A Lisgarite in Kenya

I went off to Kenya this summer, happily enshrouded in naivety and idealism. Armed with what I remembered from my first year of medicine at Ottawa U, nervous that I hadn't properly memorized the Malaria Cycle from the parasitology lectures we'd had or that I would forget how to put in an IV line, I arrived at the Kisumu District Hospital full of excitement, nervousness, and on high doses of anti-malarials. Though I expected to see different medicine than what I was used to in the aseptic, fully stocked hospitals in North America, I was at once amazed, disheartened, frustrated, and awed by what I saw and experienced. Though the facilities were rudimentary (one functioning blood pressure cuff in the whole hospital of 600 people!), rusted, infested (cockroaches, cats, chickens running through the wards), and overcrowded with patients who were more critically ill than I have ever seen at home or on TV, there were amazing moments of medicine and caring, and small miracles that I cherished as I walked home exhausted and spent after every day.

Without ANY diagnostic equipment, the doctors that came to do major ward rounds were geniuses of a different time. Many could just eyeball a patient and know exactly what ailed them, without even examining them! And when questioned, could explain the 10 reasons they came up with that diagnosis and the exact lab results I should expect as well as the dosages of medications that were required. All by looking at a patient for 30 seconds!! And when I would go home at night to study what I had seen on the ward that day, they were always right and the dosages correct down to the milligram. It was old-school medicine at its best, and it was a privilege and honor to learn from some of those physicians.

Some moments, however, were so sickening that I wanted nothing more than to return home to cry. Most patients (especially those in the medical wards) had HIV/AIDS, and as most did not have access to ARVs (Anti Retroviral Drugs, used for the treatment of HIV/AIDS), their health declined precipitously and they arrived at the hospital suffering from all manner of opportunistic infections. Many were simply dumped by relatives in the wards (known as "the place to die") and were left to struggle with the pain, anguish, and indignity alone. Though most were so weak that they simply soiled themselves in their beds, some lucky few had bedmates (yes, two patients to a bed and sometimes even one under it) that could still stand. And so I would cry inside as I watched two grown women who could not have weighed more than 50 lbs each, prop each other up and walk, teetering and moaning, to the washroom together. It was a scene either from Dante's Inferno or the Bible, or something else I couldn't reconcile with any past experience I had witnessed: A skeleton helping a skeleton, both waiting to die, but still finding the courage to comfort the other as best they could.

But the most distressing, especially for a daughter of Universal Health Care and a born and bred Social Democrat, was witnessing the stark reality of economics informing medicine, dictating treatment options, or condemning to death. No painkillers were available to numb the pain of invasive procedures if the patient couldn't pay for them first; there was nothing to take the edge of prolonged and difficult laboring without it being brought in from a "street lab" (guy sitting behind a wooden table outside of the hospital compound); the lab not "able" to provide blood for an emergency transfusions because the patient's husband had not yet sold their land to pay for treatment; and a young mother given antibiotics that everyone knew would not treat her cerebral meningitis because her family could not afford the right drugs. They gave her the "wrong" medications, asked her mother to pray for her, and watched her die. Or the young mother whose child was semi-comatose and convulsing with malaria who requested I give her a discharge when her son had not yet gotten any IV Quinine. "But Mama," I tried to argue in Swahili, "your son will die if you bring him home without medication, you must stay here." "Daktari," she answered me while steadily holding my gaze, "I have 9 other children at home that are not eating because I am here with this one. I cannot afford the 50 Shillings for Quinine [1$ CDN] anyways, so what would you like me to do?" Idealism crashed into realism, and I paid for her son's treatment. They both went home healthier than when they had arrived (a small but sure miracle), but I was certain they could not afford mosquito nets and that either this child or one of his siblings would be back with severe malaria at some point soon. Had I really done anything useful? I'd like to think so, but I still can't sleep at night because of the guilt of wondering if I did enough or too much.

However, through all of the learning about medicine, about reality, about life that occurred at the hospital, it was at the orphanages where I felt the most alive. One of the orphanages, Cradle of Hope Children's Home, took in a few of the children who were abandoned by their parents at the hospital (and it was through my check-ups on those children that I came to know the orphanage). The other home was St-Theresa's Children's Home, run by the cousin of one of the doctors at the hospital, who after working as a lawyer during the day, would go to the home at night to be with the kids. This home was less well off financially, and was struggling just to maintain the 35 children under their care that they had to turn away other needy children for lack of funds. Though the roof leaked (so when it rained, some of the older children slept in puddles in order to shelter the younger kids), the children didn't get enough to eat, their clothes were horrible and not warm enough, and most of them had a pneumonia that could have used a course of antibiotics, they laughed and sang and struggled with their homework and asked me a million questions about Canada. Here I could let my idealism run wild, for in each of those sunken but sparkling eyes, I saw hope and desire for something more. Some of these children were so bright, their curiosity so deep, that I could see them in another context as young Grade 9s going to Lisgar, tabulae rasae waiting only to be filled with knowledge and guidance and direction. Though they had lost parents and siblings, and known more deprivation than I could ever imagine, they were willing to admit how scared they were and how much they longed for food, and warm clothes, and school fees. When I looked at them I remembered how much I was, as a scared teenager, encouraged and given direction by the likes of Mr. Arrand, Ms. Bradley, Mr. Peters, Ms. Poetschke, and Mr. Taylor, and I wanted only to be able to provide that for them. It was amazing to me how much I could love children that were not mine, and want to guide them and share with them all the things I knew. Is that what a teacher feels when she looks out at her class of Grade 9s on the first day of school? What those kids wouldn't do for a chance to hear Mr. Peters read Macbeth or Ms. Bradley show them how to hold a violin bow. Why should I have had those opportunities to learn from such great people and not them? There but for the grace of God go I.

And so if I could ever live up to the ideals of Alere Flammam, to light the flame of education, to illuminate the wonder of hope and possibility, I would like to try my best to do it for these children. And if Lisgar has taught me anything, it is to dream big and not accept anything less than success. And so between struggling through second year med school, I am planning to incorporate a charitable organization to raise money for these children's homes, food, clothes, and educational opportunities. If anyone in the wider Lisgar community has any thoughts on incorporation, time to help see this project off the ground, ideas for fundraising, or general encouragement, I would be honored to hear from you.

To see pictures of the children at the orphanages or the District Hospital in Kisumu, please go to http://consciencerevolution.spaces.live.com/.

Julie Hakim (1999)