On death and dying

This will not be a happy post. Maybe not the best one to read if you are having a good day…

I understood what I was getting into when I moved to Malawi to work in an HIV/AIDS clinic. With between 4-26% infected with HIV (12% overall), I did not expect to be laughing all the time at work. Most days, I am just fine: The clinic is full of people who are doing well on their antiretroviral drugs, people generally appear healthy, and the sickest patients go to the inpatient center, not to us. Plus, I look mostly at the clinic data and help the programs improve – an indirect link with patient care. This week, however, we ran out of some key medications leaving some people to exhaust their supply and spend a few days (or weeks…) without their drugs. People were audibly angry, as was the staff (not at the patients, but at the situation). The drugs are actually literally right across the street at the central medical stores, but the logistics folks can’t seem to get them here. Compounding this, we also had a woman who brought her very sick child to the clinic for HIV testing and treatment; the baby died within minutes of arrival. The wailing from the day care ward was indescribable, but haunting as you would imagine. Another death later this week, also in the day care ward, released another series of bone-chilling, eerie cries.

Our clinic also sits right next to the newest maternal health clinic in the country. The new clinic is clean and sparkly, in part because only half of it is open. There are not enough nurses or staff to actually run the new center. Malawi has one of the highest maternal mortality rates in the world: 1% of women who deliver in a facility die in childbirth (usually the rate is higher for women who deliver at home). Even more frightening: 1 out of every 18 women in Malawi will die due to pregnancy or delivery-related causes. Most of the time, I can ignore the dreadful conditions for new mothers and their infants, but not this week. First, an OB/GYN friend of mine told me that she lost 3 women in one morning, all due to preventable causes. In brief, she noted that one woman died because the assistant nurse didn’t want to bother her supervisor; one woman died because there was no blood available; and one woman died because the clinician failed to recognize the presence of a second fetus (just a week after training on twins). I walked back to the clinic after this shattering conversation to find out that the newborn baby of one of the staff nurses had just died of pneumonia. I met the child, all swaddled, just 3 days before.

Folks at the clinic talk about the period from 1995-2005 as the period where funerals were everyone’s main social activity and every day was filled with loss, mostly due to AIDS. But, it still feels like death and dying are too common, almost commonplace, to me. Our “social welfare” committee reports every day on wedding, deaths, births, etc. This week: one wedding and funerals for 2 staff parents, 6 cousins, and 1 husband. The thing is, this week was pretty typical. I cannot imagine what it was like before. I find it hard to stay tethered with the situation as it is now.

And, that’s a brief rational for why I am off for my second nap of this warm Saturday afternoon.