A Hospital In Africa, A Toddler’s Life

A Tanzanian friend of mine had a sick niece in the hospital. I got to know this little child.

One of my favorite places to get a meal in Iringa is an old, log cabin-like structure squeezed amidst a few buildings lining the rough-trodden tar street. Walk through the worn wooden threshold and you enter into a dim room with concrete floor and some plastic chairs and tables. In the back are the young guys frying up the chipsi mayai, a dish of potato wedges and fried eggs.

Once while ordering, a young woman stood halfway through the doorway to the back area where the guys were cooking. She was tall—I’m guessing 5’10”—and athletic, a lighter-complexioned 20-year-old Tanzanian whose full lips and round cheeks complemented her frame. She stood there tall and proud talking with the guys and said hello to me. Her English decent, we said a few words including each other’s names. Hers was Salma.

From then on, I’d occasionally catch Salma walking about town, each time saying hello, how are you, and what’s new. This led one day to her updating me that she was headed to the hospital to visit her aunt. Her aunt’s daughter was sick, Salma’s little niece. This was just over a month ago–June 6th.

“Want to join me?” she asked.

The Iringa Regional Hospital is a complex of probably ten office and medical buildings—all of them white, some with brick at their base. They sit on either side of a neighborhood street with plenty of foot traffic crossing as a result. We had met this day just a few yards away from the entrance and headed into the west side of the complex by way of a sidewalk leading to a chinsy, black gate with a guard manning it. Salma explained our purpose for being there, and he let us in.

We entered and turned right along the concrete walkway through the plain and basic, but also neat and formal campus with groomed or mid-landscaped grounds, well-constructed buildings, and the occasional nurse in scrubs or doctor with white lab coat walking by. We made our way the length of the football-field sized campus and walked into a last building—a two-story pediatric ward. The concrete transitioned to tiles upon crossing the threshold. The entryway was abundant in sterile whites. Salma led me to the right to a door behind which was her aunt and niece. Did I need permission or a face mask? What would the scene be like inside?

Salma opened the door to a quiet, open room with 12 shiny metal-framed beds on wheels. Each had a mattress with blue sheet. Like the outside aspects of the hospital, things in here were plain, but clean. Only five of the beds were occupied. In them, small children lay with a woman sitting bedside. I assumed these women in everyday-wear to be their mothers.

Salma’s aunt and niece were the first bed to the right. Salma greeted her aunt, Josephine, a woman of maybe 30, shorter than Salma, but with a similar face. Next to them, a little girl sat up in bed. Though she was up, the eighteen month old sat hunched over and supported in a pile of blankets. The temperature in the room was comfortable, yet she wore a cap down to her eyes which themselves wore a tired expression. A ten-inch tube coming out of her nose decorated her thin face that moaned a constant, dull ache. It dug into me in its consistency and signal that she wasn’t just uncomfortable, but in pain, tired of it, but sadly also kind of used to it and too weak to fully express it. Her mom sat next to her in silence. She looked tired, too.

“What does she have?” I asked Salma.

“Karen has pneumonia, oh and malaria.” she responded almost casually.

I looked down the row to the mothers and their children. Things in the room were dispirited.

I didn’t have much to say. Little Karen wasn’t people-friendly, and despite no real  indication, I wondered about Josephine’s thoughts of me being there, as well. I did give modest greetings to a couple of the other mothers. But I didn’t stay too long.

I was interested in seeing Karen again, though. So after we left, I asked Salma if it would be okay for me to return. Salma said absolutely.

We met again the morning of the 8th. Entering the room, little Karen was laying down and still moaning. Had she been in pain for 48 straight hours? Josephine held her daughter with the same bland expression. I asked Josephine through Salma how she herself was doing. Josephine said she was tired.

“Where do you sleep?”

One the bed with Karen, she responded.

“You need to be healthy for your daughter,” I said. But Josephine just offered an obligatory response, mouthing without expression what amounted to, “yeah, I know.”

