2010 Nairobi Hospital

DAY ONE FRIDAY

A new family has arrived at DECIEP , Felista Kibe’s wonderful openhearted rescue and refuge home for orphaned, abandoned and vulnerable children in Waithake, Nairobi.

Their story is as common in Kenya as typhoid in the rainy season. Their mother died of AIDS and their father abandoned them. They were helped by a woman in the village, but mainly had to fend for themselves till Child Services brought them to Felista. Joseph is somewhere around 11 (as usual, they have no birth certificates and ages are determined much in the manner of items on the Antiques Road Show) and has a growth at the base of his spine. Jane is about 9 and is peeing blood, complaining of pain in her abdomen, viewing the world through eyes the shade of Coleman’s Mustard and running a temperature. Miriam is probably six and also has a sore tummy. A ‘tummy’ distended like that of a woman carrying triplets at eight and a half months. Moses is five-ish and has the sore tummy too. Michael is six months and boasts a cough like a sixty year old chain smoker. But they are lovely kids. And don’t have ringworm, which is a plus.

First stop is Lea Toto, a church run clinic for HIV+ children. They also do free testing and so we all get the finger prick test and see who is brave enough in the face of the dreaded needle to win a mandazi and tea. Turns out we are all brave enough. And, even better, we are all negative ! We celebrate with the promised mandazi and diabetogenically sweet Kenyan tea.

Thence (at around 9.30am) to Mbagathe District Hospital.

Outpatients is housed in a building in an advanced state of decay. Or maybe it was never completed in the first place. A grubby, stone-floored room, with gaps in the walls for doors and windows, is heaving with hurting humanity. Tired looking mothers and sick looking kids perch where they can and stand when they can’t. The air is thick with the sounds and smells of sickness. We queue to pay to get a card so that we can get into a queue to be weighed and have our temperature taken. The results are scribbled on a scrap of torn paper and thrust into the hands of each bewildered child.

Jane is shivering now, and huddles into her pink sweater. “She has a temperature” notes the fat scowly woman at the table. “You must remove her clothes” she intones and pokes a syringe into a jar of some sort of Calpol substitute. “She’s shivering. She feels cold” I point out. “Her temperature is high. You must remove her clothes” repeats Fatty, more Mengele than Nightingale. I suggest that her temperature is high because she has an infection and NOT because she is wearing a jumper. Fatty withdraws the offer of sticky pink stuff and mutters something to her friend. They glare at me.

Felista is horrified that I have dared to contravene the orders of The Nurse and wrestles Jane from her outerwear. She then collects the syringe, grabs Jane by the jaw and squirts.

Miriam needs to make one of her frequent visits to the toilet. The toilets are, however, unuseable – blocked, being both waterless and overflowing. A little disease factory made of shit and piss and soiled bandages, nestling right alongside the corridors (ok, one corridor) of healing. Miriam goes behind the portacabin housing Social Services.

And we wait. Our boredom is leavened by watching a small boy fall off the bench where he has been placed and break his hand … and by listening to the screams and marvelling at the showers of sparks coming from the adult OutPatients cubicles next door. They are, we discover, doing a bit of heavy duty spot welding there today. And this is not helping the man who has been dragged in screaming and writhing, suffering from, we discover cerebral malaria. He is bound to an iron bed with ropes and left to scream for a bit.

We wait about four hours for our names to be called and troop through expectantly. Unfortunately we had just got through to the third circle of hell. A corridor where you sit and wait some more. Fewer seats and a grandstand view of the aforementioned toilets through bare gaps in the pitted walls. Jane is still shivering so I put my jacket round her. Felista has confiscated the jumper.

Someone in a white coat comes in and announces that if you think your child is about to die, you should notify a nurse and you will be allowed to skip the queue. “There is no need to wait until your child has died” he advises, reassuringly. Good to know.

A couple of hours (and a couple of trips behind Social Services) later we are ushered into a small room with one person in a white coat who seems to know what she is doing and one person who self evidently doesn’t have a clue. One by one the children are examined, poked and prodded. Jane has a problem with her kidneys, Miriam has an enlarged spleen, Joseph has a mystery lump on his spine, Moses has a sore tummy and Michael had a cough was the expert opinion. Who needs Gregory House ? But just in case the children need to see ‘the other doctor’. And Jane and Miriam need blood tests and Joseph needs an x-ray.

