07/28/07

Thoughts \ Developed Thoughts \ Rants \ Raves \ Writing

06/29/2005 19:27 +0200 GMT

The Walk of Mourners

I have a notebook that I carry with me. It's something I acquired from an HIV meeting or some-other function along the way in the last 8 years. On the notebook's cover are inscribed the brand names of four HIV drugs. Two or three of these are now available in Lusaka, but weren't available when I first arrived here in Lusaka with this particular notebook in hand.

Here I sit transcribing a painful memory from that notebook, two or three years past now. It's about Lisa's son, my sister-in-law's eldest son, nicknamed Boba. It's taken me this long to face this pain again. It is in honor of Boba, and all of the Zambians who have suffered the loss of loved ones in the course of this terrible HIV plague. I hope that you will honor Boba and countless others by reading it with an open reading frame, using both heart and mind.

In entries from 2005, I believe that many of the sorrows that are portrayed here will have been averted. That is my hope, and that is my personal mission in the years to come.

*    *    *    *    *    *    *    *    *    *    *    *    *    *  Year 2001

It is difficult to describe the horrors of the University Teaching Hospital in Lusaka (UTH). We brought Boba there because of his laboured breathing, and the guards would not permit entrance at first.

'Who do you think you are,' the guards asked Maggie while holding a steel gate closed across the driveway.

'Who do you think you are talking to?!' Maggie replied with force, a pointed finger, and a look that I know leaves the recipient with no questions.

The guards relented.

The emergency department is called 'Casualty'. The rich stench of urine permeates even the yard. Windows lay open without screens, and when a breeze moves throughout the extensive compound of buildings, the smell is circulated, but never abated. On a white sign with red lettering reads a warning: 'You are entering an area of high risk for cross infection of T.B., meningitis...' I stopped reading beyond that. The sign is the only new-appearing thing in the place.

There are four dividing walls in casualty. The acute bay is the first on the left. There is no oxygen available in the first bed, and the other three are occupied. No curtains are available between patients. We were fortunate that the on-duty physician was the brother to the late Sheba Chali, who is a friend, so he was attentive. With competence, he started an IV on the back of Boba's left hand with the first attempt. Aminophilen (sp?), a bronchodilator, was administered. Intubation was considered, but no ventilator was available. (They checked in the ICU-  no vent available in all the hospital.).

Visiting hours are two. 18:30 to 19:30 in the evening, and 06:00 to 07:00 in the morning. We checked Boba into Casualty at about 20:00 hrs. If one  looked quickly, the beds in Casualty would appear empty; the degree of emaciation is so severe in all of the patients. My assumption is AIDS, but illness takes its toll in so many forms in Zambia. An assumption of AIDS is incorrect. In Boba's case, an aneurism 8 months ago is the likely cause of his current troubles. He could recognize us, and he could mumble some words with difficulty, with all the strength he could muster. His lips and hands and feet are the only parts of his body now that are seemingly substantial. His right side is paralyzed, and his gag reflex is diminished. Over time he has developed two problems: he has become malnourished, and he has aspirated into his lungs, developing pneumonia. It is difficult for him in ways I can't imagine, and it is difficult for Lisa, who is his mother and Maggie's elder sister. Lisa lost a husband a number of years ago, and now a son is going. It is a story that is all too typical here.

We left Casualty with the following plan: oxygenation, antibiotics, and a nasogastric feeding tube. We mustered the modicum of confidence that we could, and left - leaving Lisa behind to sleep in a backless chair at Boba's bedside.

(In the time we were there, we were able to move Boba to a cot three beds over, by the window. This was the only cot equipped with oxygen, but I suspect it was only compressed air, delivered through a recycled cannula. We used a handkerchief to remove mucous from Boba's mouth. It was thick, clear stuff that seemed to connect, unbreaking, from his half-opened mouth, directly to his bronchi. Twirling the hanky in gloveless hands, I gagged, averting my head and breathing through my mouth, hoping the family didn't observe my revulsion.)

We arrived at 06:00 and found Boba in the same bed by the window. His chart read that he had received 600 ccs of saline and that he had wet himself. No effort of cleaning him had been made. The woman that had lain next to him had died in the night, and the plastic cot was vacant. The next bed over, a dead man I estimate to weight 30 to 35 Kg lay under a blanket, covering him head to toe. I read his name on a small card, lain over worn shoes at his lifeless feet, vowing to remember it, and failing even until now. After another half hour of our attending to Boba, a doctor came, listened to the chest of the dead man next to us, and he flipped the blanket over the dead man's face, confirming what we knew.

A single tube was taped into one of Boba's nostrils. His breathing was a little easier, and he took some porridge while we propped him upright. 

In a state of frustration, I went out to Medical Records to request a history chart. The lady looked at me with incredulity, 'At this time? Maielo.' [Tomorrow.]'

I said, 'Tomorrow he may not be here!'

She began to excuse, and I fixed her with the coldest eyes I have ever had. I walked out, sardonically interrupting her with thanks for her kind assistance.

Leaving later, and in walking across the first parking lot, I observed a mortician wheeling a sheet-covered body past the cars in the car park. A woman walked, weeping, behind. We left an uncle with Boba, to give Lisa some relief. To get to our car, we walked outside past the open door of the mortuary. Bodies were sheeted on shelves, and also naked on the floor, visible to all passersby.

By afternoon of the second day, Boba had been moved to one of the high cost wards, E21. Another den of emaciation, the worst sounds of struggled breaths through pus and phlegm one can imagine, the mixed, sharp stench of urine, old and new, mourning women howling inhumane sounds, and on the third floor, looking out on a vista of broad boughs of African green and orange in the courtyard...

