Wednesday, August 29, 2012

Three weeks already!!

Little ham cheesing it up for the camera

Today marks my 3 week anniversary with “my” little one.  As an ode to that, I thought I would jot down a few things I’ve learned/ways my world has changed/things about Kadiatu. 
1.        There’s a commercial for a TV show that was on for a while that always made me laugh.  It was a cartoon and the mother was in bed sleeping. The little kid walked into the room and said, “Mom. Mom. Mom. Mom. MOM. MOM. MOM! MOM! MOM!!!!!!!!!!  Finally the mom yells WHAT!?!??!?!  The kid quietly says, “hi.”  Ha! That is my world now.  Emily. Emily. Emily. EMILY. EMILY!!!  Fantasies of her sitting quietly in the morning eating her plumpy nut while I read my Bible are just that….fantasies. I’m SURE I never needed all that attention when I was that age. Right Mom???  J
2.       I never knew that someone could pee so much.  During our first few days of adjustment there were definitely times when I did something Kadiatu didn’t like, she looked right at me like she wanted to beat me…..and promptly peed on the floor.  That was a bit frustrating.  We’re still having lots of accidents, but I’ve decided that it’s most likely due to the fact that her belly is really big and we’re getting rid of all the extra fluid in there.  Also, like a pregnant woman with those big bellies, when she has to go, she has to go NOW!  Laundry days can’t come soon enough! I think I shall forever smell like urine.
3.       I have never ever thought it was cute when little kids cop an attitude and get mad.  But with her, sometimes I just burst out laughing because the expressions she gives me are just hilarious! I think some things must get lost in translation because sometimes she will just turn on a dime and be happy and laughing, then in the next second shooting lasers at me with her eyes.  She will also look right at me and blink really slow.  One of my friends said she reminds him of the girl on “Mean Girls.”  Attitude!  Pick your battles, Emily. Pick your battles.  
4.       After 3 weeks, I have finally definitively determined the word for “poop” and “pee” in little one’s language.  Three weeks.  To learn 2 words.  Important words.  There’s a chance I don’t really have an ear for languages…..
5.       This girl is spoiled rotten.  Since I take her to the hospital with me all the time, everyone gets to know her. That, along with the fact that she’s just really cute makes people want to give her all sorts of things.  She’s quite the ham and I think she’s up to about 15 husbands and is constantly coming to me with things people have given her.  She’s just so stinkin cute. Who can resist??
6.        Kadiatu is not a morning person.  Oftentimes it takes her about 45 minutes in the morning for her to get out of her funk and be the happy little girl that she usually is.  It’s a long 45 minutes. Especially when you’re trying to keep her from waking your roommate up.  There is a moment though, when she first wakes up and I go to her bed to free her from her mosquito net that I love.  As she crawls to me and reaches out to hug me….precious. Just precious. 
7.       Kadi is definitely a girly girl.  She likes wearing dresses more than pants (which is nice with the “lots of urinating” problem and loves having her fingernails painted.  She would repaint them every day if I’d let her.  Also, she loves pockets.
8.       She’s an African girl! I love when she “plays house” and it obviously has it’s Sierra Leonean twist.  She’s brooked (handwashed) her baby’s clothes, walked around with my bread on her head yelling “HOT BREAD” trying to sell it , built a fire to cook (no matches of course), and pounded various leaves to “cook.”  So cute!

My life has changed pretty drastically over the last 3 weeks. I can’t say there aren’t times when I can’t wait to have my life back, but praise Jesus it’s getting better. We’re learning to communicate better and even though I have no idea what she’s saying about 80% of the time, I’m fortunate that a simple “uh huh!” will usually do. 

Today Kadi’s mom came to visit the hospital to get the nutrition supply for her son.  I went down to the hospital to take Kadi to her and when we saw her mom, she got really shy and hid behind me.  When I went to leave to give them some time together she started following me. I told her to stay with her mom and made myself scarce for awhile.  When I walked by later she was sitting there chatting with her mom and brother.  It made me a little nervous because we’re only 3 weeks into the 8 weeks.  I don’t want to scar her and I don’t want to hurt her mom. I know that in the long run she’ll adjust fine to being back home.  She has adjusted well to coming here, and it’s completely different, so I know she’ll eventually be fine back in her village. Today just made me start to pray already for her adjustment back.  

Now for your viewing pleasure (or maybe just my viewing pleasure)'s some pics of the little darling.
She made this little bed for herself so she and her baby could relax and watch my neighbor wash her clothes.  So helpful. 

Enjoying rainy season.  When we have to walk to the hospital in the rain I  chant "Are we afraid of the rain????  NO!!!!"
Someone gave her this piece of cloth and she wore it like this almost all day. We weren't sure if she was  Mary Magdalene or showcasing her Muslim heritage.  Either way, she went around bowing and greeting everyone in her native language all day.
Like a good mother, she is breastfeeding her baby.  You may notice that her form is perfect.....
Taking advantage of her 50th invitation to join one of the patients families for chop time.

Thursday, August 23, 2012

It's a dangerous thing......

I would like to preface this post by saying that if you are not medically inclined it might be a little too boring.  And gross.  Sorry.  You were warned.

Last night I was working during the evening.  When I got to work we had zero OB patients….the first time I’d ever seen the ward empty.  I was hanging around, just in case something came in.  Kadiatu was having a bit of a rough time and at about 6 I went up to the house to change my clothes after she’d peed on me.  Again.  I was just about to jump in the shower when I got a call that they needed the ambulance to go out.  I grabbed Kadiatu and we ran down to the hospital.  Fortunately the rest of the hospital was quiet so my friend agreed to watch her for me while I went out. 

We were going to an area that isn’t served by any health center. It’s kind of in the middle of nowhere and neither of the closest health districts will claim responsibility for it.  For some reason (impassable roads?) we couldn’t go directly to them but were going to meet them at an arranged meeting place and pick up the woman.  The ambulance driver told me it was going to be 2 hours one way.  Oh dear. 