So I queue to pay for the tests. Then we queue for the tests themselves. The sounds from the room where they are taking blood are not pleasant. Small wonder when the staff utilise a technique similar to spear fishing but less accurate. Taking blood samples is a labour intensive process, as each child has to be held down by one man while the other pokes needles in its arm in the manner of Delia testing a sponge for readiness.

An hour and an ocean of tears later we are in an even smaller room with another person in a white coat who appears to know what she is doing and another clueless hanger on. They decide Joseph needs an MRI scan, the girls need ultrasound and Jane has liver failure. Moses and Michael are written prescriptions for vitamin syrups, broad spectrum antibiotics and Calpol (which is prescribed for absolutely everything that can go wrong with a child under the age of 10 irrespective of its appropriateness).

By this time it is around 8 at night and the children are drooping. Jane is still shivering. I buy us all mbuzi choma and ugali at Kenyatta Market. They want to drink Fanta, and need liquid, so I set my morals aside and buy it. I shall tell them another day about the worldwide cancer that is the Coca Cola Evil Empire.

We try Kenyatta Hospital and three private medical centres for an ultrasound but all are closed. Well, the centres are open (they are 24 Hour services) but the doctors have gone home. So, finally, so do we.

DAY TWO SATURDAY

We are back at Mbagathe at 7am and the ultrasound is done (Kerrching !). Interestingly, we then have to go and pay someone else (The Consultant) to read the said ultrasound.

He says Jane has severe pylonephritis, pleural effusion and something up with her liver. Ooo, it’s just like being in an episode of House. Not. Miriam he decides, also has pylonephritis, but no enlarged spleen. “What,” I query, pointing at the spleen scan, “ is that ?”

He writes ‘Pus?’ on the scan.

He then, unbidden, opines that Jane is very sick and that he does not “see a long life” for her. He suggests that it might be best to send her back where she came from. Pre-empting the MRI scan (16,000ksh – we are still saving), he says the same about Joseph. I feel the red mist descend but Felista has me in a vice like grip and steers me out. She really doesn’t like it when I talk back to doctors.

We go back to the big, grubby, outpatients room where, when we are eventually seen, we are told Jane and Miriam will be admitted. Which means Felista goes off clutching a fistful of notes to register the girls for admission and I wait while an impressively competent and even gentle female doctor inserts a cannula for each girl.

Finally we walk to the children’s ward. As we walk past the rooms, each with eight single beds on concrete floors under fluorescent strip lighting, the sounds of crying and choking, screaming and gasping for breath are a soundtrack which will become all too familiar to me. A small baby is being pinned down by a large orderly as a boy who should never have allowed near anything sentient with something sharp is stabbing it, first in the back of the hand, then the arm, then the calf, the foot and finally the jugular in an attempt to insert a cannula. He looks faintly irritated. The baby is hysterical. The mother looks away.

Our room – number three – is the same as the rest. Eight beds, broken windows, broken door and a one bar electric fire at the end where baby milk bottles stand and warm. One blue blanket is on the bed. No pillow.

This, is to be my home for a week. One room, eight single beds, seventeen children and sixteen mothers. Cosy.

It is one aspect of the state hospital system here that is at one and the same time a good and a bad thing : f you have a child admitted then you, the mother/carer must move in with the child. Otherwise the child will receive no care. No food, no liquids and medication will be pot luck. It was quite common for mothers to arrive at the hospital to visit a child only to find it dead. So now mums stay with their kids, abandoning other children, businesses, and anything else that has a lien on their time. But it is great for the kids.

I have to admit that my entrance created quite a stir. The last time I felt so many eyes scanning me with that mix of suspicion and derision was when I told a room full of Upper East Side lesbians that I was bisexual.

I help the girls onto the plastic mattress and leave them to decide whether the blue blanket goes over or under. The promised doctor’s visit eventually materialises and a young man with an exuberant fro’, Buddy Holly specs and a generally bemused expression mixes up the charts, suggests an ultrasound, thinks Jane’s eyes look yellow, wonders aloud about her liver and says he can’t find Miriam’s spleen, pus-filled or not. I talk him through the tests and he suggests antibiotics for Miriam and nothing for Jane because her liver might not be able to cope. He suggests we see another doctor. Who will be around in the morning. Probably.

