I couldn't sleep last night. I lay awake in my bed on top of the covers with the windows open on a warm night in the village. Tucked beneath the mosquito net, I listened to the bloodcurdling screams of a child in pain. The ward is just a few hundred feet from us, and you don't have to listen too closely to know what helplessness sounds like.
A two-year-old boy in desperate need of an IV had severe dehydration. It was nearly impossible to find intravenous access on his body. Baby Alfred wailed as multiple attempts were made on his tiny little hands. Eventually, the clinicians succeeded and breathed a sigh of relief, and they moved on to the next patient. Our over-worked and exhausted clinicians served through the night as the hours eked by. Every bed was full. Patients continued to come through the night, whether on the back of a motorcycle as it hastily passed along the dirt path to the hospital doors or on one of the multiple runs of the hospital ambulance.
Earlier in the day, a 25-year-old woman had been found unconscious in her cornfield and was carried nearly lifeless to the hospital. Upon seeing her lab results, one of our Vanderbilt medical students reflected that this woman's condition was the kind of case that might have come by helicopter and immediately given attention by an entire medical team in the US. But here, there is no such resource, no such protocol, no such expert team.
On most days, the noises here in Lwala are the songs of small triumphs, murmurs of hope through the daily work of transforming this community toward health and healing. But last night, staring into the darkness, through the sounds of rushing vehicles, crying babies, and colleagues shuffling through the dorm to grab juice and bread for the overwhelmed nurses, I could only hear the deep, dark voices in my heart that spoke about defeat and injustice and inadequacy.
The infuriating reality is that there are angels here. In the form of more than a hundred committed Kenyans who are trying to tear away a corner of darkness through clinical care, community health outreach, economic empowerment, nutrition and education - but their limitations, our limitations, are severe. We do what we can with what we have. We often hear the voice that reminds us that it just isn't enough. Nine children under 5 died here last month alone.
Baby Alfred's father left the room, and the baby ripped that IV right out. So the nurses tried again and again and again, without success. More deafening screams.
And then the sound of weeping. My own. This is what helplessness sounds like.
For baby Alfred, for the unconscious woman, for the clinical officers, for the nurses, for the community health workers, for the patients on motorcycles, for the parents who worry about the fate of their children, for you, for me, for James, this is the voice that ultimately spoke to me last night:
Fear not, for I have redeemed you; I have summoned you by name; you are mine. When you pass through the waters, I will be with you; and when you pass through the rivers, they will not sweep over you. When you walk through the fire, you will not be burned; the flames will not set you ablaze. - Isaiah 43
The waters here are deep and murky. The fire, impassable. And yet, there is a promise given to us here. I yearn to believe it.