We live on a beautiful hillside in Kenya, a couple hours from the border of Uganda. Idyllic scenery to say the least: gorgeous mountains, rippling streams, shady old trees, and sweet song-birds. On my way to work I pass shepherds grazing their cattle or sheep on the hospital property and have to be careful with the large cow pies. I love walking to work, stumbling in at two in the morning on a moonless night when the Milky way is at her most glorious.
But the genteel landscape doesn't hide the back-breaking labor of the farmer tilling his land, the five-year-old child carrying gallons of water, or women lugging hundred-pound firewood packs. But even with these heavy burdens, my patients are some of the most kindest women you will ever meet. If you had been with me on rounds last week you would have met Isabella a G9P8 with an abusive husband who caused her own septic abortion by shoving a 13cm nail into her uterus desperately trying to get rid of a pregnancy; Albina a cachectic young lady with AIDS who precipitously delivered her 32wk infant and is now breastfeeding, since she has no money for formula; Jeseah a mother recovering from her cesarean delivery with a live infant, her last two children had died in utero; Judith three days postpartum referred from a health center comatose, jaundiced, and with diarrhea; or Theresa a 25yo blind woman with fungating breast cancer, thyroid cancer and 20 weeks pregnant. Most of the time I feel like I can be of some use, whether it be delivering a live baby, helping a mother recover, removing a cancerous uterus, etc., but sometimes it seems futile.
My phone rang at 2am, the nurses were calling me about a referral, Ketai, a young pregnant woman with abdominal trauma and a concerning abdominal exam. I stumbled in, under the glittering Milky Way and found a 20yo G4P3 at 30wks status-post a fall while carrying firewood two days before. She had a dead baby, a belly full of blood, heart rate 140, saturation 85%, hemoglobin of 6, and was writhing in agony. I ruptured her membranes, delivered her tiny baby, called Bill (the general surgeon) and we took her for an exploratory laparotomy. We found liver and renal lacerations and he attempted to repair them, finally just packing her abdomen with abdominal packs and closing, saying if she survived we could go back in a couple days to remove them. She did not survive the night.
I still wonder what is going to happen to her three young children, her grieving husband? Who will pay for the hospital bill that costs more than they earn in a year? Why did it take her three days to come? Why was a pregnant mother carrying 100 pounds of firewood?
For so many are crying:
My God. My God why have you forsaken me?
Why are you so far from saving me,
So far from the words of my groaning?
Oh my God I cry out by day but you do not answer, by night and am not silent.
But He is with those who are suffering:
… they have pierced my hands and my feet.
I can count all my bones;
people stare and gloat over me.
They divide my garments among them and cast lots for my clothing.
And I know that:
The poor will eat and be satisfied;
They who seek the Lord will praise him-
Posterity will serve him;
Future generations will be told about the Lord.
They will proclaim his righteousness to a people yet unborn –