The girls get Calpol (pointing out to Buddy that paracetamol is hepatotoxic didn’t stop the squirt of the pink panacea) and Felista and I make a list of what I need to buy : change of clothes, bowls, spoons, cups, food, drink, soap, toothpaste , towels, slippers, pillow, bedding and a load of drinking water because the hospital water we had access to wasn’t really safe to drink. Oo and toilet tissue. Plus a sleeping bag for me to use. And anything else I might need.

I leave with my friend David and we hit KIbera Market – the infamous one built right on the railway tracks but a boon to the woman with two hospitalised girls to care for.

Back at the hospital, Jane and Miriam perk up slightly at the arrival of food and juice and hot tea and new clothes.

David and Felista go.

I am so far from what we call my ‘comfort zone’ that I don’t even know in what direction to look for it. But I am still luckier than most. No one here has a comfort zone.

All the mums are chattering. Every so often I hear the word ‘mzungu’ and peals of laughter. Children are howling, one of the children in the bed next to us is gasping for every breath like it is his last and making strange clicking noises like some sort of Kafkaesque insect-boy.

I sort out the girls with water bottles and spread the blankets over them.

I unravel the mosquito net. Tie little knots to close its many tears and tuck it over my girls.

Then, to much sniggering from the mums, I unroll my sleeping bag under the bed, pile my jacket and any other clothes I can find into a pillow, and lie down.

I feel something hard under my hip. It is a discarded syringe.

Sleep does not come easy in Mbagathe.

The crying doesn’t stop and those striplights never go out.

The only thing this place lacks is a truckload of orange jumpsuits …

DAY 3 SUNDAY

2.30am

I must have fallen asleep because the next thing I know I am being suddenly awoken by the stentorian shout of “Dawa ! Dawa!” (“Medicine !”). The bed above me shakes. Something of a dessicated nature detaches itself and falls on my face. I scramble out from under the girls, much to the obvious surprise of the two aproned women pushing the meds trolley.

“Spoon” they demand. I dive into our plastic bag and retrieve the spoons. Miriam gets some red stuff and Jane nothing. Then the burlier of the two grasps Miriam’s arm and shoots an entire syringeful of white stuff into it. Miriam tries to stop her, cries, squeals in pain and looks at me in a mix of hurt and betrayal. I am momentarily frozen. As the trolley proceeds round the room the sounds of howling and screaming, crying and struggling follow it and grow louder. I try to comfort Miriam but she pulls away and hides under the blanket, crying.

The trolley trundles off to the next room and, as I crawl back under the bed I hear the tears and the screams start there.

3.30am

“Mzungu!” I am woken again, this time by one of the women in the bed opposite. “Mzungu !” The women are up, scrambling for the thermometers that have been thrown on the bed nearest the door by a passing orderly. You grab one as soon as the previous Mama has finished with it and shove it in a fold in your child. Most don’t work properly but by poking a pen in to where the button should be until something shows on the tiny screen you usually manage an approximation. I write two sets of numbers on my hand and get back under the bed. Until …

4.15

We are all awake again and lining up to give the orderly our temperatures.

Miriam need to go to the toilet. I help her out of the bed and into her new flip-flops (35p, Kibera market and really rather nice). We pootle along in the early morning air to the toilets four doors down. The floor is flooded and even from the door we can see – to say nothing of smell – the piles of yesterday in the floor in the stalls. Miriam backs off. She is a fastidious girl, as many rural children are. We disappear into the night around the side of the block and she goes on the ground. I pop the tissue onto an overflowing bin on the way back and we use a splash of our drinking water to wash hands.

7.00am

I am awoken by a flurry of activity. I am not quite sure what is happening, but something is and I am almost certainly meant to be joining in. Mama Miriam – in the bed opposite – explains that ‘the men are coming’. And she doesn’t make it sound like fun. I go outside to see a trolley with canisters of water outside the room three doors up. Accompanied by two men in overalls and wellies who don’t look particularly happy in their work.