The road was pretty bad the whole way, oftentimes barely resembling a road.  We ended up reaching in about an hour and 15 minutes and the woman was just sitting on a bench (the driver told me he said it was going to take longer so I would be pleasantly surprised when we got there sooner.  Nice call. Very un-Sierra Leonean!)  She was weak but was able to walk. The story we got was that she’d been in labor since the night before. She wasn’t bleeding and hadn’t urinated or had a bowel movement in a long time.  It was her first baby. 

When I first started going on the ambulance I would always want to do some exam. Do a vaginal exam, listen to fetal hearts, etc.  I’ve come to learn though, that usually what we need to do is just get to the hospital quickly. If the woman’s not bleeding, really weak/unconscious and/or seizing, I usually just scoop and run.  That’s what we did with this lady.

After going back over the wonderful road again (can’t even imagine doing it when I’m in labor!) we reached the hospital.  (This is where I may be a little too graphic for some of you so….sorry).  We took her into the labor ward to get her checked out. Her blood pressure was fine, the baby was full term.  I listened with the Doppler but didn’t hear any fetal heart tones.  Honestly, I would have been shocked if I had.  When I did the vaginal exam the baby’s head was almost crowning.  When I stopped to look at the woman, I noticed that she wasn’t contracting very much.  If she’d been in labor for that long, her contractions should have been coming hard and fast.  I decided to start an oxytocin drip to see if we could strengthen her contractions. I also attempted to insert a foley catheter to drain the urine since they said she hadn’t urinated in a while.  The only foley I could find was huge, but I decided to try.  It was difficult because the head was so far down. I pushed and pushed but got no urine, just started to get some blood.   Huh.  Well, I left it and decided to let her try for awhile and then use the vacuum to try to get the baby out.  Since this was her first pregnancy I wanted to avoid a c-section for a baby that wasn’t alive. 

That’s where I was when the cavalry showed up.  I love having a cavalry here!  In addition to the two doctors we have here who are pretty much on call 24/7, right now we also have a Sierra Leonean doc who’d doing a surgery residency and a doctor hanging out with us for 7 weeks.  Anyway, they came in and one of them immediately mentioned an odor.  Huh.  I hadn’t really noticed.  I felt bad, but honestly there are so many smells in this country that are unfamiliar to me…I don’t always notice the bad ones from the really bad ones.  Opps.  Anyway, I told them what was up.  I couldn’t find any fetal heart tones but asked if we should use the ultrasound to try and confirm.  They confirmed that indeed, the baby was already gone.  Next we looked at getting this baby out.

They tried to use the vacuum but agreed with me, that her contractions just weren’t coming very strong. There was also the problem of the full bladder. We tried using two other catheters but couldn’t get any urine to come out.  They could feel the bladder and it was really distended. It could have been what slowed down some of the progression in the first place.  We also started to suspect a ruptured uterus.  Although her hemoglobin was fine, something just didn’t seem right.  When her uterus was contracting, it was firm at the top, but not at the bottom.  But was that just because her firm bladder masked the firmness of the belly, or was it indeed soft?  In America they tell us that one of the ways you know that a woman has ruptured her uterus, is that she is writhing around in pain.  Not so much here. It’s very difficult to tell.  You can try to use the ultrasound, but it can be difficult to see.  We decided that since we were no questioning a ruptured uterus and couldn’t seem to get the baby out with the vacuum anyway, we would head to the OR for a C-section. 

OB can be such a fun place to work…when everything goes like it should. But cases like this, where we already knew the baby was gone….no fun.  Also, because of the smell we were suspecting that the baby had been gone for awhile and had started to decompose. 

The first thing they had to do after opening her up was to drain her bladder. They couldn’t even get to the uterus, it was so full.  They ended up using a large bore IV catheter to put a hole in the bladder to drain it.  She probably put out about a liter of urine.  After that was getting the baby out.  One of the docs told me I needed longer gloves to help them.  Wait, what?  Because the head was so far down, I needed to go under the sterile field and help push the head up through the vagina to help the doc break the suction and be able to pull the baby out.  When my time came I got down on my hands and knees and started to push.  I wasn’t confident in what I was doing because I’d never done it before and the doc who had his hand at the other end started saying, “Push. Push, Emily.  Emily Push!!”  It was on the tip of my tongue to comment that it sounded like he was trying to get me to deliver…but didn’t think it was the time.  Thank you social filter.

The baby came out and it had definitely been gone for awhile.  I took it into the other room, cleaned him up a bit and went back into the OR.  When I came back in the room they were looking at a badly ruptured uterus.  At this point I usually leave but since it was a pretty rough surgery I stuck around in case they needed me to go grab stuff. 

They finished the surgery without any major complications and took her back to the ward. I headed up to bed.  When I got there the next morning and asked the nurse how she did overnight I was pretty surprised to hear that she wasn’t doing well. I kind of assumed that she was going to be doing fine. Apparently they had called one of the doctors down at five thirty when the nurse couldn’t find a blood pressure or feel a pulse.  They did everything they could for her which included giving her a mask for oxygen.  That’s pretty much it. Her hemoglobin that morning was fine, but she just wasn’t doing well.  The doctors came by a little bit later to do rounds and we sat around trying to think of anything else we could do. We suspected that she was in septic shock.  The baby had been gone inside of her for so long that the infection had spread to her bloodstream, making her incredibly sick.  We gave her some more antibiotics and hoped for the best.  None of us were very optimistic.  At 10:04 this morning I was turning her to get her cleaned up a little bit and she stopped breathing.  That was it.  She was gone. 

Of course the doctor from America and I were going over the things we could have done if we were home but it really only served to make us frustrated at the lack of resources here.  Her first baby…and it killed her.  With one in eight women dying in childbirth, Sierra Leone has one of the highest maternal mortality rates in the world.  The hospital where I work does an incredible job in saving so many lives….but it still hurts when there are ones we can’t. 

