Nurse in Kenya: home away from homesick

"Although the world is full of suffering, it is also full of the overcoming of it." - Helen Keller

I feel like taking a big sigh of relief. ::sigh:: Phew. Glad that’s over. What? Oh, I was sick again. Yeah, I guess I can talk about that.

I didn’t write this past week at all. This time I was not too busy, I was just beat down by the apparently bi-weekly dose of Strange African Illness. I know some of you back in the States have been concerned about my health over here and I want to tell you first and foremost that I am better, that I am alright, and that as a medical professional I am not seriously concerned about being ill the handful of times I have already been since I arrived. Really, I'm okay! Today I'd like to tell you why.

In my daily practice with the children and staff, I encounter one illness above all the others. Malaria, obviously, is endemic in this area, with tenacious strains requiring high-powered anti-malarials to clear the parasites from my patients’ blood. Some people, especially babies, can become seriously ill. Others, especially those who have been exposed to the parasite since birth, usually don’t become more ill than the “flu” makes us back in the states, at worst. For some, it’s just like having a mild bug, even.

Malaria is caused by the parasite species Plasmodia; the most prevalent strain here is one of the most severe, Plasmodium falciparum. We call this “falciparum malaria”. The “eggs” (gametocytes) of the parasite are carried in the body of the female anopheles mosquito, which bites between dusk and dawn. After it bites you, the “eggs” travel to your liver, where they invade some of your liver cells and set up camp. They mobilize some of your liver cells’ resources against you to make early forms of the parasites themselves. Your liver becomes a kind of “home base” for the disease. At some point, at the end of the incubation period of the illness (usually five or six days up to weeks or even months), a special type of parasite cell leaves your liver and enters your bloodstream. As many of them do this at once, now entering the “erythrocyte phase”, the red blood cells are attacked and the parasites feed on the hemoglobin (iron) to thrive. Someone with malaria would now experience clinical signs and symptoms of the illness such as headache, lack of energy, nausea, vomiting, diarrhea, body aches, and fever. The red blood cells then become like satellite hubs where more parasites can be made. The parasite bodies, known as schizonts, can stick to each other and then get themselves deliberately stuck in capillary beds (areas where blood vessels decrease in size to the microscopic level) and impair organ function. Complications arise from this feature of the illness especially, as parasites can even cross the blood-brain barrier (protects your brain from certain things in your blood) sometimes and cause serious damage to brain tissue. “Cerebral malaria” can cause anxiety, paranoia, hallucinations, psychosis and coma, eventually leading to death. Without treatment with antimalarial medication, thousands of people in Africa die every day from malaria. There is no vaccine for malaria (though some of you may heard in the past few weeks about a promising vaccine) and the only treatment is with oral or injectable drugs.

So, I’ve had malaria a few times. With that description, you might wonder why I tell you not to worry. There are a few more things that you should know.

Although malaria is not like a disease you can get once and then be immune to, like the chicken-pox, in most cases, the body does seem to mount some kind of immune response to the parasite. Adults who have lived in Kenya all their lives don’t get nearly as sick as adults who are infected for the first time. Babies here, after the residual immune effect from their mom wears off, can get rapidly and critically ill from malaria. I’ve seen adults here become suddenly and violently ill who have never previously been exposed to malaria. I’ll generalize the demographic to say that the more times, and the more severe, you’ve had malaria, the better your body should be able to do at least some of the work. As this happens, people here seem to just recognize a few symptoms that are unique to when they have malaria, recognize it, and seek treatment early, avoiding the complications. I’ve never seen an adult or baby die from malaria here so far, thank God.

The reason I am made well from this illness is because we are blessed to be in an area, and in a position, to have access to a reliable supply of antimalarial drugs. The government doesn’t give them out – they have to be purchased at the pharmacy. Most of them that really get the job done are not cheap, but they’re worth the money to the sufferer and their loved ones. I feel extremely grateful to serve in an area where I don’t have to fear for my life, like countless children in Africa do, because of this illness. Sometimes I wonder how many of our own children here at In Step would have died from malaria if they weren’t with us. After that I usually wonder how many more children would be here, who died after being abandoned outdoors, who we’ll never have the chance to love.

In the past week I was on treatment for malaria, but also for some “other” illness that caused fever, severe (and I mean severe, like the worst in my whole life) abdominal pain and its consequences, and left me in my bed for several days, wondering if I’d ever be able to do my work again. I’m a bit of a baby when it comes to these things. I too my medication as directed, however begrudgingly. Here, the primary site of intramuscular injection is the “dorsal gluteal” (the upper lateral quadrant of the buttocks) but is known in the developed world to be associated with sciatic nerve damage and chronic pain, so I don’t get my injections from the clinic here (it works for them, I respect that, I just want something different) and I just do it myself at home, in the “vastus lateralus” (the anterior thigh, where the “Epi-pen” goes). This is where the kids and staff at home here get it too.

I guess there’s a lot that goes into being sick. I guess there’s a lot that goes into being well, too.

I have to say, though I really wish I could not, that my physical illness was not the only one that surfaced since I last wrote to you. I had been warned that homesickness was an inevitable part of my experience here, and I had wondered what that would feel like and how it would affect me. I was starting to understand how it felt before I came down with this last bout of “whatever”, but when I was in my bed not feeling well, just thinking, I couldn’t help but notice my mind wandering to some truths which I only reluctantly acknowledged.

“If I were back in the States, I probably wouldn’t be sick right now.”

“When I get better, I can’t wait to go to Wegman’s and get some of that ice cream I lo--… oh, wait.”

“The toilet paper is nicer over there.”

