Nurse in Kenya: my hero

“Not all of us can do great things. But we can do small things with great love.”

- Mother Teresa

Sunday comes a day late this week. It’s Monday morning and I’m writing to you all, with heartfelt apologies to those who have asked where the week’s blog was. Sometimes it’s hard to believe that people actually want to read this stuff – emotional drivel interspersed with cute anecdotes about the kids – but then I realize that it’s not quite about what I think… and probably not even about what I write either. Besides, I hope it’s more about the message of what lessons the children, and God, taught me this past week.

Last Sunday we said wished our Canadian team of visitors “safe travels” as they returned home after their two-week visit. Toward the end of their stay I was, as I mentioned, under the weather with my first bout of malaria, and I wish I could have spent more time connecting with each of them personally. Their generous contributions continue to bless our children. I’ll tell you about one of my favorite examples of this.

We were so fortunate to have with us a seven-year-old girl, Kathleen, here with her parents. For some time before the trip she worked very hard to accumulate a stock of something valuable to her, which she thought would be valuable to the children here. She brought fifty pounds of a particular gift, which she had requested from friends and family. What did she offer them? Stickers.

It might seem strange, you think, and you might even ask, “Isn’t there something more practical with which to bless these children than stickers? Really, they’re colorful and fun, but they don’t last long. They fall off, get dirty, get lost, and are quickly forgotten.” Maybe you didn’t think that; maybe it was just a part of me that thought that, for half a second. She left for me dozens of sheets of stickers, and I had an idea…

Kenyan nights seem to be a running a special on malaria, especially among the little kids. I usually have to administer a few intramuscular injections to the kids every day and occasionally someone needs an IV antibiotic too. Splinters and thorns on the soles of their feet – most of which go unnoticed until they form a painful, pus-filled blister (sorry, gross, I know) – are also common as they often disobey our instructions of “mevaa viatu vyako!” (wear your shoes). Pretty much every day I have to pull out a sharp object in front of a child and nine times out of ten they need to be held tight by one of the staff (usually Ray, sometimes Adam or Carla or Jeff, and lately Rachele, who I’ll tell you about; thanks for your help, if I haven’t said it enough) while they cry and sometimes kick and scream and writhe around in their arms. I do all that I can to make the process quick and painless. There’s usually a deluge of tears, a drizzle of snot, and a trickle of drool involved. I dreaded it in the beginning, but have come to accept that without this life-saving method of medication administration, these children could suffer the fate that many other children in Africa will suffer today and everyday: malaria-related mortality.

After the shindani (injection) has been administered, the kids usually get hugged and swaddled and rocked until they stop crying. I try to do this myself so that they learn that I’m not just Miss Pain, the Big Bad Nurse, but that I can give them their shot and then comfort them too. I worried that they would all be afraid of me since I’m the one who gives them their shots most of the time, but so far it seems that being able to comfort them has helped prevent this. There are one or two babies who have had relapsing malaria and have required two or three rounds of injections that do cry the moment they see me, but even they are learning that I’m not all about the needles. It’ll take time and trust. It’ll happen when they’re ready.

I’m happy to share with you a new way that a little girl’s love has changed the aforementioned experience for our kids here. I have such an abundance of stickers that as of this week, every time a child gets a shindani, they get to pick out one sticker afterwards. Usually each round of medication is for three days and I’ve found that this week, more so than in weeks past, the children seem less afraid on administration days two and three than they were. I haven’t conducted any peer-reviewed, double-blind studies about this phenomenon. Even if I had, and had noted a correlation between preemptive alleviation of anxiety responses in In Step Children related to post-injection sticker selection, I could not imply a causative relationship. Obviously I’m kidding – I’m pretty sure they’re less freaked-out about getting stabbed in the leg with a needle because they remember that cute sticker they got to show off on the previous day. When someone comes to the med room for a bandage or for medicine and they see the box of stickers, (unintentionally and coincidentally in a reused box that once held syringes, with a picture of it on the outside, I realized today) they always ask for one. I remind them that “stickers are only for when you get a shindani.” Over the past few days I’ve gotten used to the kids passing by the kitchen window and calling to me, as I’m washing dishes or medicine cups at the sink (when everyone else isn’t doing it for me, thanks again), “Julia! I want a shindani!”