The E21 unit is on the top (3rd) floor. There are buckets at the foot of nearly every bed to catch the drops from the leaking roof. The roof is decayed; scores of plaster stalactites have formed where the leaks are most persistent.  And the Minister of Health commands a fleet of new Mercedes. If this is God's waiting room, it lies in the palm of Satan's hand.

"If this is God's waiting room, it lies in the palm of Satan's hand."

Morphine is not available. Boba seems the same, but consuming two spoonfuls of porridge are more effort than he can bear. His lower lip quivers, and a tear drips down his left eye. Nevertheless, he is able to communicate a little. After trying to feed, he coughs, from deep within his chest, and we stop. We change his clothes and the sheets and blankets. His breathing is not as laboured as it was when we brought him 44 hours ago, but it's not good. Someone nearby expires and the wailing of women relatives fills the unit. The man in the bed next to us breathes in sharp hiccoughs, ten seconds apart. Imagine that for a moment.

After about fifteen minutes two morticians in white plastic coveralls and new gloves joke around at the nurse's station with white string used to tie dead limbs together. They smile and jostle one another. Families at every bedside turn to look.

A man passes through, ringing a small bell, signifying the end to the morning visiting hour. I notice another new red-on-white sign warning of the dangers of cross-infection, and with thoughts of TB and meningitis, I am secretly relieved to get out of the place.

Boba passed away at around 11:00 hrs on that day. It is always received as unexpected news. The funeral will be at Maggie's house, and burial may be on Tuesday. (Today is Sunday.) I was sitting having a beer and playing chess, in complete leisure, as my nephew passed away. The guilt I felt as I indulged while a loved one lost the struggle for life is something that will remain with me forever.

With the Mumbis

People are gathering from all around. Chairs are set up all around the yard, and a tarpaulin is hung from the roofs to provide a shelter from the likely rain. A choir arrived on foot from the nearby Catholic church. One could hear the singing approach from afar. Women lead, and the deeper voices followed in cadence. They sang in rich Ichinyanja or Bemba - I'm not sure which. The song would have been less sorrowful had I not recognized some words...

'Don't cry...'

'Heaven...'

All prayed, and the women wailed indoors as the men sat outside. Food was prepared, as was a large fire. The men will sit outside throughout the night. I was ushered away for fear of malaria. I will return at dawn.

Today we buried Boba. There were between two and three hundred people who gathered at the Mumbi homestead to attend the burial. All shapes and sizes of four-wheeled motor vehicles were used as transportation. There was a large coach, holding over 60, and there were minibuses, vans, passenger cars, and more vans (i.e. pickups, in the Zambian use of the term).

One would not know the cemetery existed where it does among the vast, green rolling hills north of Lusaka. There is no identifying sign at the turnoff, and there are no visible rows of headstones that I am used to. At the dirt turnoff there is a sign that forbids digging. The road carries on  northeast. After about a kilometer, the city has organized a huge rubbish dump. Piles of refuse that are five meters high line the roads, and the stench of garbage, sometimes burning, fills the air. We pass the dumping grounds, and arrive at an eroded, sloping plateau congested with people and parked vehicles. 

It is appropriate for vehicles in a funeral procession in Lusaka to have their hazard lights blinking. And there is lovely, woeful singing coming from their open vans. In the vehicle I occupied, a sort of jazz cassette was playing. It was difficult to hold back all the tears, even then. We arrived and filed out of the vehicles.

At the burial ground northeast of Lusaka, graves appear to be above ground. Very few bear names. Mounds of dirt a meter high form an obstacle course of dirt moguls that we traverse on the way to today's burial site. The first graves are covered in broken glass to prevent grave robbers from digging. Several mounds are littered with the dead stems of roses and hand-formed wreaths of straw; the flowers that were affixed to them have long since disintegrated. A few have a stone placed at one end or a piece of wood with a name, hand-written, and with dates. We wove between the gravemounds, and then into the bush and meter-high grass. After several paces, I realize our footpath was traversing scores of weed-covered, unmarked graves that had been flattened by the walk of mourners.

Christopher 'Boba' Mwaamba's casket was carried to the site, and diggers measured it with thin bamboo reeds, plucked from nearby. The women lead the procession, singing, followed by the men; all genders moved in single file, weaving through the burial ground. It was not until we arrived there that I realize we are not alone.

Other mourning parties filled my lines of sight in every direction except behind me, like concertgoers on on open meadow, for as far as the eye can see in a 180˚ vista. There was song and clapping and silence all at once.

I could not hear all the pastor's words because other mourning parties were so nearby, deafening my senses. I wept at the site of Boba's casket, and I wept at the sound of my mother-in-law's mourning of the death of her grandson. I wept at many thoughts that crossed my mind, including a feeling of impotence when trying to prolong Boba's days. I bent down, plucked a blade of grass, and studied it, trying to refocus, trying to hide my weakness. As the preacher's words faded under the sound of other mourning parties, and under the sound of drums, and under the sound of a British Airways jet that seemed to float, fat, and unknowing over the burial ground before me, a fleeting thought passed across my mind, that these Westerners had no idea what was going on here, and I wept for Lisa, and for her losses, present and past.

Finally, as I fiddled with that blade of grass, I let it all go, knowing my family was close to me, and I let the tears and mucous flow as it would, without care. I wept for the entire continent on that day, despite myself.