Monday, August 20, 2012

"Mama?" Part III

The time came and I headed toward the car. Her mom was carrying her and handed her over to me.  She was talking to her in her tribal language.  Kadi started to get a little teary eyed and her mom told her she was going to come see her tomorrow (little lie there) and Kadi stopped .  She was silent the whole way to my house.  Watching me, watching her surroundings in the car.  As we pulled up to the house she continued to be silent, just watching.  I took her into the house and she promptly peed on the floor.  Poor thing, who knew how long she’d been holding it.  I decided to go ahead and get her cleaned up at that point so I heated up some water for bath time.  I spoke to her in Krio the whole time, not knowing how much she was understanding.  She just nodded her head yes to everything I said.  Always watching me.  After a silent bath time I gave her some plumpy nut to eat and made a sandwich for myself.  My mom had sent some cartoons for some of the missionary kids and somehow they had ended up in my stuff so we watched cartoons while we ate.  I was really thankful for that mistake!!  Some kids came over and wanted to watch a movie but since it was her first night I begged off until tomorrow.  I did some dishes and cleaned up a little and the whole time she was just watching me. She started exploring a little, picking up some crayons but not brave enough to actually color yet. 
At about eight o’clock I decided it was probably time for bed.  Please keep in mind that I’m not a mother.  I haven’t even babysat in forever and my friend (shout out Kaysie) and sister have both fired me from babysitting their children after a couple incidents involving falling over in the crib and eating gravel that were absolutely and completely not my fault!!  Ok, mostly not my fault.  So I have no idea what time 4 year olds are supposed to go to bed.  It’s especially confusing since she’s a Sierra Leonean kiddo.  I’m not sure if bedtimes really exist here,  as I’ve had a 2 year old at my house at 10pm before.  Anyway, it was dark, so I figured we could try to go to bed.  Since I figured co-sleeping was what she knew, I had her sleep in bed with me.  I got her in bed, tucked her in, prayed with her, laid down beside her and turned out the lights.  After a few minutes I turned on the flashlight to see if she was asleep yet.  She was just laying there.  Staring at me.  After a few more minutes I did it again.  The stare again.  Now, this little girl is one of the cutest things ever, but it’s still a little disconcerting to have someone just stare at you while you’re pretending to sleep.  Always staring.  After a few minutes I decided to get my computer, put in my earphones and watch an episode of Lost. (I know I’m a little behind, but I’ve been saving it!)  After a couple minutes she turned over and was asleep.  Thank you Lord!!

That night was another pretty restless one for me.  I was so afraid that something was going to happen to her.  Did she fall into the crack between the wall and bed? Was she too hot? Was she too cold?  Was she still breathing?  I woke up about a hundred times.  It didn’t help that Little Miss Thing likes to make noises in her sleep. I kept turning the flashlight on expecting her to freak out but she was just talking to somebody while she was sleeping. 

The next day was my first full day with her. I had a plan to ask one of the ladies I know and trust to keep her for me while I was at work but I wanted to keep her with me for the first few days. Ideally I would have taken a couple days off of work but we’re so short staffed that it wasn’t really an option.  Now Mothers, don’t hate me for this, but I never really understood what you meant when you were late and said it just took you forever to get out of the house.  Why don’t you just allot the amount of time it will take you and your kids to get ready, and plan accordingly.  Now I know. I repent.  The was so much crap I had to bring with me…potty, blanket, toys, change of clothes, snacks, water, etc. that I could barely carry it all out of the house, let alone do it on time.  Finally, we were ready and headed down to the hospital.  Kadi was again, just taking it all in.  She hadn’t spoken yet, just nodding her head to everything I asked.  We got to the OB ward and I set up camp across the hall in the part that we’re not using right now.  There wasn’t a lot going on at the time so we sat out in the hallway for awhile to people watch.  That was a bit of a mistake.  I guess the sight of a white girl with a little black girl is quite the sight because everyone kept stopping and asking if she was my child, pinching her cheeks, and generally making quite a fuss.  Eventually I got tired of it and was afraid it was overwhelming to Kadi so we went inside the ward and people watched from inside, where we weren’t so obvious. 

The day was long, but good.  The OB ward was really quiet which I was utterly thankful for because I could spend most of my energy focusing on Kadi.  I did everything I could to keep her occupied and she tried to be a good sport but was mostly….just watching.  At the end of the day we went to the market to get a couple things.  Again, it was impossible to keep a low profile and we literally had a crowd following us around.  They were all asking if she was my child, if she was sleeping with me, etc.  I thought that being white made me stand out here, but having a little black girl with me made me even more conspicuous.  One of my missions in the market was to find some more clothes for her.   When I was praying about whether or not to have Kadi come live with me, I told my mom about it and had her send some clothes….just in case.  I was so so so thankful for these, as Kadi literally came with the clothes on her back and nothing else.  But I needed a few more things.  Our lack of communication and history of just peeing anywhere ran us through 7 pairs of underwear in one day.  While I was hopeful that it would improve, I knew I needed some more backup things.  The crowd that was following us was very helpful in their many, many opinions. 

The rest of the evening was pretty uneventful.  I cooked my first African meal by myself and I was nervous that she wouldn’t eat it.  I’m not super in love with African food so I can’t tell if it’s good or not. But she chowed it down. Yeah!!!  I gave myself a little pat on the back there.  Just a small one. J  When it was bedtime she went down without a fuss. Some kids even came over and watched a movie and she didn’t stir.  I was so so thankful at how things were going and the thought crossed my mind that this was easier than I thought it was going to be!!  Then began what I have coined “The Dark Days.”

“The Dark Days” were 3 days where I didn’t think I’d make it. I picked Kadi up on a Wednesday and the Wednesday and Thursday were pretty easy.  Friday morning she woke up and was pretty clingy, kind of whimpering a lot.  I had to work so we headed down. At around 10am she was so clingy, whining, rubbing her eyes and yawning, I knew she had to be exhausted. I tried to lay her down and she flipped out.  I tried the ole’ “crying it out” thing but she just kept screaming and becoming more frustrated and I was at the end of my rope. I knew that she needed sleep, but she wouldn’t cooperate.  One of the other nurses who speaks her language came and started consoling her.  She would barely look at me. I was a failure. 

