A Poverty Spectrum

Pouring rain again today. Kisenyi was a bog, we slipped around for the first several hours. Red mud caked in inches on my flip flops and splattered up the back of my legs. The first house we went to was the poorest I’ve seen yet. We approached the wooden shack hearing voices within. The inside room was pitch black save for a single candle, next to the empty chai cups left from breakfast. Two single beds lined the walls and the uneven dirt floor was covered with thin, ragged mattresses. The walls black from smoke from the charcoal jiko. We interviewed a 65 year old woman who thanked us profusely for visiting. She was endlessly apologetic for the pungent smell of urine emanating from the mattresses on the floor where one of her young grandsons had an accident overnight. She’s had 16 pregnancies, six children and eight grandchildren. Seven people live in this room, smaller than my own bedroom.

Yesterday we had approached a similarly crowded part of Kisenyi, simple brick buildings, the open sewers trickling by. Kisenyi has sporadic patchy electricity but no in-house plumbing. Water is collected from taps spread throughout the community at a cost of 50 Ugandan shillings per 20 liter Gerri can. As we ducked in the short doorway between curtains I stopped, confused. From dirt to a carpeted floor. A couch lined one wall, directly across from the large TV, with DVD and VHS sitting below it next to a huge speaker. In the corner was a flat screen computer monitor, keyboard and computer. But the thing that I couldn’t take my eyes off, was the massive fish tank bubbling away, spanning half the length of the room with tropical little fishies shooting back and forth. As we started the interview a stark naked 3 year-old shot screaming into the room, soaking wet from her bath she ran around oblivious to us. Finally noticing me she burst into tears and buried herself next to her mother’s pregnant belly. We all had a good laugh.

Last weekend I took off to Jinja, just north of Kampala to go whitewater rafting on the Nile with some other folks working at the hospital. It was unbelievable. Spectacular scenery and exhilarating rapids (obviously). I felt refreshed and renewed after the weekend, ready for another week of witnessing human stories. I had a mildly profound conversation with an internal medicine resident from Yale, as we sat sipping tea, and looking out across the Nile. We were discussing how we, as residents, are abysmally trained on how to be present for patients in the midst of suffering and death. We neither have the vocabulary, or the emotional and spiritual skills to respond to a suffering human being in the face of no treatment options we can offer them. And that is exactly the situation we find ourselves in everyday at the hospital here. There are no ICU beds for the gasping patient with agonal breathing, so we either go home for supper and return to an empty bed the next morning, or watch him die. Similarly in obstetrics, a woman in hemorrhagic shock, despite the medication and resucitation that are available to give her, but there is no anesthetist available to take her to the operating room. We can stay and be present, or leave. Either way the woman has passed away by morning. Helplessness in the face of suffering and death is the most uncomfortable place I've ever been.