The Ward

A few weeks ago, I wandered into my neighbor’s yard; there was a bowl sitting on the ground which contained the bottom half of a goat. “Goat?” I said, conversationally, because there were hooves, and my neighbor confirmed that it was.

Goat II

We made lunch plans, and as we stood there, I looked down and realized that her young son had taken the large knife on top of the goat and was kneeling over the bowl, busily sawing away with his tiny hands. I made a sound that landed somewhere between “scream” and “gurgle”, and she casually surveyed what was happening. “Ohhh,” she said, half-heartedly trying to manufacture concern. I no longer remember how we got the knife away from him, but we did, and his mother said, “African children are strong”, her tone matter-of-fact, explanatory. The knife was a plaything, a toy car; it was only I who saw anything amiss, the thin line that lies between fun and missing fingers.

(On a sidenote: I did come back the next day for goat, and as I seated myself on the floor, she whipped the lid off a bowl to reveal a pile of goat intestines, lungs, and other sundries. One of my hard and fast Zambian rules is that I must at least try the food that is offered to me, and so I took one bite of lung, and contented myself with the rest of the meal. The broth was pretty good. If you are thinking, “I wonder if goat lung tastes like a tire that has been submerged at the bottom of a lake for many years and recently hauled to the surface by a grizzled fisherman,” you are correct. Some things you only need to try once. My neighbor is a lovely woman, and it was incredibly kind of her to invite me to her home.)

***
It is difficult to explain how close injury and illness feel here, how constant, and how perhaps that is partially what renders a mama calm, cool, and collected when her two year-old ¬†plays with a knife; she knows it could be worse. I went to my village’s clinic on Monday, and stayed through the morning rush (they’re closed on Sundays). A group of women made their way to its front porch from the main road, babies and children on backs. The head of the clinic had me sit and watch while he saw the first patient–a seven year-old boy, drifting in and out of consciousness in his mother’s arms. His temperature was 104 degrees. The clinic has not received its supply of malaria tests in some time, but he was diagnosed with it anyway, and they laid him down on a bed behind a small screen that shields patients from the front door, slid an IV needle into his arm, hooked him up to a bag of fluids, and started his medication on the spot. He had been sick for three days. I was in the way.

I walked back into the room they call the maternity ward. When I say maternity ward, I mean that there are beds, and a small table covered in forceps. They had almost lost a mother there, a few days prior, but she lived. On the walls were large pieces of paper covered in instructions, written in faded marker, in case of emergencies during labor and delivery. One sign was headed “MANAGEMENT OF P.P.H” (postpartum hemorrhage).

The first instruction: “1. Shout for help.”

***
About two weeks ago, my other neighbor began experiencing abdominal pain. This went on for several days. Her normal genial stoicism vanished–no one knew what was happening to her, at the clinic or otherwise. Long story short, I accompanied her to the closest hospital with an ultrasound scanner, around thirty miles away, in the hopes that it would shed some light on what was happening to her insides (and because I am a pushy American, and because I was worried, and because I did not want her to go alone). How to describe what happened next? We sat together in a waiting area, and when her name was called, we went into a small admitting room, where a man questioned her about her symptoms and recorded her responses in a small notebook. They spoke quietly. Then the door flew violently open, and a man and a woman staggered in carrying a girl in their arms, bleeding from her head and crying out in pain. They dropped her onto a small table in the corner without ceremony. I blinked. They spoke a few brief words of explanation to the man from the hospital, who tutted with disapproval. When we left, headed to a different part of the hospital for more testing, it was explained to me that the girl had fallen out of a mango tree from a great height.

My friend could not get an ultrasound: the only person who knew how to operate the machine was on leave. She laid on a bed in the “female ward” and wept. I sat with her. The mango tree girl was brought in and laid on a different bed. Her head had been wrapped in gauze. We waited; they were going to get a doctor. It was quiet. But then two men walked in with purpose, and donned gloves, and before I could grasp what was happening, they were putting the mango tree girl’s head back together. A male nurse went to and fro with what appeared to be bowls of scissors. Her family rushed in, en masse, and held her body down on the bed, and she screamed. She screamed like I have never heard anyone scream in my entire life, and do not want to, ever again. I was frozen in place. At one point I looked at the faces of everyone standing around the bed, and they wore identical expressions of disgust and horror. I made myself look at the floor.

When they were done–it took ten minutes to stitch her up, and not the ten hours it felt like–one of the doctors walked over to my friend and I, and greeted us cheerily. (I actually saw him again later in the week, and asked about the mango tree girl. “She was very uncooperative,” he said, smiling. “Were there any anesthetics?” I said, faintly. “Oh, no!” he said.) ¬† He examined my friend, and decided she had appendicitis, and that she would be given antibiotics and painkillers. My arms crossed, and I felt the pushy American in me rising up unstoppably.

“My father had appendicitis,” I said, “and he had to have an operation.”

That was not necessary, I was assured, unless the symptoms came back. There was no way to get an ultrasound to check, however. There may have been a time in my life when I felt more helpless, but I cannot currently recall it. We kept talking. Many, many more things happened, and I pushed. I went back to my village.

My friend is in the capital now, where there are private hospitals and ultrasound machines with someone to operate them, and read the results.

***
When I look at my arms and hands and feet now, I see blisters and cuts and burn marks. Here is where I grip my cooking brazier and broom. Here is where the pot handle scorched a line into my palm. Here is where I split my knuckle on a lump of coal. Here is where I sliced my hand open on a piece of grass. Here is where a nail scraped open my bicep. On my right foot, there is a scar from where I dropped the sharpest knife I own onto my foot as the sun was setting, gave myself a puncture wound, and frantically washed and bandaged it and then cleaned all the blood off my floor with bleach by the light of my flashlight. It was a month before I could walk without limping.

One night in late August, I was eating fish with the father of my host family; the fish, caught from the dam adjacent to our home, was full of bones from head to tail, and tricky to handle. I pulled some of the meat away with my fingers and put it in my mouth, and when I began to swallow, I froze: a fish bone, moderately sized, was hovering in the back of my throat, too far gone to to spit out. It went down.

“I swallowed a fish bone,” I said to my host father, and drank water and ate more dinner to try and push it down as spiky waves of pain started radiating through my chest. I went back to my hut, and the pain grew. I ate bananas, one after the other. I went online, where everyone said the same thing: go to the emergency room. I looked around blankly. It was 9:30 p.m in the village of Chikonkotoo, Zambia, and an emergency room was not forthcoming. I talked to my parents and the Peace Corps, and went to bed on a wing and a prayer. In the morning it was worse, and the Peace Corps whisked me to a hospital in the capital for a chest x-ray. The bone was gone, but my esophagus had not escaped unscathed, and it hurt to eat for some time. It felt silly, all of it; silly that I hadn’t paid attention, silly that swallowing a fish bone could create such a panic, that it would either be just fine or puncture my lung, and that I had no way of knowing which was which right away. Silly that it was so scary. But it was.

My friends and family know that I have made a rule for myself in Zambia: if I am doing two things at once, and one of the things can hurt me or kill me, I have to stop doing one of the things. Distraction is a luxury I am not permitted, because I am especially prone to becoming lost in thought, and can lose thirty minutes thinking something through while a pot of water burns itself down to steam. Dinnertime is especially fraught–knives, open flames, the fading sun. My personal injury rate has gone down significantly since the institution of this rule.

But my life is not that hard.