The next three days proceeded much the same way.  She seemed so tired but just wasn’t sleeping well.  Each day seemed to be getting worse and she started fighting me in everything.  Bathing became an issue.  Sleeping was an issue. Taking her medicine was an issue. I felt like everything was a fight and I was exhausted.  (Keep in mind that I hadn’t slept much in the few days leading up to taking her and the sleep since having her was still small in interrupted).  Praise the Lord so so much for my neighbor Bethany.  Kadi loves her and would spend some time at her house and be comforted by her when I made her do something awful like take her medicine (she was being treated for malaria, worms, a respiratory infection and an infection in her belly….lots of medicine).  It was hard to be “the bad one.”  But I told myself that I wasn’t there to be her mother.  I wanted her to get well. If I had to be the bad one to make her take her medicine, etc. I was willing to take that roll….as long as she had someone to comfort her. 

The most painful thing was that it just seemed so hard on her.  She was an emotional rollercoaster….fine one minute, having a meltdown the next.  It felt like I was living with a time bomb and was constantly on edge, waiting for the next fit.  I started crossing off every day that she was with me.  The total was 62.  When that didn’t give me enough satisfaction I went through my calendar and counted backwards from 62 so I would always know exactly how many days were left.  Yes, it was different having my whole life changed and taking her to work was especially challenging, but my real countdown was for Kadi.  When she would be fussing and looking pretty miserable I would remember that this was just a short time and we could get through this. We would get her healthy and then get her back to her village where she was happier. 

I took her to church Sunday morning but ended up leaving early because she was just so fussy and was inconsolable.  By Sunday evening I was at my wits end. I was about a fraction of a second away from breaking down in tears at any moment.  My friend came down to the hospital and was talking with her and took her on a little walk. I had 10 minutes of peace and it was incredible. I wasn’t sure how much longer I could go on like this.  I wanted to take her back to her village.  It didn’t seem to be working for her.  She was miserable.  Probably the only reason I didn’t was because I had signed that contract and didn’t feel like I could break it.

Monday morning we woke up and it was the worst morning to date. Usually, the only way to console her was to wear her on your back, but this morning even that wasn’t working.  I had planned to take her to her village that morning to see her family. I wasn’t sure if that was a good idea. Did she just need more time to get adjusted? Was seeing her family and village going to make it harder on her?  Lord, what do I do?!?!?!  I decided to go ahead and go.  It didn’t seem like it could get much worse.

We left that morning and actually met her mom coming to bring her other child to get some nutritional supplement from the hospital.  When Kadi saw her mom she was initially surprised like she wasn’t sure what was going on and then she was SO SO happy! She just started smiling, talking, and wouldn’t take her eyes off her mom.  If she thought her mom was leaving, she started to cry.  We went to the hospital and I left them alone for awhile.  When I was around, Kadi would barely look at me.  They did their business at the hospital and then I took them back to the village. When we got to the village I played with the other kids for awhile while Kadi visited with her family.  Finally, it was time to go.  I 
was on the brink of tears the whole time we were in the village because I knew what was going to 

happen.  I went to turn the car around so I could make a quick get-away.  Her auntie started to bring her to me but when she realized what was happening she started kicking and fighting.  Her dad took her and brought her to the car. By the time he reached the car I had lost it.  I was utterly exhausted and my heart was just breaking for this little girl.  I started bawling.  He looked surprised like he wasn’t really sure what to do and told me to “bia” (be strong).  Her mom came up to the car and looking slightly horrified as well said, “Emily don’t cry. Don’t cry Emily!”  I nodded my head although I couldn’t stop.  I took Kadi and we headed down the road, both sobbing.  She was kicking and fighting and I just kept whispering “Bia, bia, we just have to bia small. We’re going back. You’ll see them again.”  After a few minutes I must have let out a big sob because she all of the sudden looked up at me and saw that I was crying as well. She immediately stopped.  She didn’t cry the rest of the way, but I still couldn’t seem to stop.  She kept watching me. 

When we got back to the house I’d pulled myself together and the kid that got out of that car was a different one than the one I’d taken.  She went into the house and was playing, singing. I was in shock.  The next morning she woke up and was in a great mood, talking, talking, talking. 

Something happened on that trip and I don’t know if I’ll ever know exactly what it was. But since that time she has had an almost complete turn around.  I’m learning which battles to pick and she’s learning that there are certain boundaries she has to respect.  She still has little melt-downs but they are much less frequent and she rebounds quickly.  I started working evenings which is nice because it’s not as busy and there are several kids that hang around at that time that speak her language and she has a great time playing with.  Everyone down at the hospital loves her and when it has gotten busy there are always people (staff, family of patients, people selling things outside the hospital) who are happy to watch her for a little while.  In two more weeks I plan to start working days again and put her in nursery school during the day. Then she won’t have to go to work at all with me, which will be a little bit of a stress relief. 

She got into my measuring cups and transferred water from one
cup to another, to another and then to her baby
I love this little girl so much.  There are definitely times when I’m chanting the mantra “you can do anything if you know there’s an end in sight” (mostly it’s when she’s saying, “Emily. Emily. Emily. Emily. Emily. Emily) but there are many other times when I dread the thought of giving her back.  People are always telling me that it will be hard for her to go back.  I don’t really agree.  She will be going back to stay with her family and friends in a village that she knows, speaking a language that she understands.  Most likely she won’t remember any of her stay with me.  It will be my heart that breaks when I give her back.    
"Can't you see I'm busy washing my baby's clothes??"

She makes my heart very very happy. :)
She's definitely an African child! She loves to carry her baby on her back.  Sometimes while putting bread on her head and going around yelling "Hot bread! Hot Bread!"

