One tough job

I wouldn't necessarily classify my job as difficult, technically my job isn't even a job, more like a voluntary position. But there are moments, even days, where I wonder whether or not I will be able to continue. I wonder if God gave me enough strength to be in the position that I am.

Friday was one of those days where I questioned my endurance. Friday was a clinic day -the last day of a five day temporary clinic at Mathare North. For four days doctors, nurses, and residents had devoted their time to attending to the needs of the community. People flocked in the hundreds to the school where we had set up camp. It was a simple set up, one tent for triage, a courtyard for waiting, 3 consultation rooms, and an office that was set up for pharmacy. Each tiny consultation room was divided into two sections, each hosting either a kenyan or american doctor and a translator. The rooms were dimly lit, with the only light being the few rays that filtered through the cracks in the door. The clinic by any American standard would be scoffed at, but for these people of Mathare, it was the best care they would probably ever receive.

This particular Friday I worked triage, frantically taking blood pressures, height, weight, temp, and chief complaint -trying to smile all the while remembering the key Swahili phrases I had learned. It was a race against the clock to get as many people seen before noon that day when the clinic would close. The doors would shut shortly after noon, the doctors would eat lunch, and then be on their way to get ready for their trip back home. It wasn't until 11 o'clock that I started really getting nervous. We had been triaging patients for over three hours, and there was still a mass of people yet to be seen. We weren't going to make it. The sinking realization swept over me like a heavy shadow, and as I looked into the crowd I couldn't help but pick out the faces of desperate mothers. We would have to send them home, we were going to turn them away. Thirty minutes later the truth that I knew was coming settled on the camp. No one wanted to accept it, let alone inform all of those who were waiting. I don't know how it came to be my job, but before I knew it, I was standing in front of the crowd, "Pole sana (very sorry). Mganga anakwende nyumba (the doctors are going home). The clinic is closing. Tefadali Mkwende (please go)."

There wasn't the uproar that you would expect in the US. No one stood up and shouted at me.... it was worse. There started a low murmur, then when the murmur progressed to the point where more and more people understood what was happening, there were groans, sobs, and women pleading. It wasn't loud, it wasn't rude, it was desperate. I wanted to tell them I would visit them all, I would stay until sundown if it would help, but I could do nothing. Ashamed, and afraid I would bust into tears if I remained any longer, I retreated behind the comfort of the school walls. It was here that no one could see me, no one would notice my frustration, fear or anger.

But, my job was not done, I had to clean up the triage area. Bracing myself, I stepped outside and returned to my position, only to rip the measuring tape off the wall, collect the thermometers, and scoop up the blood pressure cuffs. Somewhere between tracking down all of the alcohol swabs and retrieving the charts, she found me.  She was no more than 25 years old, and with her was this precious little girl. "Please, " she begged me. "Just look at her head; just for a second."

I looked. After seeing hundreds of small children with white round patches on their head, I knew exactly what this little girl had -tinea capitis, otherwise known as ring worm. Once someone in the family gets it, usually all the kids get it because the sleep practically on top of each other in their one room shantis. But hers was different. Her head was infected. Sometimes this happens which a child scratches the fungal infection, then a secondary infection sets in, and due to constant scratching and unsanitary conditions, the infection spreads. Well, it had spread alright -all over her head. Yellow puss was weeping from her wounds which covered about a third of her scalp. "Please, will you help her?"

What could I do? I tried to tell her I wasn't a doctor. I tried to tell her that there must be other clinics in the area that she could visit. I was lost for words, and desperate to leave the situation. How could I possibly explain? How could I convey my great saddness that I could not fix her child, how could I tell her I did not wish to be so cold hearted, but one exception would lead to dozens of exceptions which could not happen because the doctors were litterally packing up their bags and leaving.

Once again I returned to my refuge, but this time all the more shaken up. I didn't go unnoticed. Amos, one of the Kenyan nurses approached me and asked if I was having a rough day. Not necessarily prepared to go into detail about how things were going, but not so confident to completely bluff, I summarized with, "yes, it's been a rough day, and turning away people is wearisome." Then, I simply asked what could be done for a small girl who had an infection -should she be turned away. His response was surprising -he told me to get her a card, write down these meds, and stick her in the line at the pharmacy. She wouldn't have time to get in for a consultation, but he knew what she had, I knew what she had, and the solution was simple, and her condition should not have gone without treatment. In a flash I dashed out of the room, grabbed a chart, filled out the meds, signed my name like Amos told me to, then found the woman. I jotted down her daughter's name, pulled them aside, and told them to stand in line. When they got to the lady at the window, she was to hand her this card, and then follow her instructions on how to take the meds. She thanked me, and then pulled out another little girl -with the same problem. "And this one," she asked.

Before I knew it mothers were bringing over their children, even fathers were approaching me. They all needed treatment. My efforts to be discrete were in vain, I was soon being swarmed by desperate people. Why had I made the one exception, was I wrong in my efforts to help?

The doctors were done seeing patients, the only people left at the clinic where those in charge of pharmacy and those who were directing people. There was no hope to give these people, and in the pit of my stomach I shared in their desperation. For the last time I retreated, I knew it was over, and this time I did not wish to suppress the tears. I sat in the corner, weeping for these people, weeping that they would not get care today, weeping because there was nothing else for me to do. My nerves were raw, all emotions were exposed.

It wasn't until later that day that I could start to feel again. I had been given some words of encouragement from a very wise friend who has been here longer than me. She told me that God uses our weaknesses to show us something about Himself. God is stronger than any medicine we can give. Medicine can treat, but Christ is the only one who can truly heal us. There is something beautiful about fully trusting in Him to be our savior -our saviour in times of injury, sickness, and desperation. God is provider, healer, comforter, and refuge. All too often I think we rely on ourselves to carry us through, but so much more- no, all of our reliance should be on Christ. Even my own frustration and sadness today came from feelings of inadequacy. I know I cannot heal these people, I cannot even get them to see a doctor, but there is someone I know who can. My hope is in Christ, and my refuge should be in Christ. Strength comes from the Lord, and his power is far beyond my understanding. These are his children, and he cares for each one. It is a difficult concept to consider, and even more difficult to accept, but I must take comfort in the knowledge that He is a just and compassionate God.

As I shuffled through all the charts of the patients that had been seen that day, I noticed one that stuck out. There, scribbled across the yellow slip of paper, was very familiar handwriting ordering Griso 250 and some Clotrine-B. Christina -that was her name. She was one of the 150 who received treatment, and as I added her card to the pile I couldn't help but smile. She is a child of God, a beautiful sweet child.