“This would be a great time to just vegetate in front of my Netflix Instant Queue.”

“I want my mommy.”

It’s alright, I am laughing about this now, but I don’t mind acknowledging these things in this forum. Even when I’m not sick, there are things that I am really starting to miss from “back there”, and it’s requiring me to look deeper into myself, toward God, and toward the people that love me, to be reminded of not just how but why I got here.

A day or two ago I asked Mama Carla, “Mama Carla, did you ever ask God why He had to send you to a place where there was so much personal sickness?” She replied something like, “Not really. I knew [Jeff and I] were called here, that this was where God wanted us, and we were just willing to deal with whatever came along with it.” I had asked her expecting a laugh, and her saying something like, “of course, but you get used to it,” or “don’t worry, we all go through that,” but instead I got a real answer that I apparently needed to hear. Now as I write, I realize that I never actually asked God that question myself. I did wonder for a second – “God called me here and now I’m sick. Does that mean He wants me to suffer?” I answered that question myself quickly: absolutely not. That would be like a child saying, “my mother gave birth to me and brought me into the world, and now I am experiencing a challenge. Does she want me to struggle?” As a pseudo-mom to the kids here, giving them love but having to discipline them too, I know that’s not true. I even heard myself ask, “God didn’t call me here to be sick, so maybe since I have been so much (every two weeks) that means I’m not supposed to be here.” God probably didn’t call me here to hang out with Ray and watch Star Trek once in a while either, just as an example, but just because it happens doesn’t mean that it I’m not supposed to be here to take care of the kids.

I’d say that I came here for the sickness, but it’s not true. I came here to try and do a few little things that would make it easier to keep everyone well, and then be more able to do what God calls them to do. For example, Beth Ann is called to teach and take care of the big girls, and when she’s sick I am happy to take care of her, knowing it will help her to get back to the kids’ wing of the main house faster, as she feels better and gets better. When the kids are brought down by malaria again I am glad to give them their medicine and comfort them, believing that what I’m doing will help them to get back to what God calls them to do – learn, play, and grow.

I’m just now considering for the first time (literally, as I write this) that I never thought to approach taking care of my own illnesses the same way. I hate being sick. I spend most of the time whining to everyone about how I should be doing my work, how I have no motivation, and then apologizing for not accomplishing my tasks and then asking for help. I usually feel guilty most of the time when I’m resting up, even when the doctor explicitly tells me that I have to rest. I often think, “I came here to take care of the sick, not be the sick.” Based on what I said in the last paragraph, I’m now seeing that this simply isn’t a fair perspective to take on myself. I knew I was going to get sick. It’s totally natural that when we’re uncomfortable and are actually feeling what the challenge really entails that we can get scared and angry, losing perspective from to time. Apparently, for this chick who spent most of her years living on Long Island with life handed to her, losing perspective means feeling sorry for herself and fantasizing about the comforts of “home”. It’s okay.

Being sick is a part of being human. Not one of us has ever been, is now, or will ever be, exempt from illness, whether it be physical, mental, emotional, or spiritual. Sometimes illness is a necessary barometer to indicate that something is out-of-balance in our lives or that something has to change. Sometimes it is a result of choices we’ve made, and other times it happens just because we are vulnerable to another life form, substance, or force. Regardless of the illness,or its consequences, I’ve seen God act in all forms of illness to do everything from cure chronic diseases with statistically dismal outcomes, to allow the traumatically injured to function in a way never before imagined, to bringing the mentally ill back to life from a real hell of psychotic torture, to mend a broken heart and give it new life. I experience His healing power every day – I see it all around me as He keeps our kids well (I am astonished at how few kids have malaria here, actually) and protects them from injury and disease. I learn about His incredible love through stories of how He enabled His servants to overcome unbelievable circumstances – like when Mama Carla told me about those three months, years ago, when she had malaria seventeen times in three months before becoming well. The power of God in healing disease is real. I believe it, I trust it, and I depend on it, as much as I depend on Quinine, the most powerful and last-resort antimalarial I have to fight the parasite. I prayed through my illness and immediately after I got ideas about what I needed to take and what I needed to do to get better. I prayed through the pain - and remembered that if anyone knows anything about pain it’s Jesus Christ – and it was so much easier to tolerate. As I pray about feeling homesick, missing my friends and family and even my grocery store, I feel the Lord allowing me to take a new perspective, grateful that I have had the opportunity to experience so many luxuries in life, and still having all my needs – and ninety-percent of my wants - met here every day. I’ll get sick again and I’ll take meds and pray and He’ll heal me again and put a smile back on my face. I trust Him with my life. I trust Him with the lives of the babies I love. I even say this knowing that some have died here. He was there and taking care of them too, and Knew something we can’t. Medication is critical, but God is the Real Healer. He works when we pray.

You don’t have to take my word for any of this. In fact, I’d wish you wouldn’t. If you’re not sure, and you’d like to know more, I know Who you can ask about it.

After all, when I was sick in the States and the doctor told me that I “would regret it for the rest of my life” if I went to Kenya, I prayed. I took the meds too. I asked God all about whether or not He could heal me, and asked Him to not even being totally sure He could. I waited for His answer in my heart – I wanted Him to tell me whether or not He would heal me. I was getting discouraged, not being told the answer.

Until He showed me.

This is why I tell you that I’m okay. This is why I tell you that I’m not concerned and that you shouldn’t worry. Trust me: I’ve got powerful medications and a Great Doctor.

Bonnie chowing down

Dorcas - I asked them, "show me how you eat." I was tempted to say, "show mommy how the little piggies eat!" (A Christmas Story) She did this all on her own.