do we stop?” Leslie pushed the eggs around her plate. Her appetite was negligible. She ran her hands across her khaki skirt. Although she had several years of working as a nurse-practitioner in clinics, she felt ill equipped for her new role.
“Normally, things start to slow down midafternoon. We try to be finished by five or six.”
Before she began to see patients, Leslie met Elizabeth and Agnes. Elizabeth, the receptionist/ bookkeeper, was a couple of inches taller than Leslie and very slender. She was probably in her late twenties or early thirties, with a beautiful complexion and very short kinky hair. Agnes, the clinic’s housekeeper, was a bit older—Leslie guessed she was probably about forty. Barely over five feet, she was slightly plump, at least by Kenyan standards.
Leslie quickly learned that Agnes’s English was somewhat limited, but Elizabeth’s was very good. “Whenever you need help translating or have a question, please ask, and I will drop everything.” Her eyes were sincere, and her smile was infectious. Agnes was much shyer, although just as welcoming, and both women proved to be eager to help Leslie settle in.
Throughout the morning and afternoon, Leslie was introduced to a vast array of maladies, many of which she had only read about. During the first part of the morning, she followed Mama Joe and Naomi and quickly learned how to treat malaria, dysentery, scabies, intestinal worms and an assortment of venereal diseases. The variety of cases was amazing, and prenatal checkups were interspersed with the suturing of small cuts and treatment of dermatological complaints.
For the most part, the problems were routine and could be managed with simple instructions, basic first aid and, occasionally, medications. The day flew by, and it was after six when the last patient left.
“Whew!” Leslie exclaimed as she looked around the empty waiting room. “That was exhausting! Is it like this every day?”
“No. Sometimes we get really busy,” answered Mama Joe. Seeing Leslie’s astonishment and slight panic, she grinned. “Just kidding. Actually, this was a fairly heavy day. Normally we see about thirty or forty patients. Today we saw more than fifty.”
“That’s a relief,” Leslie replied. “I don’t know how we’ll manage this many patients without you.”
“We always seem to take care of everyone. If it is really busy, we’ll work faster.”
Leslie helped the other women prepare for the next day before realizing she was starving. Thankfully, Agnes had prepared a hearty supper of vegetable soup with bits of cut-up chicken and rice. She and Mama Joe sat at the kitchen table, eating hungrily, all the while talking about different cases and how to manage various problems.
That night—after checking her room for spiders—Leslie crawled into bed exhausted. As instructed, she carefully arranged the netting to insure she was completely covered. In the quiet darkness, she allowed her thoughts to settle...and realized she was happier than she had been in a long time. She was smiling as she fell asleep.
* * *
IN THE SEVEN YEARS Leslie had been a nurse, she had never lost a patient. On the second day of practice at the Namanga Clinic, she lost two. She had been warned multiple times before she took the assignment that death was common, and she thought she was prepared. She was wrong.
Leslie slept well and awakened refreshed. She felt confident and quickly began seeing patients alone, occasionally seeking Mama Joe’s or Naomi’s advice on how to manage a new problem. The morning went smoothly, but around noon, an expressionless young woman carried a small baby wrapped in a colorful cotton cloth into the exam room. The woman gestured to the infant and said something; Leslie recognized the Swahili word for baby. She nodded, smiled and indicated the exam table. As the woman placed the infant on the table and unwrapped it, Leslie felt a chill. A quick visual inspection revealed an emaciated face with half-closed eyes and loose skin. Gently, she touched the infant’s chest and discovered an unnatural coolness. There was no hint of movement. As she positioned her stethoscope to listen to the baby’s heart, she yelled, “Mama Joe! Naomi!” The other nurses appeared within seconds.
“I don’t hear anything,” Leslie whispered to Mama Joe as the older nurse picked up the limp form and gently rubbed its back, trying to elicit movement. Like Leslie, she pressed her stethoscope to the tiny chest. Less than a minute passed before she looked up at her colleagues and shook her head. Naomi discreetly left the room to return to her own 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
