The One In Front of You . . .

Nurse Amy wrote this in her blog, "Through A Porthole".  My daughter is sixteen, two years older . . . I can't imagine . . .

Will you help me?
Eye brows indicate a positive response.
I need your Malagasy and your muscles, tonight you will be Superman.
OK.

His answer was “Yes” before I mentioned Superman. Francisco works in the centre for Obstetric Fistula (OBF) in Tamatave. The same centre where we are training 16 Malagasy nurses to be fistula specialists.

Our hope for the future.

I told him about a girl who needed our help.

Come with me,
I want to show you the poor family.

That’s what the midwife had said to me a few weeks before. I knew the midwives; their ways, their depressing department and demanding voices. I had delivered training programmes there the previous year. We trust one another. It is not abnormal for them to reach the end of their capabilities and ask me to help. Normally I can not. Their patients don’t fit into our protocols. Their needs can not be fixed with one of our surgical packs.

I followed her down the dirty and familiar corridor past the room of Mums with brand new screams,  past the room of silence where women lay without the title of Mum. Those who have bore an agonising 9 months of wasted expectation. Then we passed the room of women bearing C-section wounds – some open, some closed, some infected, some not, some with child, some without.

The midwife had already shown me all the new fistula cases for that week. I took their names and passed them on to the screening team. They would need to go home. Recover. Return.  Once they found the money to pay their hospital debts they would leave for their village with the hope that Tamatave would embrace them and their fistula in the future, either on the ship or in the new clinic.

She showed me in to room seven, the poor family.  And there she was. Minette. Lying in a hospital bed, sinking into its soft, urine drenched composition. It embraced her and cooled her fever, swallowed her tears of despair and held her emancipated body. The smell overpowered the ambiance and took over ones flow of concentration as she shouted endless words with no meaning.

Her cheek bones cut up the awkward atmosphere. She occasionally called out for chicken. Her family had no money for food. They had been given donations by those around them. Half a pot of plain rice here, half a banana there. ‘Indigent’ carelessly scrawled across all of her paperwork meaning destitute; in reality that meant she had no money and was already in debt to the hospital. In the dream world it meant that the government will pay for everything and she gets free healthcare.

Her family peed in a pot under her bed, they couldn't afford the 200 Ariary (4p) that it costs to use the hospital toilet. Her Aunt would rinse her soiled sheets in the well water. Put them on the ground to dry and then lay them back over the bed. No soap.

I went back to see Minette several times. She haunted me. Each time she looked worse and each time my heart broke with compassion for her.

The midwives kept asking “Can’t you help her?” I would keep saying “No, we can only help her when she is well”. I knew that Minette could die, and soon. Her fistula was fresh. She was still leaking puss, neurotic tissue and pregnancy debris along with her continual stream of urine. At 14 years old she was incredibly vulnerable and at a distressing 26kg with no food & no drugs, it looked a little bleak.

I broke my own rules.

I brought her drugs and food. I paid for them. I vowed I never would. It sounds harsh but If you work in a similar environment then you will understand why.

God broke me. Compassion caught up with me in a way that can only be explained through God’s gentle persuasion. I went home and sobbed like never before. I was mad at myself for buying her things. For disrupting the cultural norms. I was mad at the fallen world that allows 14 years olds to be dying of a fistula caused by childbirth. I was mad that I didn’t buy her chicken. I sobbed until my husband's white t-shirt had a black shoulder and my eye lashes were clean.

Time passed, stories were shared about broken hearts and empty stomachs and somehow an inconceivable dream came true. We started to discuss whether we could admit her and get her to a place where she could have surgery. The hospital leadership agreed she could be assessed.

I led Dr Norman, the OBF surgeon through the same corridors, passed the same rooms with their screams, silence and sadness. I took him to the poor family with the midwife. Together on the urine drenched bed we assessed Minette. I was so nervous. I thought that there are two possible options:

1. She’s dying. I can’t do anything with this.
2. There are loads of girls like her, she’ll be fine, come back in 6 months time.

He confirmed the presence of an extensive vaginal fistula,  turned to me and said;

OK, there are two options. ..

Oh s@%t!

1.We leave her, there are many girls like this.
2. Mother Teresa when in Calcutta said you treat the one in front of you. Jesus also healed the one that was presented in front of him. It’s my opinion that she needs rehabilitation and good care. She can get all that in our centre. There may be many but today Minette is the one and she is in front of us.

Jaw dropped. The second option.  I really liked that one.

After some discussions with the hospital management team, we decided to make an exception. To admit Minette to the centre. Feed her. Wash her. Love her. Give her physio so she can walk again, treat her so that she can live, be well and get fit for a future operation to heal her fistula. It’s kind of cool to work for an organisation that acts as they speak. We aim to follow the model of Jesus – to serve the world’s forgotten poor.

Are you ready, Francisco?
Tonight you will be Superman.
If she says that it’s too painful to be lifted tell her there will be chicken.

She did, so he did and she smiled a cheeky smile. We carried her to the safety of the clinic. I gave a short kabari (speech) to the other fistula patients, they came and gathered, each carrying their catheters in one hand and lifting their gowns as they walked with the other. They had all been in Minette’s place once. Some 20 years previously. Some two years had past since ‘their sickness’ began. They watched with a deep sense of compassion, with eyes that conveyed a never ending story of struggle.

The tribe was united.

We washed her and she slept safely under clean bed sheets wrapped in incontinence pads. Her father stayed and slept on the mattress under her bed. Holes in his shorts, no shoes on his feet.

Today Minette is at home. She has had her first surgery and awaits her second in April. She made it across the 3 rivers and two bus journeys and is currently probably telling her 14yr old friends in the village all about what a town looks like, what the sea sounds like and they probably won’t believe her or her chubby cheek bones.

She is far from a normal 14yr old but she is safe & she will live, and there is a chance for the rest of her life to be something close to normal.

Watch this space.