Today I had an amazing day. When you consider the way my day started that might seem a little shocking. The plan for today was to play with Celeste and her kids this morning and then attend the 4th of July picnic Sarah Ellen was putting on. The kids were super excited as was I. Then at breakfast Cheetah was a little bit more subdued than usual. Josie said to me, "I think Cheetah is sick?" "Really," I said, "I think maybe she's just a little tired." Wishful thinking. It wasn't two minutes later that Cheetah threw up all over me, including some that got into my mouth. Got into my mouth people, GOT INTO MY MOUTH! Of course we were in the dinning hall so I'm trying to figure out how to clean throw up off the chair and floor, while keeping Cheetah pointed toward a garbage basket that luckily had a garbage bag liner because sometimes it doesn't and trying to ignore my own feelings about wanting to vomit myself as I spit as quickly as I could toward the trash. Then I grabbed the vomit towels, my daughter, and myself and ran home to throw everything in the wash, including ourselves. It was with heavy heart that I cancelled our play date with Celeste, but what else could I do. It appeared that the day was not going to be the fun break I was hoping for.
The only silver lining was that at noon Dr. J was going to be presenting on dehydration to the moms of the pediatric patients and suddenly I didn't have any plans. When Nancy came to clean at ten, on a whim, I asked how busy she was today. "Oh I'm busy." "Oh, ok, never mind." "What did you need?" "Well I was just going to ask if you had any time today if you'd mind watching the kids while I ran up to the hospital to listen to Dr. J's presentation." "Oh I'm not too busy to do that." Well great, it was set!
So today for the first time in six weeks I was without kids as I headed up to the hospital to see Dr. J's presentation. When I got to the Sally Tess Center all of the older kids were outside on the playground and there was my husband, seated next to the interpreter, 25 woman circled around him with small babies on their laps. He was talking to them about the causes, signs, and prevention of dehydration. He explained how to make ORS (oral re-hydration solution). He actually had a pitcher where he made some to show them how easy it is to make. He pulled out his phone and showed them a picture of Peach in the hospital last year and told them about our experience having her get sick and so dehydrated she had to be admit. Those woman loved looking at that picture and they'd loved hearing that even a pediatrician sometimes needs to take his kids to the hospital for help. He was funny and humble and so caring and I thought "Who is this person?" It isn't to say that my husband can't be funny, that he can't be humble, that he can't be caring but in the 11 years we've been doing this (8 for his Md/phd, 3 completed for his residency so far) I have never had the opportunity to see him as a doctor. I see him as the guy studying. I see him as someone frustrated with something happening at the hospital. I see him when he is upset about not getting along with a particular patient, or parent, or pharmacist, or physician. These are the things he tells me about at night when the lights are turned out and he is stressed and tired. So this other guy, this great, funny, cheerful doctor, this guy I've never had the opportunity to meet and because these are not the stories I get to hear I almost had no idea this guy existed.
After his talk the woman stayed and asked questions for another thirty minutes before the kids started filing back into the center and the mom's started heading back to take sick kids to their beds. Then Dr. J asked me if I wanted to meet some of his work colleagues and his patients. This was actually my second time being on the ward so I knew what to expect. There are two sides to the peds ward. Each side has four cubes. Imagine one long room. It has been split by a hall and has a room on each side, but the rooms are open to the hall because they only have a half wall. Then there is a full wall separating them from the next room that is also open to the hall. There are two of your rooms. Add in the two rooms on the other side and you have Dr. J's half of the ward. Technically he is only in charge of two cubes, but the attending and Registar of the other two are rarely there and so his intern and he spend a lot of time helping the overworked intern in charge of the other two cubes. Each cube has eight beds in it. They are small beds, not quite as small as a stretcher but much smaller than the beds you'd find in an American hospital. Each bed has two patients in it and each patient has a mother (mostly) or father (or sometimes grandparent) who stays with them in that bed as well and is responsible for most of their full time care. It is the parent who is responsible for feeding the child (either by breast if they are an infant, or for getting the food from the food trolley and feeding them if they are a child). It is the parent who bathes the child or cleans any sheets if they pee themselves, or vomit, or soil themselves. It is the parent who changes diapers and clothes and washes them and when the child needs to go to the bathroom it is the mother who pulls them from bed and puts them over the bucket that serves as their bedpan and then takes that bucket to be cleaned after they are finished. These mothers sit together in these tiny little beds and they hold their tiny little children and they just break your heart with the love and devotion and all the fear and hope they have. This is not a comfortable or easy place for them to be and yet there they are working so hard for their babies, helping the other mothers and patients around them, hoping for some miracle from the doctors, picking up the slack that has been left by only having one nurse having to cover all of Dr. J's 32 patients.