Actually, it’s not totally true; sometimes they get stickers for other reasons, too. This past week I also gave out stickers to Tracey, our little munchkin who is still getting regular dressing changes after her scalp reconstruction surgery; she had been severely burned before coming to us. The little tyke who fell backwards into a table and sustained a one-inch scalp laceration on the back of his head also got one, after we stopped the bleeding, shaved his head, and Steri-stripped the lac closed. Our darling James also got one, after a lengthy and painful excision of a large thorn buried deep in his foot. I let Ray have one too after he volunteered to have an injection of sterile water, when one of the little girls was so terrified to have her shot; he wanted to show her that it wasn’t so bad (as a matter of fact, he said it actually was pretty bad).

I wish I could convey to you how much of a little relief it is for me to be able to do something for these kids that doesn’t just get them to stop crying, but makes them smile, after a painful and almost traumatic experience. I have even considered if it would be better to have the local doctor and nurse administer all of the injections because then the children would not have mixed feelings of anxiety around someone (me) who is trying to show them guidance, affection, and love. Still, I try to help them understand why we’re doing what we’re doing, that they’re not being punished; I try to help them connect the fact that this is a necessary step in their getting well.

It’s during these conversations that I have to remind myself, “Julia, I know you don’t like doing this. Of course you don’t like to cause them any pain. Just because you’re causing them pain doesn’t mean you don’t love them. Sometimes pain is part of love. You’re doing this because you do love them and because it’s your job to take care of them. Sometimes the most loving thing to do requires causing a small amount of pain to prevent a great amount of harm. And don’t forget, there is no harm in love.”

Most of these kids are too young to cognitively and emotionally embrace the concepts I repeat to myself, obviously, as I struggle with them in my own heart. Maybe giving them a sticker afterward is a cheap trick; an easy way to try and make it all better before it really is. These kids will learn, if they haven’t already from their time before being sent here, that usually we are not handed a sticker after every pain or heartache. They know, whether they realize it or not, that life is not fair. Frankly, I don’t care whether or not I am setting the wrong precedent by rewarding them for the challenges they endure in my med room; I don’t think it’s fair that malaria exists, that they become infected by it, and that I have to cause them more pain by treating it. I’m just trying to level the playing field of fairness. Maybe that’s what we try and do for people we love.

Kathleen, her family, and the rest of the team gave these children a true gift. While it may have seemed insignificant or impractical at first glance, it is clear to me today that the opportunity to comfort a child in this very small way has far more than first anticipated. These children teach me every day that it is not so much what we do, but with how much love it is done, that really matters. I find a deep spiritual significance in the fact that this seemingly small gift came, ultimately, from one child to another.

This week, in our evening Bible study, Ray, Adam and I (Carla, Jeff and Beth Ann were away), along with our visitor Rachele, (about whom an entire entry will likely be written) finished reading the letters of St. Paul to the Romans (that’s how I remember hearing them introduced, growing up Catholic). One line jumped out at me, from Romans 13:10 :

“Love does no harm to its neighbor. Therefore love is the fulfillment of the law.”

We discussed this phrase, along with other verses from the book, and it sparked a conversation regarding the nature of love. We each shared our thoughts and experiences, citing other verses and quotes that were meaningful to us. We talked about the failings of the English language in its oversimplification of the word, the different types of love, and the first-hand experience of feeling love versus acting in love. Given the Biblical, spiritual, intellectual, and emotional aspects of the phenomenon, our conversation eventually led to the asking of a question, the answer to which still drives me, or pulls me, on a daily basis.

Is love a choice?

