once again not intervened.

Siméon told me this evening another, related tall tale.

Friday, a boy from lie presents with a leg wound "treated" for 18 days at the Kélo Hospital. All I see is a fungating mass encompassing his entire lower leg between the knee and ankle. The foot is swollen and the eight year old is in obvious pain. We take him immediately to surgery.

His leg is doubled up in contractures from weeks of not moving so I prop up the leg with rolled up towels after giving him his spinal anesthetic. He is naturally afraid and curious at the same time. I feel his eyes on my every movement. I put on my sterile gloves and attach sterile towels around the legs leaving just the knee exposed. I'm about ready to start, but then Israel asks if I’m going to let the boy watch. I look over and see him still staring at me in wonder tinged with anxiety.

I ask for a sterile drape as well so that the surgical site can be hidden from the boy's view. Israel pumps up the blood pressure cuff around his thigh to 260 and then I pray before starting. I imagine in my head the two flaps I want to create and then slice down to bone across the anterior tibia. I retract up the skin flap with forceps and slice up the bone cutting off the patellar tendon from its attachment. I then enter the knee joint and cut across the menisci and the ligaments. There is no blood thanks to the tourniquet. The only things holding the leg on now are the popliteal blood vessels, the sciatic nerve and the posterior muscles. I dissect a little around the vessels and clamp and tie them off before cutting them loose along with the nerve. I then slice inferiorly to leave a muscle flap and have Israel pull off the leg from under the drape. He tosses it in the trash as I sew up the two flaps and wrap an Ace bandage around the wound.

As I'm about to leave the OR after the boy has been taken out and we've cleaned up, I pause over the trash can. It's in the middle of the floor filled with plastic IV bottles, tubing, tape, gauze, plastic drapes and an upside down, normal looking foot sticking straight out like someone has
been dumped in their upside down. I'm reminded of Samedi's tale during the time of Dr. Kip when they did a ton of amputations and dumped the body parts in a pit behind the hospital. One day, after a rain, a woman came running into the compound screaming that someone had derowned in the now water-filled pit. All she saw was a foot sticking out and was sure there had to be a body attached somewhere in the water. I get the same feeling now as I stare down at the bottom of the boy's foot so recently attached to a living body.

Now, for the tale: apparently, Siméon had to listen to this boy talk and talk all day long the following day. He wouldn't keep quiet and told Siméon how his leg got infected. His dad sent his mom away shortly after he was born and married another woman. According to the boy, the
woman is a sorceress who transforms herself into a cat. A few months ago, she had it out for the boy so she became a cat and bit his leg which subsequently got "poisoned" and that's why it didn't heal and had to be cut off. It was natural since it had been cursed by his witch stepmom. The problem is, these stories are not uncommon. Most people's idea of cause of disease here is that it's witchcraft and someone has "poisoned" them or cast a spell on them or performed some sorcery against them. Therefore, usually some sort of "traditional" treatment has been tried before they are brought to the hospital in the throes of death. Then, the hospital is blamed when the patient dies.


As I sit in the darkness listening to my neighbors trying to appease the spirit of the departed child, dead from meningitis, I feel frustrated and hopeless. How can one fight against not only the forces of physical disease in a resource poor setting, but against the forces of ignorance and the forces of darkness? It seems sometimes that they want the person to die to prove that they were right that it was some witchcraft and that our medicines are useless. I've seen people go out of their way to discourage a patient and tell them they're going to die and after I've spent so much time trying to get them to be encouraging and hopeful, when the person finally does die, largely in part to the psychological attacks of their family, they go out of their way to say "I told you so. I knew they would die, but you kept insisting they had a chance. See, I was right and you were wrong." Nothing that I've experienced here comes close to that for discouraging.

After lighting a kerosene lamp to bring a little light to the darkness of my room I pull out my Bible. Finally, I find what I'm looking for, but in a surprising place: right after the most famous verse in the Bible, John 3:16. "This is the verdict: Light has come into the world, but men loved darkness instead of light because their deeds were evil." John 3:19.


Yes, I can understand a little God's dilemma. He can't "mess with free will" (as he says in the movie "Bruce Almighty"). In other words, Satan has an advantage: he can use fear, force, superstition, manipulation, coercion, brutality, etc. God can't. And because I've aligned myself on God's side, I can't use those things either. As much as I'd like to take some parents by the neck and shake them until they realize they need to bring their kids to the hospital when they first become sick rather then when they're on death's door, I can't. I have to try and persuade them. But, I've found it amazingly true: men (and women) really do love the darkness rather than the light...and it's so frustrating realizing there's nothing one can do about it except continue to fight, even if it seems like a losing battle, to continue to fight, because who knows, maybe one or two will see the light and come out of the darkness...

James