Out of the Shadows

by Melanie Mitchell

  Leslie skimmed the contents of the cabinet and found it to be well stocked. Bottles and jars of medications were clearly marked. Boxes of exam gloves, dressing materials, suture sets and similar supplies took up the middle shelves, while disinfectants and cleaning implements were neatly lined up on the bottom. “This looks great, Mama Joe.”

  Leslie followed the two women through a door at the rear of the clinic into the living quarters. A generous kitchen with a small eating area took up one side of the apartment; on the other side were a 1960s-era bathroom and two bedrooms. “Our electricity comes from propane tanks and generators that are located behind the clinic,” Mama Joe explained as she showed Leslie around the homey, nicely provisioned kitchen.

  Leslie nodded appreciatively. “I must admit I’m relieved to know that everything looks pretty normal.” She grinned a little sheepishly. “I was afraid that things would be a lot more primitive—like cooking over campfires.”

  Mama Joe and Naomi laughed. “We have to be fairly modern,” Mama Joe explained. “In addition to holding my milk and eggs, the refrigerator is needed for some of our medications and vaccines, and we need electricity to filter water and run the autoclave.” Her smile faded. “AIDS is such a threat, we have to be able to sterilize equipment. Later on I’ll introduce you to the generators and water filtration system.”

  Titus entered the kitchen carrying Leslie’s bags and proceeded toward the two bedrooms, which were accessed through a short hall off the kitchen. “Titus and Naomi have been working for over a week to get your room ready.” Mama Joe gestured for Leslie to follow him, and under her breath she whispered, “I hope you like blue!”

  The warning was appropriate. Titus set her bags down in a room with cinder-block walls that had been painted a soft blue. Blue-and-white gingham curtains adorned the windows, and the single bed was covered with a lightweight blue cotton spread.

  “How did you know that blue is my favorite color? This is wonderful!” Leslie exclaimed as she gave Titus and Naomi a smile of thanks and shook their hands in appreciation. She managed to suppress a grin as she looked around the baby-blue room, grateful they hadn’t chosen pink.

  As Leslie lifted one of her bags onto the bed and started to unpack, Mama Joe pointed to the mosquito netting hanging from a hook above the bed. “Other than vigilant attention to HIV precautions and the water filtration system, using that net is probably the most important thing to remember. Long-termers don’t generally use drugs to prevent malaria because of the side effects. Instead, we rely on insect spray and nets. If, God forbid, we do get malaria, we just treat it.”

  Leslie nodded, studying the netting. “I’ll be careful.” She hung several shirts in the small closet. “Have you had malaria?”

  “Yes, a couple of times. It’s not fun, but with the right antibiotics, we can treat it quickly and effectively. But always sleep with the net.... Oh, and another thing. It’ll help keep the spiders away.” Mama Joe turned to walk toward the kitchen. “While you unpack, I’ll come up with something for supper.”

  Leslie frowned as she watched the retreating nurse. Glancing warily around the room, she whispered, “Spiders?”

  * * *

  LESLIE’S FIRST DAY in the clinic was a trial by fire. Over a breakfast of scrambled eggs, toast and fruit, Mama Joe outlined the course of a normal day. “Titus opens the compound gates at seven. There are almost always people waiting. We have some scheduled appointments, but most patients are walk-ins.” She took a bite of toast. “Once or twice a week we’ll get calls on the telephone or radio to assist people from other villages within a sixty-mile radius. Those are usually emergencies, like accidents or difficult births.”

  “When 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 eli
cit 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 was a nauseating mixture of cow dung, human excrement, body odor and decay. Leslie cupped her mouth and swallowed hard to keep from gagging.

  Her eyes adjusted to the scanty light, and she saw an extremely frail man covered by a thin blanket lying on a cot in one corner. An equally frail woman sat on a short stool near the head of the bed. Her jaundiced eyes watched intently as the two women entered the hut.

  Mama Joe whispered a greeting as she approached the cot. She reached out and touched the woman, then the man, on their heads. She asked a few questions, which were answered by the woman in a bare whisper. Mama Joe glanced toward Leslie and motioned for her to come near the cot, and Leslie knelt by the meager bed to assess the dying man. His eyes were closed and sunken, and a wet, rasping noise told them he struggled to breathe.

  Mama Joe knelt beside Leslie. Her voice was barely above a whisper as she said, “This is Mr. Kanjana. His high fever is most likely caused by pneumonia.” They briefly discussed a treatment plan, and Mama Joe drew up medications for inflammation and pain into two syringes. Although Mr. Kanjana did not flinch at the prick of the needles, Leslie cringed as her colleague injected the medications into his skeletal thigh.

  The nurses tried to get the patient to sip some water, but he did not have the energy to swallow. Mama Joe held his fragile hand for a while, and Leslie watched as she said a prayer in Swahili. A few minutes later, Mr. Kanjana’s breathing seemed to ease, and Mama Joe rose and drew the wife away from the cot. Safely out of the husband’s earshot, Mama Joe spoke to Mrs. Kanjana for a moment. With a tiny nod, the woman returned to sit beside her husband.