So we walked into the cubes and Dr J, started introducing me to his mom's. "This is so and so. Here is her beautiful daughter so and so. She came for this but we've got her on the mend and she will be going home soon." And while we are all smiling and shaking hands he looks over at her bed mate who has an extremely distended belly (some type of cancer probably although they've been waiting for several days for a biopsy to confirm before they can start chemo and are still waiting as far as I know). The little one is on oxygen but her breath is very rapid. Dr. J ask a few questions from mom which have to be translated by her bed mate. He gets the answers. Quickly he looks at her catheter bag and says, "I'll be right back." He goes and gets the intern Dr. Mohammed and Sister Nancy, the nurse, and they all congregate around the girls bed. Adjustments to the mornings treatment plan are quickly discussed. They share it with mom and then Nurse Nancy runs off to get some fluids and medications that yesterday the pharmacy didn't have, but this morning they just got a new shipment. Mom starts to cry a little and I give her a little squeeze. "They are going to work their hardest to help your beautiful little one," I say, knowing she probably doesn't understand me at all but I just want to wrap her up in an envelope of love. After Dr. J sees that the new plan is being followed and puts in a few more request for a couple more patients we head off to lunch.
I think about that little girl the whole way to Sizlers, a local joint in town that serves American style hamburgers, hot dogs, and ice cream. I think about the other extended belly kids sitting in the cube. This is a public referral hospital so anything from the outlining community that can't be taken care of by local health care workers gets sent here. As far as I know there are only two public hospitals in the whole country like this, one in Nairobi and this one, both are situated by the only two med schools in Kenya. It is one of the few places in the country citizens working in the public system have access to chemotherapy or dialysis or any other number of things. Because of this many of the kids that come to this hospital are very sick. When you throw in the fact that few are getting very basic well child care checkups many of them are coming when their diseases have already progressed astoundingly far. I understand the economics that contribute to this situation. I mentally go through the system failures we are witnessing, I think about the countless Kenyan medical professionals here that continue to come to work each day even when they are faced with astronomical odds, I think of the institutions, the money, the man hours that have been donated, the people that are here working each day trying to make a difference. I see the big picture with all it's complexities and there is a certain part of my mind that understands it, but that doesn't mean that I have to like it. I just want to scoop all those children up into my arms and rush them to Riley. I want to make the proclamation that no child should ever die of dehydration, that no child should ever die of pneumonia, that no child should die of diseases preventable by immunization, that all heart defects that are easily treatable as an infant should be fixed, that survival rates for cancers should be the same as in the US, that no child should die because their family can't afford the catheter for dialysis or that no doctor should ever have to walk away from their hospital pharmacy without the life saving drugs their patients need because of shortages or cost. I want to make these proclamations but have no power, ability, resources to do so.
After lunch we stop by the store to grab some apple juice and crackers to give to our own little one trying to avoid dehydration . We pick up a watermelon on the side of the road to take to the Forth of July picnic. We figure one person will go with the three well kids and one will stay with the sicko. We get some cash out of the ATM machine since we are down to our last 500 shillings. I can't believe how fast our money goes here. Dr. J tells me he just wants to do a quick walk through of the ward. As we approach the ward Dr. Mohammed joins us returning from lunch. When we get to the cubes Dr. Hussein eagerly greets them. "I want you guys to come with me to go and see...." I take the bags from Dr. J and tell him I'll just meet him at home as the three of them walk off shoulder to shoulder. He is late getting home tonight for the picnic but I don't really mind. I've been given a rare glimpse into his world, one that because of HIPPA, culture norms, desires for privacy, safely, and hygiene I'd never have been able to witness at home. I've seen him teach his interns with passion, complement his very overworked nurse while guaranteeing that she understands the severity of the request he has just given her, I've seen him talk with love and compassion to his patients and their parents. For the first time in 11 years I've been able to witness what all of this was about, what all of this was for. He may not be the best at replying to e-mails or sticking to academic imposed deadlines, he may not always get along with everyone, and he may still have a lot to learn, but today I got to witness that my husband is a really great doctor and that almost makes all the schooling, and hassle, and nights alone worth it.