I am advised in a mix of Swahili, English and sign language that these guys are cleaners. My mind, for some reason immediately flies to Pulp Fiction. Not quite, as it transpires. The men have water and brushes and bad attitude. And they know how to use them. What they do is stand at the door of your room, throw plastic jugs of water over the floor and then sweep it out, carrying with it the detritus of the previous day and night. Actually, not a bad method for getting into nooks and crannies. However, should you fail to pick up your and your children’s belongings from the floor before the water is flung, they too, will be brushed out along with the aforementioned detritis. I start to pile the clothes and the flask, the plates and the shoes, the water and the food, my mat and sleeping bag on any space on the small bed that isn’t occupied by sick child. It is like being caught up in some unpleasant It’s A Knockout challenge. Miriam needs to go to the toilet again and Jane wants tea. “Baadaye” I promise “Later”. But a) they only speak Kikuyu and don’t understand and b) Miriam at least cannot wait.

It is amazing the apprehension that two Kenyans, armed only with water and brushes, can engender. I carry Miriam round the back of the block and rush her back. I perch on the bed and open the flask of tea. Water swirls around, brushes swish. The men, it has to be said, do a thorough job. They have to. They are the front line between us and all manner of nastiness – and they are fighting without benefit of disinfectant. Around a tablespoon of floor cleaner goes into each vat of water. But the men give good scrub.

9.00am

The girls have been wet-wiped into relative cleanliness, given tea, mandazi, banana and more tea. The doctor should be here any minute. As should Margaret, my ‘relief’. But they’re not.

Instead we get another round of the medication trolley. I suggest that they might want to sluice Jane’s cannula with saline, as it has now been in for 24 hours without being used and there might be clotting. They look at me. “No”. Miriam recoils as the aproned one comes towards her. “Quiet baby” says the woman tonelessly as she wrenches the lid from the cannula and rams another large dose of antibiotics into Miriam’s thread-like vein. She is so brave. But can’t hold back the screams. It is something I notice about Kenyan children. They suffer in silence. I have seen them – as I dig jiggers out of their toes in Juja with a sterilised safety pin – sitting impassively. Except for the cascade of tears down their faces. For a Kenyan child to wail, to scream, to struggle, the pain must be immense.

And they are all wailing and screaming and struggling here.

We calm down with tea and bananas.

10.00am

The girls are sleeping and I am in the toilets with a bucketful of dirty clothing, almost up to my ankles in water the provenance of which I have no wish to consider. There are around a dozen of us there, taking turns under the hosepipe, swirling and scrubbing, tipping and refilling. The Mamas are fascinated and amused. “Eh Mzungu ! You know how to work ?” says Mama Precious. It turns out the recieved wisdom is that white women don’t know how to work because we all have servants to do it for us. We bond over rinsing and then all go to find a hanging spot as far away as possible from the rubbish dump.

11am

No doctor, no ‘relief’. However what we DO get is the preacher. A well-fed looking man with a face that would freeze a lava pool. I decide to wait outside, lest my obvious loathing for everything he stands for should interrupt his cant. I should have known better. Nothing short of an SAS Taskforce could interrupt him. He moves from bed to bed like something out of I Am Legend, grasping each child by the crown of its head and howling what sounds like a terrible curse into the ceiling above it. The look on my face obviously tells the women exactly what I am thinking, because one by one they start to giggle.

I leave and pretend to check if my clothes are dry. He is still going when I come back. Miriam and I exchange amused glances as he wobbles her head around and rants. I decide Miriam is quite the most wonderful child I have ever met. When Preacher Man leaves, I entertain the room with impressions of what were supposed to be ‘healing blessings’. The Mamas are amused that I don’t believe in God. I point to the children and posit the suggestion that if there IS a God, and his curative blessings have been called down upon these innocent, suffering little children, then the fact that they are all still puking and coughing and sweating and dying is indicative of the fact that he a) exists and is simply shit at his job ergo not worthy of worship or obedience b) exists and is evil ergo to be avoided at all costs c) doesn’t, in fact, exist.

12pm

Still no doctor, still no relief. I spot Buddy and he says he has told the Other Doctor everything I have said and they will be doing ward rounds soon.

I check on the girls and then walk the half mile to the little man at the Matatu stop who spends his day stirring industrial quantities of sugar into vats of tea and will fill your flask for 70 bob (about 40p)

When I get back, Margaret has arrived. With Felista, who has brought an enormous bag of toys. I immediately worry about the logistics of getting it up on the bed the next morning when The Men come. Margaret is supposed to be looking after the girls in the daytime so I can get done at least some of the stuff I paid Virgin £400 to get me here to do. But the thought of leaving before The Other Doctor does the ward round is not acceptable and so I talk Margaret through the underbed facilities, explain about the toilets and stay.

