The Agony of Africa

Late in another stretched day.  Everyone is gone.  In my office, catching up on emails, I rub my eyes.  Are these figures correct?

The maternal mortality rate in Western Equatorial State, South Sudan is 2,327/100,000 live births.  Among 590 births, that would be 13-14 deaths.

For the 590 monitored births in the safe motherhood program AMHF is sponsoring, there were no deaths.  Zero. 

Likewise, the neonatal (before 28 days) mortality rate in South Sudan is 36/1,000.  In the program, it was 12/1,000, a third of the official figure.  Saving mothers' lives saves children's lives.

Paul Farmer calls it the "know-do" gap.  We know how to save lives, but we do little.  This effort we support was turned down by a major international funder as "not innovative enough."  Caesarean sections are, as the name implies, more than 2,000 years old.  At the time, they were innovative.  Now, they are old news, so let us all move on to something novel and exciting (and therefore better), maybe a robot which does C-sections.  With a laser.  Via remote satellite hook-up.

A call.  "Dr. Fielder, this is Janet.  Jameson's wife--she was admitted with malaria--is gasping."

Jameson's wife was admitted?  He works in our facility.  "Gasping" is an ominous term when uttered by our nurses.  I hurry out of my office, down the hall, and into the ward.

A young woman lies on the bed, not moving, not breathing, lids half closed, staring vacantly.  Janet fumbles with the oxygen mask.  A nurse's aide is nearby.   A one-year old boy suckles at his lifeless mother's breast.

Jameson does not yet comprehend what is happening.  I move toward the bed.  The baby is passed to the aide.  Now going through the motions, grabbing first one wrist, then the other.  No pulse.  Warm.  Perfectly warm, having just passed from this cold place.

Janet and I exchange glances, heads shaking imperceptibly.  Stalling--that is what we are doing.  Putting off the need to turn around and face Jameson.  Time pauses, dilates.  In Malawi, people just die.  There is no "code," no heroic rescue from the brink, no futile pounding of chests and cracking of ribs.  A long moment--yet only a brief reprieve--of shared stillness passes among living and dead alike.

"I am sorry."

Now he realizes, body collapsing forward, latching on to me, sobbing.  No other family is present.  We are what he has, and we are not enough.

After 17 years in clinical medicine, it is pathetic that I still lack the most fundamental and humane of skills:  how to comfort the bereaved.  Give me a prescription pad or a stethoscope, and I will do battle with giants.  Clear the field of the living, and I am more than ready to yield and call it a day.

I idle there, mumbling apologies, then leave this husband with his sorrow, step out to call his boss.  I must go back in the room!  "Jameson, we should make arrangements for the baby.  He will need formula soon."  They had already bought some.  Exit again.

How to weigh the balance?  Our partner organization is saving many women in South Sudan.  We should exult!  Yet I do not know those mothers, those data points who never will be.  Here in Malawi a colleague's wife dies, a lone human being, and I can do nothing.  We are numb.  The scales cannot be balanced.

Much have I seen which I would rather forget:  AIDS-wasting, cancer-destroying, infection-spreading, plagues of suffocating pain and irretrievable loss.  But this--a child still grasping his dead mother--this is perhaps the worst, the agony of Africa.