Sunday, August 19, 2012

"Mama?" Part II

So, I was all set to leave Kadi in her village. My mom, sister and I went up to see the hospital when they were here and stopped to see Kadi in her village and drop off the first installment of plumpy nut. I weighed her and she weighed 10kg’s which is 22 pounds. My niece weighs 22 pounds and is 13 months. Kadi is 4. The chronic malnutrition has left her about the height of a 2 year old.  I met Kadi’s dad and talked with both of her parents about my plan to bring them the plumpy nut frequently.  Since I was only staying in the hospital for a couple days I gave her a couple days worth, stopped back again on the way down to give her some more and she agreed to go to the hospital in a couple days to pick up the balance that I’d left with a friend of mine there.  The Alpha ward has an outpatient program and since Kadi had been admitted before she was used to going to get the supplement. 

I was back down in Freetown with my mom and sister, having a grand ole’ time, but was still often thinking about Kadiatu.  I called on the day her mom was supposed to have picked up the supplement to see how she was, but her mom hadn’t come. I called back a few days later, she still hadn’t come.  A week after she was supposed to come I was headed back up to the hospital so stopped to see her.  When I saw Kadi I couldn’t believe how much better she looked!  There was a life in her eyes that I hadn’t seen before and although I didn’t get a smile, I got a slight upturn of the mouth…something totally new!  After just having a week of the plumpy nut she was already doing a lot better. I was a little bummed that her mom hadn’t gone to pick up the balance because it meant that she had had it for a week and then hadn’t had it for a week.  When I talked to my Freetown plumpy nut friend, she said that if they have it for a day, don’t have it for a day, etc. it really slows down their progress. But, I was going to be in the area for the next two months so I’d just make sure she got it every day. 

At the beginning, every time I went to the village it was quite the spectacle.  All the kids (and a lot of adults) would gather around and just watch us.  Literally, just sit and stare at us.  Awkward.  I would generally feed Kadi one of the packets of plumpy nut just to see how she was eating them.  I have a little children’s Bible so would sometimes read a story from there, blow bubbles with them, etc.  One of the first times I went there I noticed that Kadi’s little brother didn’t look too well. I asked about him and they said he was sick.  Of course my initial thought was, well, I need to take him to the hospital.  But I was afraid.  I know what a floodgate that could open. So I just made the suggestion that they take him to the hospital because it would be less money in the long run if they took him earlier than if they took him later.  Nice try. 

This was a Friday. I was working double shifts on Saturday and Sunday so I wouldn’t be able to go to the village until Monday.  It was a long weekend. I kept thinking about that kiddo and was a little afraid of what I’d find when I went on Monday.  See, whenever I have kids who come to the hospital and are super sick, when I ask the parents how long the kid had been sick, the answer is almost always 3 days.  I know that this isn’t really true. The kid has to have been sick for longer than 3 days, but I wasn’t sure HOW much longer. I knew Kadi’s brother was sick for at least a week, probably longer.  Was he going to show up at the hospital in critical condition like so many others I’d seen?  By Sunday evening I decided that if I went Monday and he was still sick, I’d take him to the hospital. 

When I got to the village on Monday, I immediately asked about Kadi’s little brother.  He was still sick, but he didn’t look like the critical kids that come rushing in with their parents.   However, when I looked at his conjunctiva it was pretty pale (meaning he was anemic).  I knew if he didn’t get help soon, he would be one of those super sick kids.  I asked the parents if they wanted to go with me and take him to the hospital and they said yes. I did tell them to bring some money to buy the medicines.  So myself, Kadi, Kadi’s mom and two younger brothers all headed off to the hospital.  We tried to put Kadi and her younger brother in the back seat but they both started freaking out, it being their first time in a car, so we brought her brother up to sit with her mom and Kadi sat on my lap. Once she was there, she seemed to enjoy the ride. 

It was getting to be late and I knew the outpatient clinic was going to close soon (even though technically they were supposed to stay open for another hour). We got there and did labs on the kiddo and his hemoglobin was 7.  We don’t usually transfuse these kids but we admit them to recheck the hemoglobin in the morning.  Kadi’s mom hadn’t come prepared to stay so we agreed that I would go collect them early in the morning and bring them back to get his labs rechecked.  They also told her that he qualified to be admitted to the Alpha program for malnutrition if she was willing to do that.

This was the time that I really started considering bringing Kadi to come live with me.  I’d been holding her a lot during the day and she was feverish again.  She also had a nasty cough.  I was afraid that with Kadi’s mom now having another sick kid, Kadi would be neglected again.  I started thinking and praying about it again. That night I don’t think I slept for even an hour.  The next day I went early to pick them up and bring them back to the hospital before work.  They were going to do what they needed to at the hospital and then wait for me to take them home in the afternoon.

That day I spent a lot of time with them as the OB ward was pretty slow.  I gave Kadi a packet of plumpy nut in the morning when her mom was busy with her little brother and it took her about an hour to eat it.  Later I gave her another one when her family was around and it was gone in 15 minutes.  When she took another one later in the afternoon I physically saw it being shared with the auntie, the brother, and some other kids.  I knew for sure then, that she wasn’t getting as much as she was supposed to get in the village.  That sealed it for me.  She was sick again with that fever and although I thought she looked better, I was afraid that one more big sickness that wasn’t noticed very well because of other sick kids, farming that needed to be done and the other many responsibilities a mom with 3 kids age 4 and under had, she wouldn’t make it through this one.  By noon, I had decided to make the offer.  I felt a little sick.

I wasn’t really afraid that the husband would say no. At one point when I was visiting the village he told me that I should take Kadi and go.  It was her mom that I was worried about. I did NOT want her to think I was trying to take her child from her. It was important to me that I talk to her before I talked with her husband.  I know the culture here, and knew that if I went to talk with she and her husband at the same time, whatever the husband wanted would happen. I wanted her to have a say in the matter so I didn’t even want to approach her husband if it wasn’t something she wanted to do. 

I went to my friend “Joseph” and told him what I was thinking. I asked what he thought and if he could help me talk to her. Even though she and I communicate in Krio pretty well and she actually helps me “translate” from my krio to krio that people understand…I wanted this to be VERY clear.  No room for error. 