1.30pm

The Other Doctor arrives. Not quite sure which of the three white coated figures is THE Other Doctor but the burly woman seems to be in charge. She looks at the ultrasounds. I point out the pus. She concludes that Miriam’s spleen IS enlarged, that Jane is ‘very sick’ and that what we need is a family history. I explain there is no family history because the father abandoned the children after the mother died of AIDS. I explain about the growth the brother has and the coughs Moses and Michael boast. She sighs heavily and prods Jane in the stomach some more. They announce that the girls need two different antibiotics. Neither of which the hospital has. I ask if the hospital will be getting some. They shrug. I ask (naively) what then will happen. I, it transpires, will have to buy them. This is, I find, quite a normal occurrence.

I spend the rest of the day searching for the antibiotics. One, Augmentin, to be taken orally, I find quite easily and pass over £28 to the big chemist behind the Oilibya Station on Ngong Road. The other we eventually finally find at Nairobi Women’s Hospital – who have a fantastic pharmacy and great prices. I buy them out of IV Ciprofloxacin and hand over £30. I buy fruit juice and water, mandazi and bananas. I get back to the hospital at around 8.30pm.

I take the meds to the doctor’s room where I am told that it is probably safer if I keep them. I point out that it says to keep them refrigerated. The Sister smiles reassuringly and says that is not necessary.

9pm

Meds trolley. In every bed you can hear the sound of pupils dilating in fear.

Miriam is spared the injected antibiotic as she’ll be getting the new one in the morning. We have officially changed from the red stuff to the Augmentin. Miriam takes it like a good ‘un. Jane is asleep. So the Sister grabs her by the shoulder, sits her upright, rams a spoon of Augmentin in her mouth, holding her chin up til she swallows, and goes.

9.15pm

Jane complains of pain in her tummy. I rub it and consider that the only words I have managed to learn so far in her language are ‘pain’, ‘fall down’ and ‘take it away’.

9.20

Jane is violently sick. She hasn’t eaten anything, so only the Augmentin comes up. I console her, wipe her, give her a sip of water and lay her down. Miriam gives her her doll. I am now absolutely sure I adore Miriam.

I go along to the other side of the block and tell the sister who hrrmphs and says we’ll see in the morning.

A couple of hours of tea and toilet and wet wiping and consoling later I crawl under the bed. Now I too have a mosquito net (hadn’t thought about THAT last night. But nowhere to hang it. So I drape it over myself much in the way my Gran used to drape a light cover over the set tea table until it was time to eat.

You would not BELIEVE how stuffy a net can be. I could never be a beekeeper.

But even that and the lights and the crying don’t keep me awake tonight

DAY FOUR MONDAY

2.30am

The Meds Trolley rolls up. I feel a wave of relief that my girls are to be spared the needle till the morning. I tell the Sister that Jane was sick after being given the Augmentin. She says (rough translation) “what Augmentin?” She says there is nothing in the notes about it. I assure her there is. She finds the bottle and Miriam gets hers. Jane doesn’t.

4.00am

Thermometer duty. Jane’s temperature is, unsurprisingly, still high but Miriam’s is coming down.

4.30am

New boy collects the temperature data and we almost need a cardiac consult for him. As I loom out from under the bed with my numbers he nearly has a heart attack. And watches, without trying to conceal his mirth, as I clamber back under my net.

7.00am

Already, by way of a pre-emptive strike, our bed is a tower of precariously balanced food and utensils, clothes and shoes with the large bag of toys dangling off the end tied to the bed with a towel. I only wish I’d played my joker.

8.30am

The Men finally come and do the throwing water on spilt whatever thing. I make a point of thanking them this time. They nod. Which is good.

9.00am

We’ve done wet wiping and tea and mandazi and mango. A bit of orange. Some milk. And more tea. We have taken the legs and the arms off Barbie and smashed her boobs in. Now we are brushing her hair and showing off her shoes. Then comes the Meds Trolley.