  “The medications will allow him to breathe a little easier, but, judging by the breathing pattern, he probably won’t live but a few more hours.” She spoke quietly to Leslie, who glanced at the pitifully thin woman seated by the cot. “I told her I would stay with her. Why don’t you go back to the clinic? Titus can take you home and then come back for me.”

  Leslie desperately wanted to go back to the clinic. She desperately wanted to leave the stinking confines of the tiny house filled with death. Instead, she looked into Mama Joe’s calm brown eyes and whispered, “No. I’ll stay.” Tears threatened to fall, but she managed to blink them back. Squaring her shoulders, she said, “Tell me what to do.”

  * * *

  AS MAMA JOE predicted, it was over in less than two hours. The nurses helped Mrs. Kanjana clean the body and cover it with a new cloth. There was nothing left for them to do but fill out the requisite forms when they returned to the clinic.

  The frail woman stopped them as they were leaving. Her yellowed eyes were filled with gratitude, and she whispered something in Swahili. Mama Joe simply nodded, and Leslie did the same. As she waited, she tried to avoid thinking about the loneliness the widow would now have to endure, and she struggled once more to blink back tears.

  Dusk had fallen and, once outside, Leslie gulped in the warm, clean air. She was surprised to see that a number of men and women had surrounded the dwelling, waiting patiently for them to emerge. Those nearest to Mama Joe nodded with apparent respect but gazed at Leslie with curiosity. The young boy who had fetched them stood with two other children near the door. Their expressions were stark.

  On the drive home, Mama Joe explained that the Kanjana family had already lost two children to the scourge of AIDS. “Mrs. Kanjana doesn’t have long. She’s taking antiretrovirals, but they’ve only slowed the disease a little.” She sighed audibly. Her lined face showed fatigue, and she closed her eyes.

  As soon as they arrived at the clinic, Leslie excused herself and rushed to the bathroom where she was violently ill. Afterward, she scrubbed her hands and face and rinsed her mouth, all the while trying to regain her composure. When she finally returned to the kitchen, she found Mama Joe seated at the table drinking a cup of hot tea. A second cup had been prepared for her, and she sat down and sipped it gratefully.

  Leslie interrupted the silence a few minutes later. “How do you do it?”

  Mama Joe smiled sadly. “Just when I think I can’t take it a moment longer, when I can’t bear to see one more child die, or treat one more case of some dreadful, preventable illness, or when I think I can’t face walking into the clinic one more time—something happens. Sometimes it’s something big and impressive, like saving a life or delivering a baby. But it’s usually something little, like a smile from a child or a grateful look from a parent.”

  Laying her roughened hand gently over Leslie’s, she said, “I wish I could tell you it gets easier, but it doesn’t. You just do what you can and leave the rest
to God.” She reflected for a moment before adding, “After all of these years, I still find myself asking why? But we can’t expect answers. I’ve learned to try to help whenever I can and to fight death any way I can. We don’t always win, but we can always help ease pain and suffering.”

  Mama Joe gave a tired smile. “Leslie, Dennis Williams told me your story—about your husband and daughter...” She wiped away a tear and continued, “I believe that you were sent here for a purpose, and I’m glad you’re here. You can understand what others experience... You’ve been prepared in a very hard way to do what needs to be done. And you can do it.”

  “I want to be strong, and I really do want to help.” Leslie sniffed. Her smile was faint. “You’re a very good inspiration...”

  At that, Mama Joe placed both hands on the table and pushed back her chair. “Agnes made supper for us and left it in the oven. I’m kind of hungry.”

  Thirty minutes ago, Leslie doubted she’d be able to eat for a long while. But words of encouragement from a brave woman had helped. She wiped the tears away and blew her nose. The corners of her lips turned up slightly. “I don’t know if I can eat much, but I’d love another cup of tea.”

  CHAPTER FOUR

  SUNDAY BROUGHT A badly needed respite from Leslie’s first hectic week at the clinic. Her confidence and knowledge of the practice had improved significantly. Her Swahili, in contrast, was developing much more slowly. Mama Joe and Naomi were encouraging, however, and Elizabeth and Agnes were patient. Overall, she was pleased with her progress. The days were busy and enormously rewarding. Time off from seeing patients, though, was welcomed.

  Unless she was called away, Mama Joe was adamant that Sunday mornings were to be spent at the local church where the service was led by a missionary family named Merdian. “Paul and Judy and their adorable children have been here for almost three years,” Mama Joe explained during breakfast. “They’re working on translating the Bible into one of the tribal languages—like Ben’s parents used to do.” She smiled proudly. “Paul is highly respected by the local people, and most everyone calls him ‘Preacher’—even those who don’t come to church. His wife, Judy, is wonderful, too—she’s a terrific cook.” She sipped her coffee and added, “Oh, that reminds me. They’ve invited us to lunch.”