Amekua!
Jambo from Arusha!
Hope all is well amongst you! I am writing to you today at the one-month mark
of my time here. The learning curve has been steep in the past few weeks. I
have been challenged in many ways, especially working in the Neonatal ICU at
Arusha Lutheran Medical Center. As I mentioned in my previous email, the NICU
at ALMC is a really incredible place. Even since I last saw it in February of
this year, they have made great strides in caring for sick newborns in this
young city. Another great joy that I have experienced this month is working in
the pediatric’s clinic at Plaster House. The Plaster House is basically a
children’s rehabilitation home, providing a beautiful place where children with
various medical conditions can stay while receiving medical care. Many come
from remote villages throughout Tanzania with conditions like skeletal fluorosis
(similar to Rickets), club-foot, extensive burns, cleft lip/palate, intestinal
malformations, and others. The house is set with an incredible backdrop of Mt.
Meru, a 14,900 ft volcano, in a peacefully removed plot of land. Therapists,
medical providers, and other professionals care for the children between their
surgeries or casting. One of the incredible things about this place is that
these kids, though their medical or orthopedic condition may otherwise keep
them on the margins of normal childhood in their village, at Plaster House,
they have a place where they can be kids. They constantly run and play with
each other in the yard. Laughter, dance, and singing are constant. They have
different disabilities, casts, and burns; they each have their own way of
getting around, whether crawling, tip toeing on a casted and bowed leg, pushing
in a wheelchair; they come from so many tribes and backgrounds, the stories of
which I have not even scratched the surface. But they are all kids, and here they
are at home.
For today’s Swahili lesson, I would like to share a phrase I
learned in the NICU: amekua, which
means: he/she grew. This phrase comes from the word kua, which means to grow. Each day in the NICU, we weigh the babies
to see how each is progressing. To summarize NICU care into an overly simple
objective, it is essentially the goal that each neonate would grow. Most
problems occurring in the neonate are a factor of them being too small, lungs
too immature, skin and bones too undeveloped. Growth is the answer to making it
out of the neonatal period. Simple as it seems, this takes the efforts of many
devoted persons: nurses, parents, doctors, and many more. Each contributes in a
different way to grow the infant: one may come up with the general plan, but no
one person can carry out that plan by their own effort. Growth is a factor of
not only nutrition, but of caring for all of the details. For example, the
child will not grow if the lungs are not supported, they will use all the
calories received for breathing. Thus on a daily basis, the plan may include
the following: The feeding must be given correctly, in the correct amount, at
the right time, in a feeding tube or by mouth. If oxygen is being used, it must
be by the right method, in the right amount, not too much or too little, and
the cannula must stay in the nose, which is a constant battle against the tiny,
uncoordinated newborn hands. Intravenous lines fit into veins in such tiny arms
that a light held behind a hand or foot can display them all like the veins of
a tiny leaf. Subtle signs in the newborn’s condition and behavior must be
observed (such as breath-holding, tachycardia, change in abdominal distension),
as they can herald serious infections, heart problems, or other life-threatening
situations. The team cares for these details, amongst innumerably more, each
minute, hour, and day. The circumstances in Arusha magnify the difficulties in
caring for these little ones. How can one diagnose a serious infection with an
armament of lab and radiology tests that can be counted on two hands, compared
to the hundreds that we use on a daily basis in the States? How can we teach a
mother correct feeding of a premature infant with an exact amount of breast
milk fortified with an exact amount of fortifier to achieve 24 calories per
ounce in the amount of 30 mL every 3 hours when she cannot read or write? How
can you explain the condition of a sick neonate or the medical plan to someone
who may have never been inside a hospital before or who does not speak the main
language, Swahili? Despite these challenges, it has been a joy to see the staff
at ALMC and the parents of these neonates watch their babies grow. Amekua! became a daily reminder of the
small victories being observed most days. If the opposite was true, if the
child had lost some weight, it was a reminder of the fragility of our work and a
motivation to improve our strategy.
Each day here, I am challenged to grow to meet the challenges that the day brings. There are small challenges: dodging motorcycles on the street, finding my way around town, and communicating in an unfamiliar language. Then there are big challenges: how can I help in any meaningful way with these huge problems of poverty, disease, and injustice? what are my true motives for being here? am I becoming the person that God is calling me to be? Each day, I hope to see a bit of growth, to rise to meet the challenges presented. Some days, of course, I don’t. But here’s to hoping that at the end of this, I can say, along with these kids, nimekua! I have grown!
Ryan Fabrizius
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| Me with some of the kids at Plaster House (http://www.theplasterhouse.org/) |
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| Me with some of the NICU nurses |