When I talked to Joseph, I explained exactly what I wanted to do. I would offer to take Kadi for two months, get her nice and healthy and then give her back to her parents.  We could come visit a couple times a week if they wanted.  Ok. Time to go talk to her.

When we called her to come talk, she looked nervous, like a kid who’s in trouble.  While Joseph was talking to her, she wouldn’t look at me.  She just kept nodding her head.  Joseph did a great job of explaining everything.  At the end, he asked her what she thought and she said she wanted to do it.  At this point I jumped in and asked if she was sure, telling her that I really didn’t want her to think I was trying to take Kadi from her.  She started getting a little teary eyed at this point and said that no, she was happy.  I took her at her word.  We decided that the next day Joseph and I would go to the village and talk to her husband. I was going to draw up a contract that I, Joseph, both Kadi’s parents and one other witness would sign.  The details would include the time (2 months) and the fact that they were voluntarily agreeing to come have Kadi stay with me for the agreed upon time and that no money was exchanging hands. (Call me paranoid, but I really really did not want to be called a kidnapper! J)  Joseph also made it clear that I was agreeing to take care of Kadi, but was not going to be able to start supporting the whole family financially (another one of my fears).

That night was another pretty sleepless night as I just kept going over things in my mind.  I had prayed so much that if it wasn’t something God wanted me to do, he would just close the doors. I prayed that if it wasn’t what he wanted that her mom would say no. Now I was praying the same thing for the conversation tomorrow with her father. 

I wanted God to just shout from the heavens that he wanted me to do this.  But I wasn’t getting that.  It wasn’t even like I had a clear inner voice telling me, “Emily. Do this.  I want you to do this.”  But I couldn’t get her off my mind. I thought about her constantly.  Oftentimes I get frustrated when I don’t feel like  I want to do what God wants me to do, but I’m not sure what that is.  So many times I’ve been grumbling to Him saying, “Just tell me already! What do you want me to do?!?!”  Then more often than not I hear the Voice say, “I already did. I gave you a whole Bible.”  This was one of those instances.  I wanted so clearly to have confirmation that I should do this, but wasn’t having that bolt of lightening.  When I turned my thoughts to the Bible, the words at the end of James came to mind.  “True religion is this.  To look after the widows and orphans in their distress, and to keep oneself from being polluted by the world.”  Kadi wasn’t an orphan.  She has two parents.  But for whatever reason, she just wasn’t getting the care that she needed.  Does that count?  Maybe?  I kept mulling over this verse and just begging God to close the doors if it wasn’t what he wanted.  And I tried to prepare myself for the conversation tomorrow.

The next day I was ready.  I was a little nervous, but I was also excited and felt peace that God would do what he wanted.  I was done with work at 3:30pm and Joseph and I were going to head to the village then.  At about 2:30 a patient came in that was going to need surgery.  Joseph was going to scrub in, but they had to wait for the surgeon who was far away.  I was frustrated because I’d been waiting for this all day and now because the surgeon (who was on call by the way) was far away, I knew there was no way they would be done by 3:30. Maybe 5:30 at the earliest.  Since we weren’t going to the village yet, when I finished work I went downtown to get a couple things I thought Kadi might need.  As I was walking, I was praying the whole time that if this was God shutting the doors, he would make it clear.  I wanted what He wanted.  My friend called me from the hospital while I was downtown and needed me to bring something to her.  Instead of going straight back to my house I stopped by the hospital.  I was literally muttering under my breath, “Lord, close the door. Close the door if this isn’t what you want” when I ran into Kadi’s father.  His wife had obviously told him what we’d suggested and he had walked the 4 miles (in the rain) to come meet with me.  Lord?

I called Joseph (who wasn’t in surgery yet because the surgeon was so far away…thank you Lord!) and he came to talk with us.  He went over everything that he’d gone over with Kadi’s mom the day before and the husband was very excited.  He kept smiling and saying “thank you, thank you.”  After we finished, I pulled out the contract I’d drafted and Joseph, Kadi’s father and I signed it.  Then we left Joseph to his surgery and I went with Kadi’s father to the village to collect her.  

When we got to the village, Kadi’s mom had obviously been preparing for our arrival, as Kadi was decked out in her best outfit.  We explained to Kadi’s mom that we’d talked with Joseph and agreed upon the parameters of the contract and needed her to sign.  She went to call someone representing her family to sign as well. As we waited for them to come, I sat with Kadi.  We waited. And waited.  And waited.  I checked a couple times to see if someone was coming and to make sure there wasn’t a miscommunication and they didn’t understand what I was wanting.  No, they knew. We were just waiting on the uncles to come.  Ok.  I blew bubbles with the kids that were just standing there. Staring. J

After 45 min. or so, three men showed up to represent Kadi’s mother.  We went through the details of the contract and one of the uncles signed.  They were all saying “thank you, thank you” and while I nodded my head saying Ok, I began to get sick to my stomach at the thought of what was coming.  Taking her.  I was dreading it.  I was dreading the screaming and crying that would happen as I took her away from her mom and the only life she’d ever known in the village.  Lord help me. 

To be continued…..

Thursday, August 16, 2012


I’ve been so so so behind in my blogging, but I have a valid excuse.  I’ve had almost zero internet access for the last couple of weeks. My Facebook stalking is taking a serious hit.  I had a couple other blogs I wanted to write including “Boris Gets Stuck For the First Time in the Mud and is Pulled Out By an Angel With a Chain” and “Things You Didn’t Know Could Mold.”  However, since the time I wrote those blogs in my head I’ve had a rather life changing event occur so I decided I’d write about it instead.  No Mom, I didn’t run off and get hitched. 

I now have a four year old little girl living with me.  The plan is to keep her here for the next two months.  Oh my gosh, I cannot possibly express what a huge change this has been!!  I don’t know if I have ever been as exhausted or overwhelmed or frustrated or filled with such an unbelievable love for this little girl.  Yikes.  So where to begin.

