A part of life

Written two weeks ago...

I feel bad writing about death. No one wants to think about it if they don’t have to. And when I write of our interfaces with death here, people have such sympathy for Erin and me, which we feel is undeserved – we’re not the ones suffering the loss. To tell some of the stories from our blog to a group of rural Ethiopians wouldn’t elicit the same response as we Americans might have. The human compassion and pity would be there. But the shock and tears probably not.

This past week has been a difficult one. A 5 month-old baby presented with severe malaria that affected his brain causing him to seize uncontrollably. He struggled to survive for over 1 week, but in the end passed away. Another baby was admitted the following day with severe pneumonia and died that night. And last night, one of our severely malnourished children began having frequent diarrhea and passed away early this morning. If we didn’t leave the confines of our health center compound, we might think that death is the main occurrence here in Africa. In reality, the sickest of the sick come to us, and there is no referral center for emergencies. So, we are the final stop and part of our job is to help patients and their families deal with death and the possibility of death.

Sometimes our job in this regard extends beyond what I would have expected. This weekend, a body was brought in on a stretcher from a health post (one tier below health center) after passing away in the early morning from a bullet wound. He was shot to death and the police needed official medical documentation to file the reports properly. He was brought in on a huge stretcher, which wouldn’t fit in one of our exam rooms. So I found myself examining this young 25-year-old man’s body in broad daylight with solely a wooden divider blocking the crowd of people curiously watching. As we examined him, I looked over my shoulder and noticed one of our orphans Tariku peering over. I thought to myself that he doesn’t need to see this. He’s only a kid. But maybe he does need to see this. Maybe in Ethiopia children face death and learn about it in a different way than we may in the U.S. I asked him about what it was like seeing the body afterwards. He simply said, “sad.”

We’ve had many deaths since I’ve been here – probably 15 or 20 in our inpatient ward and several others that we discharged to respect their wishes to die at home. As I get “used” to death, am I losing what makes me American? Am I losing my ability to show empathy? Or am I protecting myself from feeling too much and burning out? I don’t know what the right answer is to how bad we should feel at another’s loss. I don’t think there is a right answer. It’s necessarily cultural. And I work in a culture different from my own, so I struggle with this dichotomy. In the end, I think both cultures have something to learn from each other. For example, I don’t think its wrong for me to teach the Ethiopian nurses to show more compassion for the pediatric patients than is typical for their culture. But I must learn from them as well. I need to learn that the world is sometimes not fair and to accept death for what it is. It may sound cliché, but (especially in Ethiopia) death is a part of life.