Salma took Karen from her mom. The little peanut buried her head into Salma’s chest, tube still coming out of her nose and curving around the side of her head.

I looked around at the other children and got to meet Jeff two beds down. The toddler was thin-faced and, like Karen, wore a pained expression more often than not. The woman with him was his grandmother. She liked me from the start with a big, tooth-missing grin and an introduction to her little man. Now I wanted to return to see how Jeff was holding up.

I went back to Karen, who again wasn’t in much of a mood for strangers. I thought next time to bring her something to help make her stay here a little more pleasant.

I returned a few days later with a stuffed animal monkey that I bought from a street vendor. Walking in and handing it to Karen, she let out a moan and crunched up her face to begin to cry when I placed it in front of her.

Maybe next time I’ll try a teddy bear.

Karen’s best reaction to me this day came when I simply gave her my finger to grab and then used my others to stroke her little hand.

I looked down the row to Jeff. His grandmother had just finished bathing him. Waiting to be dressed, he lay there with arms and legs spread, a skeleton of loose skin and a contorted pained expression. Grandmother, apparently used to this, readied him as if nothing was the matter. In fact, once dressed, grandmother actually welcomed a picture.

Unfortunately, that wasn’t a blurt of expression on Jeff’s part, but a consistent face.

But other kids in the room—a couple patients and their siblings—were up and about. One school-aged girl worked on math problems with a slide rule on her lap. A couple of younger ones ran around after a ball. The mood had become chipper.

I went back to Karen where mom was feeding her—formula injected through the nose. I thought such a consumption would surely make Karen cry. But she was good. Maybe the vibe in the room was contagious.

Mom Josephine feeding Karen with monkey on the bed

And Salma had gone and returned with food—I assumed food for mom. But she took out a bag of chipsi mayai and mishkaki (skewers of beef) and started to break it apart for Karen. Karen contently took a potato wedge and ate it.

Then Salma upped the ante and handed little Karen a piece of beef. An amusing sight, Karen just held the little grease ball in her hand. I wondered if this was okay to give to a sick toddler. But more than anything, I was just pleasantly surprised to see Karen eat so well and took her appetite as a positive sign. We left the food and said goodbye.

Three days later, I received a text message from Salma. Karen was back at home.

“Terrific!” I thought. She has been discharged, and now this poor girl who had been through such an ordeal, can go back to being a happy little toddler like she ought to. So I assumed. I made plans to visit her at their home in the outskirts of Iringa.

On June 20th, tar road and larger buildings gave way to bumpy dirt roads, dusty air, and wood and mud/bricks structures of Mtwivila. Sitting in the cramped van/bus, we eventually got to a stop in the neighborhood where Salma told me to get off. We disembarked along a downward-sloping road staring at a valley of this rolling, green-yellow terrain dotted with small homes. Some such residences lined the road where we were along with a shoddy, wooden vendor stall selling tomatoes and cucumbers.

Walking 50 feet downhill, we made a left along what looked half road/half trail heading between a couple cabin-sized homes. Small children played in the dirt nearby. Behind these roadside residences were more bunched together. Winding around a couple of them, we came to Salma’s grandmother’s home, where Josephine stayed with Karen.

It was a small mud/brick building, comprising a bedroom on each end and small living space in between. Walking into the curtain front door, we entered a dim, concrete-floored room with couches up against near and far walls. Sitting on a couch,Josephine held Karen who disappointingly looked as sick as she did before. This being my fourth time seeing her, I was used to seeing Karen like this and had a tough time imagining this little girl as anything other than a weakened, diseased child.

But Salma came out with some pictures of Karen from just a couple months prior.

Here was her this day:

Grandma, thin and short, walked into the room and lit up a smile at my presence. Speaking what little Swahili I knew with her, I shared the food I liked here in Tanzania. Out she came with some sweet potatoes. I ate a couple. But I brought Karen a chocolate, and all she could do is hold it with her frail hand. As I left, I wondered how long it would be until she was able to enjoy it.

