Greetings,

So many things happen each day that I (Anna) feel are worth recounting.  There's something about telling stories that brings meaning to dire situations and suffering.  If we all can grow and be shaped into more generous and holy people by the stories of our new friends, God has already started to use their suffering for some good.  

I'll start by sharing some pictures of our everyday life, then share a bit on malnutrition at the end.

Wednesday morning women's prayer occurs weekly at the hospital.  It is completely in Kiswahili, so I don't understand a thing, but its been nice to start to just be with these women and share a bit of life together.

I will be co-teaching anatomy and physiology for the nursing school with this professor, Mariste.  The students do not have books, handouts or anything.  There is only a chalkboard on which to write notes.  French is very much a second or third language for most of these students, so along with learning complicated anatomy, they must learn new french terms they've never heard.

Julien is our gardener and new friend.  Luke begs to go outside and 'help' him in the garden.  He is the father of 5 and very obviously knows how to love kiddos well.  Here he's teaching Luke how to care for our eggplants.  

Mama Georgette walks about 5 miles to sell us produce, then walks all the way back to sell at another market.  She is a widow and very poor.  She showed up at my house last week with a massively swollen cheek.  She tried to sell me some rotting bananas and I declined, but then she showed me her cheek and asked if she could have $2 to go to the doctor. Of course.

The nursing and doctor team in the pediatric ward.  See the mosquito nets hanging above the beds in the back? Because of close quarters, many kids come in for problems like pneumonia, but while there catch malaria or TB.....

MALNUTRITION

I had the opportunity to do rounds on the malnutrition ward with the pediatricians and nurses recently.  I would love to have pictures to show you, but the thought of pulling out a camera or iPhone and taking a picture seemed trite, rude and insensitive.  The ward has wall to wall beds and is constantly full of children who are on the brink of death.  We were planning a discharge for a two year old patient one day, and I looked at the baby sibling the mom was nursing and was shocked by her small size.  In the end she was evaluated and also admitted to the malnutrition unit for being more than 3 standard deviations below the acceptable weight per height for her age (the criteria to be considered malnourished).  But all the while, the physicians were saying under their breath, “If we evaluated everyone, we could fill this whole hospital with malnourished kids”.  Only the sickest of the sick kids get admitted. Those who have malnutrition AND a life-threatening illness like pneumonia, malaria, TB, or HIV. 

An extreme case: An infant born premature, returning 2 months later after being unable to feed effectively (due to prematurity and possible intestinal atresia, among other reasons). The child died soon after admission.

So, the big question is, why in this fertile land is there such dire malnutrition?  The reasons are vast and complicated, but here is what I have learned thus far:

-Children are often orphaned because of wars and conflict, and thus are not breastfed to a sufficient age or provided for.

-Fathers often abandon families in search of gold, diamonds or other ways to sustain their addictions.

-Birth control is almost never utilized. When a woman gets pregnant, she stops breastfeeding her current baby, no matter their age (this is just what is done culturally).

-Women are often married to men who have other wives. If they are the 2nd or 3rd wife, their children are ignored and not sufficiently provided for.

-Children with physical anomalies, like heart defects, have no recourse for healing and treatment and start to whither away.

-Women with insufficient breast milk supply (due to their own hunger, twins, physical defects, etc), are unable to effectively supply what their baby needs, and cannot afford to supplement with formula.

-Children with underlying illnesses like tuberculosis and HIV are using so much energy to fight their illness, they cannot meet their nutritional needs.

-Economic problems play a huge role.  Families often have at least 5 kids.  One mother of a kid in the malnutrition unit shared that she has had 10 kids, 5 are living.

-For economic or reasons of ignorance, kids are not fed a well-balanced diet, often leading to kwashiorkor (protein deficient) malnutrition.  Beans are cheap and prevalent, but the amount of money needed to buy wood to boil them for a couple of hours is more than the family can afford.  Thus often children end up eating only rice or fufu for a meal, and no protein is consumed.  No child that we've met here consumes milk regularly, its too costly.

An outing for children on the malnutrition service. Note the young children carrying even younger children. I think there was a three year old carrying another child!

Thanks for being on this journey with us as you read and learn about life here.  I do really believe that it brings some justice to these super unjust situations to give voice to this suffering.  We are all changed by seeing and hearing about suffering.  May God give us the grace, courage, strength, and selflessness to be his hands and feet in this world and to take part in his work of making all things new!