The Dirigible and the Dirge-less

What follows here is the tale of 2 deaths that occurred within a day of each other-rather than focus on how they died, I want to focus on what happened after they did and the contrast between them.

Every morning that I have been here I awake at the same time - almost to the minute. I don’t have an alarm clock or any time telling device at my bedside to help accomplish this either. The curtains in my room might as well be made of paper mache for their light filtering ability (and remember, besides water going straight down the toilet-dawn and dusk are at essentially the same time year-round. Rather than a lame radio DJ waking me up, I have the crow of the rooster-which acts like an alarm clock with a broken snooze button-I get my revenge on Saturdays. Greasy, delicious revenge with a side of mashed potatoes is on the menu!

Which reminds me, every day here is either a cow, chicken, or monkey day-meaning you will see a lot of one of these three any particular day Many of the hospital staff live in the houses within the hospital compound, and the entire hospital is single story and open air. This means that some stray animals can get in the ward, most notably-Ward Kitty. Monkeys are usually kept at bay by putting the patient’s leftover meals in buckets on stands outside-which acts as an effective garbage disposal as the monkeys dive in and chow down. Being here for several weeks, you get used to a very limited assortment of sounds-the crow of the rooster, the squeeking vervet monkeys, the mooing of a cow. Imagine my surprise when I heard drums, guitars, cymbals, and what sounded like the type of repetitive chanting you would hear at soccer game just outside the hospital while we were rounding. My curiosity was high, but rounds were lasting forever and I couldn’t go outside the gate and see what was happening in the street. It sounded like a parade, and I thought it could be that as this happened on 10-19, the day prior to Kenyatta day. Every time it sounded like the parade had faded though, it would come back minutes later. When I couldn’t take it anymore, I ran out of the ward, up to the house to get my new camcorder and ran out the gate to see just what was going on.

What I witnessed is hard to describe in words, hell even the video I shot of the event doesn’t do it justice. Maybe the picture below can help you imagine what it was like.

It looked just like this, except with darker skins, shirts, no turbans, and not in a cave-but otherwise the same thing.

What was outside was a group of mostly men and children and they were dancing/parading in the street and playing percussion, guitars, and other instruments and singing this one very uplifting verse over and over again. As I approached them, I wondered how they would take a Nzungu (whitey) with a video camera filming them. It was one of those things that could either be really good or bad, but as I approached the mob they gathered around me and since no one was speaking English and they were dancing furiously, I wasn’t sure what my presence meant. As they went by me, a child grabbed my pant leg and pointed ahead like she wanted me to join the parade. Turns out this parade is a Luo tribe tradition-during the formal funeral service, the parade served to guard the funeral that was ongoing on the hospital grounds.

Next to the morgue in the hospital, there was a funeral service being held around a white wooden casket. Thirty or so mourners were near the casket, but back about 40 feet on a balcony overlooking the service were probably 50 or so schoolchildren. The deceased was either an employee at Maseno School or a student-regardless, there was a mob of people for this funeral both inside and outside the hospital. After the service, the gate to the hospital was opened and the parade ran inside to help load the body into a MASSIVE Maseno School bus-which the whole crowd boarded-with people hanging off the side and on the roof like an Indian Train. One person on the parade route told me I had to go on the bus to where they were burying this person. I refused but he kept insisting, I had to tell him over and over again that the patients needed me and I couldn’t just grab onto the side of the bus and ride like everyone else. Later that evening, I talked with David and Helen about the experience-Helen and David learned when they were on home visits for HIV patients that a white person at a funeral or visiting just after someone dies is considered good luck.

This is Anne

Anne is one of the many patients of the Comprehensive Care Clinic (CCC) branch of the hospital that deals exclusively with HIV patients. Helen and David met Anne on their home visits which the CCC does weekly to check on their HIV patients without any way to make it to Maseno Hospitial. This involves the workers of the CCC walking miles on end to see these patients. I tried to go with the CCC this past friday on their home visits, but the distance was so far they were going to have to take a Peki Peki (a motorcycle taxi) and if I went with, they would charge a lot more because I am white-so I didn’t go. When Helen and David met Anne in her home, her family was preparing for her to die. She was extremely malnourished and cachetic-skin taunt against her protruding bones. The CCC employee told her she needs to be admitted to the hospital immediately. Her family was not oblivious to the situation-they stated they didn’t have enough money to pay for the hospital visit, so they were going to let her die at home.

I need to interject something very striking about health care in Kenya. There is a feeling of duty to pay for medical services here completely unlike the US. If you are sick in the US, you go to the hospital regardless if you can pay or not-but not in Kenya. We actually keep patients until they can pay their bills-and charge them daily until their bill is paid-this is standard practice at all hospitals here in Kenya-even the government hospitals.

Back to Anne’s story, David and Helen tell me about this woman at dinner and how her family was going to let her die at home because they couldn’t afford hospitalization. Imagine my shock when 2 days later-she’s here in our hospital on the wards. She was unable to swallow anything and when we did the chest x-ray she had milliary tuberculosis all through her lungs.

We put an NG tube down her and began feeding her aggressively to help gain back some of her strength and started her on anti-TB medications. Then something amazing happened, despite her wasted state and constantly frantic appearance (she didn’t talk), over the next 2 days she started to look better-she was getting plenty of calories. We have pulled folks with advanced AIDS from the brink, would this be another one saved just in time?

It turned out that it was not meant to be.

She died on the 3^rd day in the hospital, we tried hard to give her the best chance...but we lost her. Worse still, there was now a 5000 shilling hospital bill-converting this into US dollars-this came out to be around $66 US. Her family walked out from their home over 6 miles away and talked to me and Helen. They didn’t have enough money to pay the bill (as we already knew) and they wanted to know what they should do because the hospital wasn’t going to let them have her body for burial until they did pay. We as doctors (or more specifically volunteers-even Dr. Hardison is an unpaid volunteer) have no control over the finance department of the hospital and unfortunately the financial department was closed because she died on a Sunday. The family had to walk all the way back the next day.

In Kenya, there are no cemeteries. When you die, you are typically buried on the family land. If Anne’s family did manage to pay their bill and get Anne out of the morgue-she was going to be carried back to home-not in a huge Maseno school bus with scores of people-but carried overhead, 6 miles, back to her family’s land to be laid to rest where she was born-I didn’t see the family the next day-I don’t know if the bill was paid so they could take the body-I just hope she is finally able to get some rest in heaven.

Painful Lessons in Swahili

I have to side with Sade on this one-Yams are stronger than pride-c’mon, eat through the shame!

Alijivunia kula viazi vikuu

He was too proud to eat yams.

They had to make another death binder just for me