On the 23rd, I got another text from Salma: “My niece she’s much better now.”

The roller coaster continued.

“Finally,” I thought, and I imagined her as I saw her in her photo. I arranged to see her again.

On June 25th, we returned to their home. As I sat on the couch, Josephine came out from her bedroom with Karen in her arms. I looked at a girl who was sicker than I had yet seen her. Josephine sat down, and Karen just lay against her mom’s chest with same thin face and almost non-existent expression. Her mom’s healthy face did an unfortunately good job of mimicking her daughter’s expression with somberness.

I gave Josephine a little squishy green ball I had bought for Karen. Karen could hardly hold it.

Sitting back down, I turned to Salma to my right and said quietly but firmly, “You said Karen was getting better.”

“She was. Now she’s worse.”

I questioned whether she was ever really better, whether she ever should have left the hospital.

“She can’t see,” Salma said to me.

I asked what she meant, and Salma responded that Karen’s eye is causing problems. I stood back up, made a couple steps toward Karen and mom, and leaned in to see that Karen’s right eye—which had been lazy—was now more a slit with a hazy gloss over it.

I sat, and we talked about something else: conversation about Salma’s college courses or what the family does for work. But it didn’t last long before I asked out loud,

“Shouldn’t we take her back to the hospital?”

Salma translated and Josephine responded that the doctor said “two weeks.” From what I gathered, this meant to give Karen two weeks before coming back. I think they took this as an order more than a suggestion with room for exception.

“Her eye is making her worse,” said Salma.

“No, Salma. Her eye is a symptom. Her eye is bad because of something else.”

“Do you think so?” she asked.

I thought about saying, “Let’s go!” and leading Karen back to the hospital. But thoughts of me rushing in were tempered by my realization that I didn’t want to be a know-it-all outsider unnecessarily causing a ruckus.

We continued to visit.

A hen with chicks came right into the living room from the outside through the fabric doorway. The mother clucks were the bass line for the soprano melody of the chicks’ chirps and peeps. The unorganized fowl familial parade went into Grandma’s bedroom where they found corn to nibble on in the corner.

Josephine decided to wrap Karen around her back with a piece of thin cloth in the style mothers do here and go out for a walk. She came back in a couple of minutes saying Karen was cold. Soon Karen fell asleep against her mother’s back. As Josephine sat sideways on the couch. I set my hand lightly on the mound of thin fabric under which was Karen’s head and said goodbye to Karen and mom.

The next day I had to go back to my village school for a night. Sitting in the bus mid-afternoon, and about ready to roll out, Salma texted me:

“My cousin she sick very sick my aunt cal me and tel me but am at to university”

I thought about getting off the bus, heading to their home, and taking Karen to the hospital. But this was the only day for me to go to the school to do the work I needed to do before students all went home for break.

I texted back: “tell your aunt to take Karen to the hospital”

Salma replied: “They take karen to my grandpa at to the village.”

I thought to myself, “Tomorrow morning when I return I’ll see how Karen is doing.”

An hour-and-a-half later, the bus stopped at my school. As I got up to gather my bag and disembark, I got a phone call—a rarity in this text-friendly culture.

“Hello?” I said as I got out of the bus and walked around it toward the school.

“She dead. Karen dead,” an exasperated Salma said to me.

I didn’t say anything but just felt the weight–that the life I saw just the day before was now out of that little body. And what do I even say?

“Brandon?” Salma asked to see if I was there.

“Yeah,” I said back.

Then the phone cut out. Bad reception.

Salma texted me: “Karen shes dies now.”

I replied: “I heard you. I’m surprised and sad. And I am very sorry.” Then a few minutes later I added: “Would you like me to visit tomorrow?”

Salma texted back: “Okay.”

I went to my room and set my bags down, carrying on with adjusting to being back in the village and having a job to do with the surrealization of what just happened to Karen.

