Andy

Andy showed up to Monday clinic yesterday. As many do, he has waited until he is very, very sick to come for testing and care. In triage, I find his BP is 76/50, heart rate 130, temp 39C (axillary) and weight at 48 kg (for a man who is about 5’10”). He walks only with assistance, and is so shaky I cannot trust him to make his way to the doctor’s room alone.

Later, another nurse gave him an injection of gentamycin and sent him home with an IV drip (luckily our clinic driver was around and took him home in the truck) that would hopefully rehydrate him a bit. We planned to visit him today on homecare.

Andy is staying in a house his uncle is helping to rebuild/refinish. As is common, his uncle is allowed to “squat” in the home while they are working on it. The house is un-adorned cement, windows and doors gaping holes to the world of wind, rain, and insects. We find Andy awake, on the porch slumped in a wicker chair. He is shaking, with the tremors in his left hand getting worse. The cannula that we left in the right hand is still there, but is open and dripping blood occasionally. The other nurse caps it off. I shudder.

Andy is kind of staring, kind of wide-eyed, and I wonder how mentally savvy he is right now. Because my Luganda is not up to a mini mental exam-caliber, I trust the others when they say he is “ok”. I try his blood pressure (80/60), his temp (still around 39C), and his heart-rate (about 140). In these situations I can never help but think what I might do if I was back at Dartmouth. Something, anyway. Our clinical officer opts for another two liters of IV fluid (we are out of normal saline these days, until the drug order comes in, so a combo of D5 and LR will have to do the trick). Another few antibiotics. The other nurse and Andy’s uncle help Andy out of his wicker chair, and half-carry him, half-lead him through the very empty shell of a house to a back room, where there is a well-worn mattress on the bare-cement floor, and a chair holding andy’s medications. The drip from yesterday is hanging from a nail on the wall (uncapped). Christine discards it and hangs the new drip. Explains the medications. I stand around, mute. The barren-ness is awful. Although I realize that it is great that Andy’s uncle even has a roof and a mattress to offer him, I can’t imagine that this very chilly room with a mattress on the bare floor is at all a place of rest. I pray for Andy. We are about to leave, when Francis suggests I give him some food out of our supply in the back of the truck.

Food, I’m told, is not a sustainable program. This, I realize. Nor is it fair for me to “shower” our clients with food while I’m here, and then leave the clinic staff to answer for the absence of food after I am gone.

I realize that it may be very, very selfish of me to insist that we bring food on our visits (and by the way, I am so thankful on behalf of the clients for those of you who are helping them in this way). I realize that it may be my very American/western character that wants to “hand something out,” instead of just walking away and trying to forget it all until I come the next week and enter into the private hell of Andy, or any of our other clients.

I suppose it goes with the territory, of working here. We (Americans) have a history of walking into desperate situations and trying to throw a quick solution on it, money, candy, whatever. This is one of the reasons I wanted to work with MCC—it has a history of a being a relief and development organization that emphasizes being in relationship with your community—focusing on the relationship as being the lasting impact, and the vehicle by which one can accurately assess the needs of the community and the offer assistance as a friend, rather than as a “benefactor” or “donor” or “rich white stranger that will never come again.”

Still, though, sometimes I really want to forget about sustainability and relationship (should I try to befriend Andy before I give him food? Would that make it a ‘better’ solution? In reality this is not possible- he is sick and hungry now!) and just staunch the flow of blood, if you will, so that the individual will live long enough to benefit from a “sustainable” solution to their problems.

It really doesn’t help the guy to have a fishing pole, if he is too hungry to learn how to use it.

Anyway, the end of the story is that Andy didn’t get better, he is now (as far as I know) admitted to the government hospital (from which he will be lucky if he comes out alive). I have no idea if the food we gave him helped that day, or for two days, or not at all. Do you see how it can be a bit discouraging and confusing, to know how to proceed in these situations? The jargon of development doesn’t give me much help. I pray for discernment, and for wisdom. And for healing for Andy.

Peace.