I know that love is more than a feeling. Having studied the brain in college, and becoming disillusioned to the neuroendocrine and psychochemical basis of “love”, it is my personal view that many of the “feelings” we experience in “love” are not actually the manifestations of the purely intentioned fruits of the spirit described by Paul. Having read a few books on the mechanisms and pathologies of psychological attachment, and having made more than a few mistakes of the interpersonal nature in the past twenty-five years, I am convinced that the word “love” is occasionally, and unfortunately, hijacked by a variety of unhealthy emotions and relations: the fear of being alone, the seeking of external validation, a lack of self-esteem, disorders of self-image or personality, desires for control over another person, sexual impulses or pursuits, or frank dishonesty. In today’s common culture of the media-driven mind, the word “love” has become casually used and easily discarded. I personally have suffered a long-term, deep-seeded confused regarding this word; I’m not sure I could define it for myself today. Nevertheless, I am loved, and I do love, in ways that surprise me; I experience love from people and toward people that surprise me every day. It happens a lot. It is the thing that I know the least about and think about the most.

Earlier this week I stopped by the girls’ bedroom (three or four double- and new triple-decker bunks, mosquito nets over each portion canopied like a princess bed I remember dreaming of when I was little) for a late night med pass: amoxicillin/potassium clavulanate for one girl, dexamethasone/neomycin eye drops for another, and miconazole cream for a few more. The princess needing the eye drops seemed to be in a foul mood, so I prescribed and administered one round of tickling-her-to-the-ground followed by one episode of abdominal raspberry-splurting. The treatment was effective: uncontrollable laughter, a big smile, and an end of the silent treatment. Of course, with eight or ten other girls in the room, with more in the hallway rubbernecking and traipsing in, my services were about to be in high-demand. As I found myself on the floor, having tickled eye-drop princess to the very spot herself, I was attacked with hugs and kisses, and before I knew it, I was the one to whom the tickle-her-to-the-ground treatments were being administered. Here I was, taken by force by a bunch of girls aged four to ten, practically in tears from laughter, on the floor. Before long they were all piling on top of me, hugging me, kissing me, giggling all the while. They had me subdued, literally, and I wasn’t fighting it too hard. After experiencing a few moments of an intensely carefree, uninhibited joy, I staggered to my feet.

Again, I was bombarded by little arms reaching up to my waist and some even to my shoulders, hugging me and tickling me and making all sorts of attempts to assist in my return to the floor. I carried on with them for a few minutes but after a while I was tired and excused myself from our revelry. I turned toward the door where I saw Michelle, who of the darlings who had piled on top of me just a moment prior, reach her arms up to me once again. This time, she spoke, with an innocent smile that seems to “run in the family” of these kids. Her bright eyes were wide and her two front teeth, with a little gap in the middle, shined up at me. She spoke without inhibition, without pride, without fear. She spoke just three words.

“Julia! Love me!”

I felt the smile drain off of my face along with all the blood I had from the neck up. I’m pretty sure the whole world stopped spinning for a second. At least, mine did.

I felt my face pull the corners of my mouth back up and my eyes squint as I asked her, “What, Michelle?”

“Love me Julia!”

There it was again.

At this point, the rest of the little girls catch on, and start chiming in. A staggered chorus, like that which is well-rehearsed in a round of “row, row, row your boat”, belted out their demands.

“Na mimi! (And me!) Love me Julia!”

“Julia, love me!”

“Love ME!”

I did everything I could to give each of them a hug – a real, heartfelt, eyes-closed, take-a-deep-breath, hug – and a kiss on the head that night. I put my hands on the sides of Michelle’s face and gave her a big kiss on the cheek. We said goodnight and I walked back through the main house, through the veranda, to the adults’ hallway. I smiled, shook my head and laughed to myself, “If they only knew. If it were only that simple.”

Maybe it is that simple.

I sat on the couch in the hospitality room and was stunned. Although I am unfamiliar with what each of them imagines the meaning of the word “love” to mean, I know what I imagine it should mean in this context. These beautiful girls, some of whom were abused, all of whom abandoned or given up or removed from the care of the incapable, looked me in the eye and asked me to love them. That’s a privilege I have never experienced. That’s a responsibility never before asked of me.

I was inspired by the courage of that little girl, Michelle. How vulnerable she was to be the first to ask that! I am convinced that no human being on the face of this Earth could have uttered a more honest phrase in that instant. Was she not speaking the deepest desire of all human beings? Was she not sharing a little slice of her perfectly innocent dreams with me in that second? Was she not brave for looking to someone she barely knew and asking for the thing she needs more than anything in the world? She was my hero.

