to their sick children in the sun, outside the waiting area. My arrival created a wave of activity. A nurse approached me and bowed. She was dressed in a neatly pressed and starched uniform---a dark green blouse and white pinafore. Her hair was short, cut like a man's. Her eyes glistened and her skin shone, reflecting the light indirectly. Her smile was comforting. After our greeting, she explained, "We have been too busy today. There is too much measles in the village and the mothers know that it will be difficult to come here tomorrow because of mosque. Mr. Mlanga will be with you in a few minutes. May I get you some tea?" she asked, ushering me through a door marked "Chief Medical Officer."
True to promise, in a few minutes a tall man in a white coat entered. It was immediately evident why the D. C. had such favorable comments about him. He beamed at me and apologized for his delay. He walked to a sink and washed his hands vigorously, drying them on a well-worn but freshly washed towel. He then reached over and shook my hand, adding as he did, "I've been dealing with all kinds of infections today. I'd hate to pass something on to you on your first day here."
Shaking my hand energetically, he bent forward in a natural and friendly way to lower himself to where I sat. "It's a pleasure to meet you, Miss Jarrett," he said. "We have all been looking forward to your arrival, but I am afraid I am going to have to continue my work here a little longer before we can chat.
I assured him that his other duties had to be more pressing and important than meeting me.
“Miss Jarrett, maybe you would like to join me while I examine some of these children. Then I can take you on a tour of our hospital."
In the examining room he showed me a young girl he said was about two years old, although she appeared much younger. "These are the ones who suffer most. We call them the 'abandoned ones.’ Her mother has a new child to care for and this one no longer has the breast, so she has to compete with her brothers and sisters for her ndiwo and nsima. With those tiny hands she will always lose out. Look at her hair," he said. It was a reddish color and very thin. "This is what we see in kwashiorkor, along with the extended belly and the thin arms and legs. And they always get that look in their eye," he added as the child stared blankly, as if unaware or unaffected by what was going on around her.
"She undoubtedly also has hookworm, bilharzia, amoebas, and maybe tuberculosis, but it is the measles that will kill her first," he said, putting his stethoscope to her tiny chest. "I can give her antibiotics to fight off the measles, but what this baby really needs is the right food. Without protein she will never get the strength to resist her illness. But, now she is dehydrated and needs fluids straight away."
He turned and talked to his nurse in Chinyanja, then explained to me, "I will try to get the mother to stay with her a few days in the hospital, but frequently it is useless because the mothers can not stay. They have other children to take care of at home and they have a superstition that the hospital is where you bring someone to die. Anyway, she is probably also getting treatment from an nganga---you may call them witch doctors---in her village and she may be afraid to be away from his cures."
The nurse told Mr. Mlanga that the mother had already insisted she could not stay, but said that if he were to give her baby a shot, she would come back every day until her child was well. The mother had walked fifteen miles and would rather return each day than keep her child in the hospital. "I could give her a shot of penicillin and give some milk powder to her mother, but this child will surely die if she goes home," he said.
He asked the nurse to try again, "Tell her she will just have to stay for two days, until baby’s chikuku gets better. Otherwise the baby will die."
The mother reluctantly agreed and Mr. Mlanga smiled at her and praised her for being such a good mother. "I wish I could promise that her child would not die, but we probably lose about half of the babies who come in this late." With some sense of hope, he added, "However, I don't think this little one's pneumonia is too bad yet. Maybe the penicillin will work in time."
Mr. Mlanga washed his hands and examined his next little patient with purulent eyes, "Luckily, it is quite easy to treat. Two days of tetracycline ointment and this baby will be fine."
In succession, we saw two infants with diarrhea, a five-year-old with an open sore on his leg, another malnourished two-year-old with measles who needed hospitalization but whose mother refused, a newborn with tetanus and several more children with combined problems of parasites, malnutrition, malaria, and measles. The next patient was an elderly Yao, who told the medical assistant that he could no longer make love to his wives and he feared that they might leave him to find younger men. The medical assistant laughed but did not belittle his problem. He tried to reassure him as he examined his manhood, "Most likely you are just trying too hard," he reassured. "I can find nothing wrong with you. Your powers will come back to you most certainly if you stop worrying." He gave the man three vitamin pills and told him to take one each night, right before he went to sleep. Turning to me, he said, explaining the use vitamins for the old man, "I always have to remember that I am competing with the village doctors and they never walk away from them without an ointment or a cure of some kind. I always ask our storekeeper what we have the best supply of," he added with a wry smile.
By three-thirty the last of the outpatients had been seen. Mr. Mlanga, appeared oblivious to "lake shore hours" and showed no outward sign of fatigue. "Come to my office for a minute and we'll have some tea and then I'll show you around," he said.
An orderly brought tea immediately, as if the Medical Assistant's routine was known by all. "I understand that you will be working on T.B.," he said. "That is very important and so far we have been able to do so little to keep it from spreading."
"Yes, but it looks like there are plenty of other problems just as serious," I added, probing for more discussion about the sick children we had seen earlier.
"There are plenty of problems. Our concern is that we can do so little to prevent most of the diseases. The people are very ignorant of ways to help themselves and they accept so much illness as being "just God's will", especially the Muslims who do not trust modern ways. Some years the problem is the weather. If there has been a drought, there is little anyone can do. Perhaps, now we can begin to find ways to prevent diseases in the villages. It has worked for smallpox. At first the villagers would not allow themselves to be vaccinated, but now that they can see that the disease no longer kills their people, they line up for shots."
"Where are you from, Miss Jarrett?" he asked.
"Oh, please call me Susan. I'm from a little town in North Carolina that you probably never heard of—Rocky Mount."
"I've never even heard of North Carolina," he laughed. "Is it near Texas or New York?"
"No, it's way down in the southeastern part of the United States.”
The tea was served in chipped enamel cups, milk already added. I nursed my way through one cup, reminding myself to ask for it black the next time. "I understand you'll be working with one of our health assistants, Mr. Kamwendo. Today he has gone to one of our health centers with a team to do vaccinations but he will be here in the morning," he said shifting the subject back to my work. "He will help you select the villages to work in and I hope you will be able to tell him all about your work." He stood and asked politely, "Now would you like to see our hospital?"
The main building contained the outpatient clinic, offices, laboratories and a ward, filled with children like the ones we had seen earlier. There were more patients than beds. The less ill children sat outside in the sunshine with their mothers. The two-year-old girl with the reluctant mother we had seen earlier was already in a bed, an IV dripping into the desiccated little creature via a needle in one of her tiny scalp veins. She looked sicker than she had an hour earlier; the mother more worried.
Mr.
