Out of the Shadows. Melanie Mitchell
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we keep other equipment and items that we don’t use as frequently.”
Leslie skimmed the contents of the cabinet and found it to be well stocked. Bottles and jars of medications were clearly marked. Boxes of exam gloves, dressing materials, suture sets and similar supplies took up the middle shelves, while disinfectants and cleaning implements were neatly lined up on the bottom. “This looks great, Mama Joe.”
Leslie followed the two women through a door at the rear of the clinic into the living quarters. A generous kitchen with a small eating area took up one side of the apartment; on the other side were a 1960s-era bathroom and two bedrooms. “Our electricity comes from propane tanks and generators that are located behind the clinic,” Mama Joe explained as she showed Leslie around the homey, nicely provisioned kitchen.
Leslie nodded appreciatively. “I must admit I’m relieved to know that everything looks pretty normal.” She grinned a little sheepishly. “I was afraid that things would be a lot more primitive—like cooking over campfires.”
Mama Joe and Naomi laughed. “We have to be fairly modern,” Mama Joe explained. “In addition to holding my milk and eggs, the refrigerator is needed for some of our medications and vaccines, and we need electricity to filter water and run the autoclave.” Her smile faded. “AIDS is such a threat, we have to be able to sterilize equipment. Later on I’ll introduce you to the generators and water filtration system.”
Titus entered the kitchen carrying Leslie’s bags and proceeded toward the two bedrooms, which were accessed through a short hall off the kitchen. “Titus and Naomi have been working for over a week to get your room ready.” Mama Joe gestured for Leslie to follow him, and under her breath she whispered, “I hope you like blue!”
The warning was appropriate. Titus set her bags down in a room with cinder-block walls that had been painted a soft blue. Blue-and-white gingham curtains adorned the windows, and the single bed was covered with a lightweight blue cotton spread.
“How did you know that blue is my favorite color? This is wonderful!” Leslie exclaimed as she gave Titus and Naomi a smile of thanks and shook their hands in appreciation. She managed to suppress a grin as she looked around the baby-blue room, grateful they hadn’t chosen pink.
As Leslie lifted one of her bags onto the bed and started to unpack, Mama Joe pointed to the mosquito netting hanging from a hook above the bed. “Other than vigilant attention to HIV precautions and the water filtration system, using that net is probably the most important thing to remember. Long-termers don’t generally use drugs to prevent malaria because of the side effects. Instead, we rely on insect spray and nets. If, God forbid, we do get malaria, we just treat it.”
Leslie nodded, studying the netting. “I’ll be careful.” She hung several shirts in the small closet. “Have you had malaria?”
“Yes, a couple of times. It’s not fun, but with the right antibiotics, we can treat it quickly and effectively. But always sleep with the net.... Oh, and another thing. It’ll help keep the spiders away.” Mama Joe turned to walk toward the kitchen. “While you unpack, I’ll come up with something for supper.”
Leslie frowned as she watched the retreating nurse. Glancing warily around the room, she whispered, “Spiders?”
* * *
LESLIE’S FIRST DAY in the clinic was a trial by fire. Over a breakfast of scrambled eggs, toast and fruit, Mama Joe outlined the course of a normal day. “Titus opens the compound gates at seven. There are almost always people waiting. We have some scheduled appointments, but most patients are walk-ins.” She took a bite of toast. “Once or twice a week we’ll get calls on the telephone or radio to assist people from other villages within a sixty-mile radius. Those are usually emergencies, like accidents or difficult births.”
“When do we stop?” Leslie pushed the eggs around her plate. Her appetite was negligible. She ran her hands across her khaki skirt. Although she had several years of working as a nurse-practitioner in clinics, she felt ill equipped for her new role.
“Normally, things start to slow down midafternoon. We try to be finished by five or six.”
Before she began to see patients, Leslie met Elizabeth and Agnes. Elizabeth, the receptionist/ bookkeeper, was a couple of inches taller than Leslie and very slender. She was probably in her late twenties or early thirties, with a beautiful complexion and very short kinky hair. Agnes, the clinic’s housekeeper, was a bit older—Leslie guessed she was probably about forty. Barely over five feet, she was slightly plump, at least by Kenyan standards.
Leslie quickly learned that Agnes’s English was somewhat limited, but Elizabeth’s was very good. “Whenever you need help translating or have a question, please ask, and I will drop everything.” Her eyes were sincere, and her smile was infectious. Agnes was much shyer, although just as welcoming, and both women proved to be eager to help Leslie settle in.
Throughout the morning and afternoon, Leslie was introduced to a vast array of maladies, many of which she had only read about. During the first part of the morning, she followed Mama Joe and Naomi and quickly learned how to treat malaria, dysentery, scabies, intestinal worms and an assortment of venereal diseases. The variety of cases was amazing, and prenatal checkups were interspersed with the suturing of small cuts and treatment of dermatological complaints.
For the most part, the problems were routine and could be managed with simple instructions, basic first aid and, occasionally, medications. The day flew by, and it was after six when the last patient left.
“Whew!” Leslie exclaimed as she looked around the empty waiting room. “That was exhausting! Is it like this every day?”
“No. Sometimes we get really busy,” answered Mama Joe. Seeing Leslie’s astonishment and slight panic, she grinned. “Just kidding. Actually, this was a fairly heavy day. Normally we see about thirty or forty patients. Today we saw more than fifty.”
“That’s a relief,” Leslie replied. “I don’t know how we’ll manage this many patients without you.”
“We always seem to take care of everyone. If it is really busy, we’ll work faster.”
Leslie helped the other women prepare for the next day before realizing she was starving. Thankfully, Agnes had prepared a hearty supper of vegetable soup with bits of cut-up chicken and rice. She and Mama Joe sat at the kitchen table, eating hungrily, all the while talking about different cases and how to manage various problems.
That night—after checking her room for spiders—Leslie crawled into bed exhausted. As instructed, she carefully arranged the netting to insure she was completely covered. In the quiet darkness, she allowed her thoughts to settle...and realized she was happier than she had been in a long time. She was smiling as she fell asleep.
* * *
IN THE SEVEN YEARS Leslie had been a nurse, she had never lost a patient. On the second day of practice at the Namanga Clinic, she lost two. She had been warned multiple times before she took the assignment that death was common, and she thought she was prepared. She was wrong.
Leslie slept well and awakened refreshed. She felt confident and quickly began seeing patients alone, occasionally seeking Mama Joe’s or Naomi’s advice on how to manage a new problem. The morning went smoothly, but around noon, an expressionless young woman carried a small baby wrapped in a colorful cotton cloth into the exam room. The woman gestured to the infant and said something; Leslie recognized the Swahili word for baby. She nodded, smiled and indicated the exam table. As the woman placed the infant on the table and unwrapped it, Leslie felt a chill. A quick visual inspection revealed an emaciated face with half-closed eyes and loose skin. Gently, she touched the infant’s chest and discovered an unnatural coolness. There was no hint of movement. As she positioned her stethoscope to listen to the baby’s heart, she yelled, “Mama Joe! Naomi!” The other nurses appeared within seconds.
“I don’t hear anything,” Leslie whispered to Mama Joe as the older nurse picked up the limp form and gently rubbed its back, trying to elicit movement. Like Leslie, she pressed her stethoscope