She made a demand, but it was really a request. In that request is a question.

“Will you love me?”

How many arguments, misunderstandings, and disagreements are based on the fear that the answer to this question is “no”? How many questions like, “does this make me look fat?” or “can you spare some change, miss?” or “would you like to go back to my place?” really ask this deeper question? How many millions of dollars and thousands of hours are spent wasted trying to get people to “love” us by our corporate attempts to change who we are, thinking we will finally be worthy of a love currently unavailable to us? What have I said and done in my life, dishonestly, in a profound internal and external miscommunication, that pointed to this question all the while?

I can tell you that for me, the answer to this question is a scary one. I told Michelle that night, as I tell you now, “I’ll do my best, but I’m not perfect.” With that little girl, and her peers, the answer to the question is automatic, on the tip of my tongue, from the back of my mind; from the pit of my stomach and the depths of my heart. It comes naturally felt but is also a conscious decision.

Of course I’ll love you.

But that’s not all I want to say.

Of course I’ll love you the best that I can. I’m not perfect and I can’t love you perfectly. Only God can do that. I’m going to make mistakes and let you down, just like you’re going to make mistakes and let me down. Our struggles can be worked through, though. I’m not even sure of exactly what you’re asking me but I know that I feel like God brought us together for a reason and I want to do my best to take care of what has been entrusted to me.

I don’t normally tell the children nakupenda (I love you) anymore. I said it a few times last year, and a few times this year, but I feel like it is a promise and a responsibility I am afraid of breaking. Sometimes they say to me nakupenda or even nakupenda sana (so much) and I reciprocate. I just sincerely hope that my actions demonstrate to them that I love them to the extent that my words are unnecessary. And I don’t just hope this for the kids. I hope to demonstrate my love the best that I can to all of the important people in my life. I’m finding that this can be a major challenge when words are all the actions that are possible, seven thousand miles away, for those of you reading “at home”. I’ve been fortunate enough to discovery opportunities to do so in person, and am grateful for your reciprocation, for those of you reading over here with me, “at home.”

I’ve come to believe that the only person who ever loved perfectly was Christ, and that the only source of pure perfect love in the universe is from God. I believe that it is through my appeals and petitions to Him that he allows me to experience these supernatural and transcendent connections with the other human beings here, whether they are eight or twenty-eight or forty-eight. I’ve found that by opening myself more to His love toward me that I have been ever more willing, and surprisingly capable, to convey my own love to others. I suspect that there is no limit to the amount of this love that can be channeled. Just when I am sure my heart is about to rupture and burst open in my chest as look at these precious babies as they sleep in their cribs, for example, it seems to stretch a little bit more, and then accommodate a greater exchange of these spiritual gifts. This all happens amid a sea of distractions and stresses, completely imperfectly, with a regularly persistent petition to God. It is work. I feel it too, though. Sometimes it is a choice that is very hard, and sometimes it is effortless and easy. Maybe I know next to nothing about this love stuff. After all, I’m just twenty-five-year-old girl: unmarried and without my own children. What do I know about love?

On Friday night just after dinner, I heard the social worker walking down the hall with a little girl. She called to me for assistance, and I saw Michelle walking into my med room with blood dripping from her mouth and down her shirt. Tears were stuck on her face; tiny clear drops that stayed on her cheeks with trails of salt coming from her eyes. It looked like she had fallen and split her lip open. After I held some moist gauze over her lower lip, I wiped up the blood, most of which was dried. It looked a lot worse than it was, and within a minute or two there was no bleeding at all; it was hard to even know that she had been injured. I talked to her at the end and told her that she was all okay, that her lip would hurt but that it would fix itself, and that she could go get ready for bed. She said nothing, but turned her eyes to me, and grabbed my face with her tiny hands, and pulled her lips to my cheek. She gave me a big kiss just like I had given her. She gently put her arms around my neck and hugged me. I let go and she backed off and looked at me with still-watery eyes. I smiled.

Then I grabbed the box with the picture of the shindani on the side, and handed it to her.

“Pick out one sticker,” I said.

That’s what I know about love.