The Sister announces that Jane has had a bad reaction to the oral antibiotic. I point out that the directions specify after food and that Jane was awoken from sleep, given the stuff when she was half concious and had not eaten all day. I suggest that now she is awake and has had breakfast, all will be well.

Jane and Miriam get their spoons of Augmentin and then the nightmare begins.

Ciprofloxacin comes as a white suspension. I cannot being to imagine the pain of having it injected with brute force into tiny veins. But I see the result. Jane is inconsolable. Miriam copes better, but is obviously in considerable pain. All I can hope is that it will do the trick.

9.30am

Margaret arrives and I explain that she cannot leave the flask empty when she leaves because then it is too late to get more from the Matatu man, and the girls like to drink very much tea. Margaret glowers. But all is not lost. She has brought a flask of porridge. Which the girls also love. I get more tea from the Matatu Man and leave.

5.30pm

I get a call from Margaret announcing that she is leaving the hospital. I tell her she must stay until I arrive at 8.30. She says she cannot.

8.30pm

I arrive, worried that the girls have been on their own, but they are sleeping.

10.30pm

The Trolley is late. But it comes. It is lucky that both girls are on the same medication, because the staff rarely know which one is which. I get bolder. “Pole pole” I say, as the pile-driver thumb of the medic thrusts the plunger on the syringe down to the end in one lightning descent and Jane screams. “Gently !” They don’t even look in my direction. In their haste to rid themselves of the irritating mzungu and her witterings they forget the Augmentin. I point it out and the girls swallow dutifully.

My fellow mamas have changed in my absence. Mama Miriam and Mama Precious have gone, as has the gasping clicking boy from the next bed. In his place I have Mama Nathan and Mama Osama next to me and, in a hilarious twist of luck, Mama Obama opposite.

Mama Osama is young, and comes, herself, from a children’s home called “Stars for Jesus”.

She is not liking being in the hospital. She is not liking sharing her bed with Mama Nathan and wheezing, choking Nathan and little malaria ridden puking Osama. She wants a bed to herself in a room with the lights off. “Inshallah” I say, ruefully. As it happens, Allah has no more to do with it than the shouty pastor’s Bwana.

All it takes to get an upgrade here, it transpires, is to give one of the askari (the security guys) a bit of a knee-trembler round the back of the ward block.

Mama Osama gets her quiet bed for the night. I wonder what they’d offer for a bit of Mzungu action.

DAY FIVE TUESDAY

3.00am

The Meds Trolley Dollies are now so used to me that they wake me themselves, kicking my mattress and shouting “Mzungu !” . More tears and more screams. Nathan next door vomits up his meds. He is so full of mucus and god knows what all else in his little asthmatic lungs that he can barely swallow anything without puking.

4.00am

Thermometers. I am so tired I sleep through. And so …

5.00pm

Mama Nathan has taken my girls’ temperatures. I wake up and panic because I think I’ve gone blind in one eye. I raise a hand to my face and find that my eyelid and socket appear to have been replaced with a hot donut. I say I panic. I am too tired to panic. Jane is complaining about being hot and thirsty so I leave her with a bottle of water and pootle along the block to the sister’s room for a syringe of Calpol. The sister raises her eyebrows and stares at me. In Kenyan medical speak this can translate as anything from ‘what are you doing disturbing me ?’ to ‘if you were thinking of bedtime reading, best go for a short story’. I fondle the small pillow that is where my left eye should be.

I give Jane her Calpol and get back under the bed.

7.00am

I am GOOD at this everything off the floor stuff. Jane and Miriam are hugely entertained by my eye. They take turns poking at the lid, then we take a picture and giggle hysterically at how monstrous it looks.

There are shrieks from further down the block and everyone tenses. Surely not the meds trolly THIS early ? But no. Mama Osama goes to investigates and tells us that in one of the other rooms, a baby fell off the bed while The Men were swilling and sweeping. And they just carried on swilling and sweeping with the baby on the floor. There is much tutting and head shaking and eyebrow bouncing. The girls have tea and fruit and mandazi and then we do one of our most favourite things. We phone Felista on my mobile. The girls absolutely love it. Especially Miriam. The entire block gets to hear her side of the conversation. Everyone in our room stops and sits and smiles and listens and laughs as she chatters.

I think they are all falling in love with her.