Once upon a time I was at the hospital. Per usual.  My home church was going to have their VBS in a few weeks and the kids were going to do a penny drive to raise money for the hospital.  I wanted to make little videos for them to watch from different parts of the hospital. I went to the OB ward and made a little video of a mom and baby who had been saved by having a C-section, went to the Peds ward to talk about a little kid who was saved by malaria medicine and a blood transfusion…you get the gist.  I went down to the Alpha ward which is our ward for malnourished kids.  That’s where I met “Kadiatu.” 

The first time I met Kadiatu
You can see that while most of the malnourished kids you see on TV are super skinny, Kadiatu doesn’t look that skinny.  Kadiatu has a kind of malnutrition called Kwashikor. Underneath all of that swelling she’s still skinny, but instead of just lacking calories, she’s lacking protein which allows the fluid to seep out where it’s not supposed to, making her swollen all over.  This was Kadiatu’s third admission to the Alpha ward.  She’s 4.  This time she was brought by the police after her uncle took her father to the police station for not taking care of his family.  The purple that she is covered with is called GV paint and they paint it over wounds here.  Her whole lower body and some of her arms and face were covered in wounds.  So this is the story of Kadiatu and I, up to this point.  It’s probably going to be a bit long so feel free to skip ahead during the boring parts (which might be most of it).  J

I’m not sure what it was about this little girl that got to me. I’ve seen hundreds of kids since I got here, and many of them have been sick like Kadiatu.  But for whatever reason, she tugged at my heartstrings and I started spending a lot of time in the Alpha ward.  I was concerned about the wounds covering her body so I took one of the guys that does a lot of dressing changes to the ward and we talked about what we should do.  The wounds covered most of the back of both legs, and her rear end.  We found a special kind of dressing to put on and so began the daily process of changing the dressings while she screamed and cried.  She had diarrhea and could barely stand she was in so much pain, because of the wounds, so keeping her dry was a challenge.  Nevertheless, another ex-pat, Erin and I changed them every day.  After every dressing change I would get her some of these cakes that she likes which were super spicy. She’s definitely an African kid.  I went to Freetown at some point and was gone for probably a week and a half.  Erin kept at the dressing changes and when I came back I was amazed to see how much better her legs were!! There was almost nothing left that still needed to be dressed! It was incredible.

Kadiatu was in the hospital for about a month. During this time, God only knows why, but I was kind of addicted to her. Her eyes were just so empty and I wanted so badly to see her smile!!  Every day during work if it wasn't busy I'd go in there and spend time, reading to her, painting her nails, trying anything to get a reaction. Usually I got absolutely nothing. The look on her face in the picture above was her look. It never changed unless she was crying.  When I tried to engage her she usually just looked at me like she was begging me to stop. It was like she just didn’t have the energy to give any kind of response. It was heartbreaking.

Just before she was to be discharged I had to go to Freetown again. I called every couple days to see how she was doing and they told me her discharge had been postponed because she had malaria again, she wasn't eating well, etc.  One time I texted my friend to check on her and he didn't text back. I texted another friend and she didn't text back either. I was sure she had died and they just didn't want to tell me.  I was relieved when they called later and she was ok. 

It was around this time that I started considering asking her parents if they would like her to come live with me for a little while until she was doing better. I started quietly asking some questions.   Why exactly does this kind of thing happen. Is it just poverty or is there something else going on? One of the nurses in the OB ward who was in charge of the Alpha ward for many years told me that yes, part of it is poverty. But there are often some other factors going on.  Kadiatu is the oldest of 3.  Her mother had just given birth to her third child 9 days before Kadiatu was admitted to the hospital.  When Kadiatu was admitted they actually wanted to admit her younger brother who was also malnourished, but the father would not agree.

One of the things that can happen here is that as the women have children really close together the older ones kind of have to fend for themselves as the younger ones get most of the attention.  My friend suspected that that’s what was happening with Kadiatu. They also said that most likely the husband had another wife who was getting more attention than this wife and her kids.  I haven’t actually asked Kadiatu’s mom if her husband does have another wife (kind of seems like a weird question) so I don’t know if that’s going on in this particular situation, but it’s common. 

I was going to be in Freetown again for a little bit and then my mom and sister were coming so I decided to wait and pray about my offer to let her come stay with me for a while.  I was terrified of making an emotional decision. It would mean a big change for me and the focus of my ministry here and would also obviously be a big change for her.  She barely understands Krio and only speaks her native tribal language.  I'd only heard her say a couple words as her mom said she never talks when she's "sick" like this.  

A couple years ago my pastor was preaching about dreams and ambitions that we get from God. He said that when he gets an idea or dream of something he wants to do, he will pray about it for a month. If it’s not from God it will usually just slip away but if it’s something that God wants him to do, as he prays about it he will just become more passionate about it.  I decided to do that. 

I prayed and prayed and agonized and prayed. I lost sleep over it. I talked to a friend of mine in Freetown who runs an organization that provides food supplementation for malnourishment cases like this.  I told her about Kadiatu, showed her some pictures and asked for her advice.  She gave me two cartons of this stuff they call “plumpy nut” which is like a peanut butter based food supplement with loads of other good stuff in it that’s supposed to pack on the good, healthy pounds. I asked her what other good kinds of food for her to eat would be and she said that really, if she was eating as much plumpy nut as she was supposed to, she didn’t even need to eat anything else.  She also told me something sobering which was that kids like Kadiatu who have that kind of swelling have a 70% chance of dying.  And this was Kadi’s third time being admitted for malnutrition.  It was serious.  

After about 3 weeks into my 4 week prayer time it all of the sudden just seemed clear to me.  I would leave Kadiatu in the village but take her plumpy nut every day to every other day.  See, there are a couple problems with the plumpy nut.  It tastes good, and is therefore valuable.  If you give it in large quantities to the mothers, it will often be shared with the whole family if not more people, or it will be sold.  We often find it for sale in the market in our village.  Kadiatu lives about 20 minutes away from my own village so I just decided I would go take her the plumpy nut every day to every other day.  That would also allow me to keep a good eye on her.  So how did I end up with this epiphany of having her stay in the village to now having a new roommate?  Tune in tomorrow….or the next time I have internet, to find out.  J

Wednesday, August 1, 2012

Third Time's The Charm?