The next day I returned to Iringa. They were burying Karen in a nearby village where the maternal grandparents live. I didn’t attend as Salma didn’t either. Her family insisted she stay back to take two exams she had that day for her college courses.

So on the 28th of June, Salma picked me up to head back out to Mtwivila and see Josephine. I asked in a couple of ways while we walked to the bus, and then on it, why they didn’t take Karen to the hospital as she got worse. Salma said they took her to their grandma’s. But why not the hospital? “The doctor said two weeks'” she said.

I was surprised by how many people were at Grandma’s home as we walked up. I had imagined me coming to see just Josephine. But like a funeral back home, the family used this out front. I was nervous about getting the attention of an outsider at this intimate event. Mostly women, with one man, the first person Salma introduced me to was the older gentleman, the grandfather (Grandma’s husband) wearing an old but proper hat with suit. Along with Grandpa were Josephine’s sisters (including Salma’s mother) and some ladies from the neighborhood.

The mood wasn’t festive, but it wasn’t heavy, either. The conversation and camaraderie was lighter than I expected given this death was such an untimely one. It was so light, in fact, that I felt compelled to take pictures, which the family welcomed. I didn’t bring my camera, so I used my phone.

Josephine was inside.

Sandals and flip-flops were piled outside the curtain doorway. I went to remove my shoes, but Salma and her mother said I didn’t have to. I walked into the dim space with the couches now gone but their cushions on the floor atop a reed-sewn mat large enough to almost reach wall to wall and providing a softer, cleaner surface than the cool concrete beneath.

There was only Josephine sitting quietly against the far wall on one of the cushions and another woman to her right. I sat down to her left and put my arm around her and held her side to side. My elbow at her right shoulder, my hand rest in her nest of long African hair. I did so for only a few seconds not knowing the custom or Josephine’s permission for physical contact.

I said pole sana (very sorry), and she mouthed a grateful, if perhaps rudimentary, response to something she had probably heard 100 times by now.

After I sat down, others came in, too. Two of Josephine’s sisters, a neighbor, and Salma and I were now inside. Salma’s mother offered me tea and bread. I sat comfortably as the women chatted. A couple had toddlers. Josephine held one contently—a sad scene knowing the circumstances.

There were some pictures of Karen being sent around—the ones I had seen on a previous visit here.

Later the mood lightened when another aunt arrived. This heavier set woman with more expressive face entered the room with a pitcher of booze—a thick, creamy, tan liquid

I got up and walked outside to take a break from the family conversation. I wandered near the outhouse whose stench revealed its identity. A pot of water boiled unattended in the kitchen hut. Boys nearby played a kickboxing spar. I wished I had my camera for that, too.

By then, many of the family had made their way back outside, and I was readying to leave. I said my farewells to Josephine, Grandpa and Grandma, aunts, neighbors, and Salma’s mom. Salma waited with me by the road until the bus came.


Salma and I still text. Her aunt is doing better, she says. I have no idea how little Jeff is doing. He has since been discharged as well.

Until, Karen died, I hadn’t yet felt or seen the real disadvantages of living in an undeveloped country. (I know you might be thinking, “What?!”)

Yes, life here lacks fast Internet and air-conditioning and most miss out on refrigeration and hot water. But seen in the residents here and—you’d be surprised—in the foreigners who come live and adjust to these conditions, I’ve learned poverty does not equal a lack of happiness or even health. (Think of camping.) As long as basics are met, things are fine, and the people here are as happy as I’ve seen them anywhere else. Though I prefer a more technological lifestyle, I learned that developed/undeveloped isn’t so much about better and worse, as it is about alternative ways of living.

But then I met Karen. Medical care is a true disadvantage here.

1 Response

  1. Diana Quintero

    This is a very touching history, and I believe that until you experience realities like this you are not aware of what does it mean the battle for human rights, particularly for the right to health in poor countries.

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