Bad news from Felista. Lovely Hiram – who was rescued by Felista having been abandoned by his family after his mother dies of AIDS and found at 3 weeks old, in a cocoon of his own shit because locals wouldn’t touch him to clean or feed him in case they got ‘contaminated’ – does not have ‘a sore leg’ as has been thought for the past two weeks. He has a broken and displaced femur.

Felista has brought him to the hospital and they have x-rayed him and put him in a nipple to toe plaster cast. When I dash to out-patients Hiram is still screaming. Anaesthetics not being considered necessary when setting a broken and displaced femur. I point out that one leg looks shorter than the other. Apparently the doctor had explained to Felista that ‘he will never walk normally’. The pre bone setting x-ray shows a femur displaced by a good inch. There is no post bone setting x-ray. Not necessary, apparently. I pay. I ask if I can speak to the doctor. No. I decide to fight Hiram’s battle later.

David is here to pick me up but I send him off to take Felista and Hiram home. He is not happy. He says the bad roads around Waithake are damaging his car and wants me to buy new shock absorbers. I tell him we will discuss that afterwards. Hiram is still screaming. I ask David if he wants the work or not, because I have other friends who can drive… He is very moody. But he goes.

I do some washing, change the girls, and refill the tea flask from my NBF at the matatu stop (he’s now giving me free tea if I have to wait for a new brew !).

9.30am

Meds, screams, tears. Puking next door and despair, as the doctor hands Mama Nathan the list of medications her baby needs. Which the hospital is not going to supply. Because Nathan is so tiny, he cannot use an inhaler as a bigger child would. He needs an extra bit of kit called a spacer and a baby mask. Plus the actual meds. Mama Nathan has already lost two children to asthma.

I tell her I will find out what it will cost to get Hiram better help and then do what I can for Nathan.

I spend the rest of the day trying for a second opinion on Hiram. I am astounded at Felista’s fatalistic attitude to Hiram’s future. What we need is a second x-ray. He needs to go to Kikuyu Hospital – an orthopaedic specialist unit. He cannot be crippled by the system’s utter lack of care. I give her the money for the x-ray. And money for a taxi to get there.

But Felista is not interested in Hiram now. Her own son has just been sectioned and taken to one of Nairobi’s psychiatric units.

She needs to go and see him. And needs money for taxi and 5000ksh for his registration fees there. And to pay for the drugs with which he is currently being subdued. He has, it appears, been found running around naked in the middle of town and is seeing things. I was in a car being driven by his older brother John when John had an epileptic fit. The myriad systemic ills of the poor in Kenya seem to have no end. And make no mistake – the core illness is poverty.

7.30pm

Back at the hospital to be greeted with a huge hug by Miriam. I am overwhelmed and go quite goosepimply. We drink tea and play at making hats with their hankies. I tie knots in the corners and show them how to wear it like a mzungu. We take pictures of them. And others in the ward. Everyone has to see, of course.

We phone Felista and ask about Hiram and Joseph and Michael (the girls’ brothers). We are almost happy.

I have brought mangoes and even Jane is now sitting up and eating well. A young girl comes into the room and asks to borrow my knife. I give her it along with some clean water to wash her mango.

There is only a minute, it seems, between her returning my knife with a nod and an “asante” when all hell breaks out down the block. The unmistakeable sound of grief is screamed to the heavens. All the Mamas are outside now.

“A baby has died”. The news murmers round the mamas.

The girl with the mango is being held down on the floor by two security men. She is screaming and twisting and howling like nothing and no one I have ever seen. It is her baby who has died. In the peeling of a mango.

The sisters are telling her to calm down in much the same tone of voice they tell the children to be quiet as they relentlessly pump antibiotics into their arms.

The baby died of pneumonia. Biggest child killer in Kenya.

Mama Nathan holds her baby tight.

I am hopelessly out of my emotional depth here. Except for one emotion. Anger. Not helpful, I know, but the thought that I could probably cure the entire block of sick children with a few hundred quid’s worth of medication, some vitamin supplements, clean water and decent nutrition was driving me crazy.

I take Mama Nathan’s prescription and tell her I’ll buy the stuff tomorrow. She cries.

10.00pm

Medication. I suppose we all feel lucky still to have children to scream as the needle goes in.