Well, it appears that I have malaria.  Again.  This will make time #3.
I've been down in Freetown for awhile...almost a month believe it or not!! I keep having things delay me which has been a bit frustrating but actually turned out to be not a bad thing.  I met a new friend.  This is Deborah.  Isn't she pretty?  This is her in her  malaria-free days.  Oh the bliss.

Deborah has been in Sierra Leone for the last two months and is living and working in an orphanage.  On Thursday my friend and co-worker John got a call from Deborah.  She had been given his number by another missionary we know who was on her way out of the country.  Deborah wasn't feeling too well.  In fact, she was feeling pretty bad.  We told her to come over to the house and we would see what we could do for her.  Meanwhile John and I went to a clinic nearby and stocked up on everything we could think of to treat malaria (which we were pretty sure she had).  When she got to the house she was feeling pretty rough. We checked her and sure enough, she had the malaria.  So we started her on  treatment, gave her a fan and some cold water (nice amenities when you have a parasite in your body doing its best to kill you) and waited for the meds to work their magic

There are several different strains of malaria.  Deborah had falciparum, which is the bad one. It's the one that makes you feel like you're going to die.  I haven't yet had the privilege.  After a couple rough nights of uncontrollable vomiting, she slowly started improving.  She continued to stay with us at the house for a few days to rest up.

In the middle of the night on Saturday I was awakened to a strange man in my bedroom saying "Hey.  Emily!" The sleep cloudiness in my brain and the fact he was wearing a big rain jacket made me think it was this guy.
Minus the shovel of course.  And...sorry John. I call 'em like I see 'em

But turns out it was my friend/neighbor John who came to tell me that his wife Kaysie wasn't feeling well and the test showed that she too had malaria.  What!?!  Another one???  She too had the "bad strain" of malaria and we started her on treatment that night.  The next day she kept saying she was wasn't feeling too bad but in my mind I just kept waiting for the evening time....that's when it seems to get worse.  I'd seen Deborah struggling. I'd been with she and John when her husband got it a few weeks ago and was in the hospital. Just wait.

But last night we were marveling at the fact that her symptoms really were a lot milder!  She felt pretty nauseous and crummy one day and slept more than usual....but other than that, not too bad!  We're thinking it might have been because she was taking some prophylaxis (although not the recommended hem, Kaysie), maybe because she caught it so early, or maybe because she drinks a lot of cod liver oil. I know, she swears by it.  I think I'll take the malaria?

So last night I packed up all my stuff, ready to head back up country.  There have been two ladies covering the OB ward 24/7 for several weeks. One of them is waiting for me to come so that she can start her vacation.  They're tired.  I felt bad about my delay down here and was ready to get back up!

Then last night, at about 1am I woke up and was really nauseous, really restless.  Oh crap.  (Can missionaries say "crap?"  I'm never sure).  Oh Sugar O's. There, that's better.  I decided that with all this malaria floating around, I would go ahead and check myself.  The "control" line came out really clear, but the line for a positive for the falciparum strain (the bad one) was really really faint. Was it positive? I couldn't be sure. Was I reading into things?  I decided to just go back to bed and in the morning do another test and have John and Kaysie give me a second opinion.

This morning I felt fine. I was a little sleepy, but I'd laid awake for a couple hours thinking about what I was going to do if it really was, not surprising.  I did another test and it looked the same. I took it up to John and Kaysie and we went back and forth as to whether or not it was really positive. The first time I'd gotten malaria (not the bad kind) the same thing happened and I wasn't even sure if it was positive.  Well, until that night when I got a temp of 103.

We were debating about whether or not there really was a line there, in the "positive" area, when it went away.  Well, if it's clearly not there now (after the time is says it says you shouldn't read it because it won't be accurate) then it must have been there before.  We called it.  Positive.

I debated about going up anyway.  But this was my dilemma.  When John got it a few weeks ago he started out on the drive knowing he was sick but not feeling too bad. By the time he finished his 3ish hour drive he had stopped to pick up a policeman in case he passed out and couldn't walk by himself to the house when he arrived.  My drive is 7 hours, four of them on bad roads, and by myself.  But I had people waiting for me!!!

In the end, I decided to stay for the day.  Cerebral malaria is seriously one of my biggest fears here.  So I stayed.  I was skeert.  I started treatment this morning and am feeling fine. I got a little achy in my back but haven't been febrile and haven't really felt nauseous.  I started getting a little bit of a headache but that could be because of the movie watching/facebooking I've been doing today.  It is a bit of an odd experience just waiting to get sick.  Knowing that it tends to get worse in the afternoon/evening changes the decisions that you make.  "Hmmm...I don't feel sick now, but if I'm vomiting in a few hours, how is that going to taste taste coming back up?"  Skip the jerky, stick to the crackers.

Maybe I'm a hypochondriac.  I may or may not have been called that before.  (Although eh...hem Elisabeth "bone pain" is a real thing and was listed as a side effect on a commercial for a medicine!!!) I'm praying that instead of giving into any kind of hypochondriasm, I just caught it really early and am not going to get very sick!  The fact is, if there hadn't been all this malaria going around, that nausea in the middle of the night would not have been enough to make me test, so it probably would have been at least another day or two until I felt worse.  Thanks Jesus!!

Speaking of "all this malaria going around," if I hadn't spent 6 years and thousands of dollars to learn that malaria is spread by mosquitoes, I would swear  that it is contagious. Instead, we've decided that this little lady
I've named her Yolanda.  She must be stopped!

is flying around here infecting us all.  Kill and destroy!!!

So here's praying for a good, non-sick night and getting to go back upline tomorrow!! Thank you all already for praying for me!