DAY SIX WEDNESDAY

3.00am

My mozzie net I now have ingeniously tucked up under the slats of the bed above me, so slipping out and in is quite easy. The girls are getting noticeably better. Miriam is sleeping right through the night without visits to the toilet and Jane is no longer sweating.

5.00

The thermometers tell a happy tale of dropping temperatures …

5.30am

Which I relay from under the bed to the young man with the clipboard

7.00am

We have a sort of Wet Wipe Bed Bath, both girls enthusiastically scrubbing away.

And – praise be ! – the toilets are clean ! We celebrate by all having an inside wee. And washing our hands under the hose – now splooshing out water.

Unfortunately we have missed our slot for getting back into bed before The Men and have to stand, shivering, outside till they are done.

9.00am

The Doctors are very pleased with Jane and Miriam and are looking at a discharge date. But first, a urine test. Seems fair enough.

Even with the doctors there the meds are not administered any more gently. And the doctors don’t seem to notice.

What they do announce is that Miriam and Jane should not be on the Ciprofloxacin. Oh no. They should be on Gentomycin. Amazingly, the hospital DOES have Gentomycin. Although the Augmentin has run out and so I have to put this on my shopping list.

I point out that I have two boxes of the prescribed Ciprofloxacin left. The doctor suggests I donate it to the hospital. I suggest they buy it. Which goes down like a vein-full of antibiotic in the morning.

Margaret arrives and I explain about the urine samples. She looks dubious. I tell her to use a bowl and I will bring a new one.

I go off to look for Nathan’s medication. Only to find it is going to rush me sixty quid. Luckily enough, the marvellous Nairobi Women’s Hospital agrees to do a part exchange for the Ciprofloxacin. There are many aspects of the Kenyan system that I like. And its lack of red tape is one of them.

I spend most of the rest of the day asleep.

7.00pm

Back to Mbagathe with all the necessaries. And Queen Cakes for the Mamas.

Mama Nathan is delighted, with the medication, although I have been unable to find the spacer so she has to try to use the inhaler.

We phone Felista and tell her that the Sister says we can maybe get out tomorrow. We are very excited.

I trip along to see Buddy, who appears to be on duty … or at least here. He announces that only one urine sample was done so we have to do them both again tomorrow. I explain to the girls and we all drink water and hope for a good sample in the morning.

10.00pm

It doesn’t get any easier when the meds come round. I always feel as if I am letting the girls down by allowing the staff to hurt them like this. “Pole pole” screams a stick-like girl in the opposite bed, writhing around. Miriam and Jane and I sit and watch and cuddle and say nothing.

DAY SEVEN : Thursday

3.00am

It is all so normal now I seem to wake at the first creak of trolley wheel. The girls have some juice (all the better to give a sample with) and we all go back to sleep

5.00am

Temperatures are normal …

7.00am

We play “see who can get the most wee in the bowl”. I don’t actually go into the (still relatively clean) stall with the girls. Rural children are really very shy about things like that. But we do rather well. And I rush along to the Sister’s station with the samples. Unfortunately no one has a clue what they are for. I take them back to the ward and stash them beside the flask under the bed. Well – it is clean. The Men have just been !

9.00am

I try to distract the girls from the pain and the upset of the medication round with lively chat (well, signing and some Swahili) about going out to play. Once the tears are dried and breakfast eaten they get on their shoes and new clothes and go out to play in the sun.

I make Miriam a football from some plastic bags and the bowl we used for the urine samples (washed !) and string. Jane makes a beeline for some mothers and takes one of their babies to nurse.

I make sure the doctors have the samples and leave.

It was another day before the girls came home. The doctor (whichever one it was) forgot to take the samples to the lab and we had to do them again.

All was clear – eventually. Then I had to sit and watch a tragically undereducated boy write out their discharge notes and a prescription for each (including, of course, the mandatory Calpol), and queue to pay the fee.

They attempted to charged me for the medication I had bought myself … and so a lively discussion ensued.

As it happened, there were no notes about any medication at all on Miriam’s paperwork so it was swings and roundabouts really. And £35 seems little to pay to save a couple of lives.

The girls are still fine. Their brother still needs an MRI scan to find out what the growth is on his spine. Hiram is said to be doing well – but was on his back for two months in that plaster from nipple to toenail. Felista’s son is still in the psych ward.

TBC

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