This story won’t have a nice ending.  It’s can’t.  I don’t know exactly how it will end or when, but the ending can’t be good.  I totally understand if you don’t want to read any further.  I probably wouldn’t.  After the last few days, I have gone on all my friends’ blogs… in search of happy endings.  Birthday cakes.  Tiny muddy hands paired with smiling faces.  Strawberry patches ready for kids to pick.  Pink princesses at tea parties.

But this is a different world. 

On Thursday, I returned from Nairobi to be greeted by the glowing faces of my two beautiful children.  Several hours later I heard that our guard Jorge’s son, José, was in the central hospital.  José is three years old. 

On Sunday, Nalia, Matias and Elio left to visit Matias’ family in Chimoio.  Knowing that Jorge also has a 3-month old daughter, who was now not breastfeeding very often because her mother is in the hospital taking care of Jose, I asked Jorge to come over with the baby and try to figure out a plan.  I didn’t understand why Jorge couldn’t stay at the hospital with his son so his wife Lidia could go home and breastfeed the baby.

We talked it over and Jorge explained that men aren’t allowed to stay at the hospital.  There have been problems with abuse.  I agreed to ask Elio and Nalia’s nanny to sit with José the next day so Lidia could go home and feed her baby.  Jorge had been bringing the baby to the hospital once or twice a day to feed, but it wasn’t enough. 

Next, I offered Jorge a ride to the hospital to see his son.  I pulled up by the gate.  We both just sat there.  ‘But don’t you want to go in and see José?’

 After what happened with Oscar, I was trying to distance myself from this.  But I could tell Jorge really wanted me to go so I relented.  We ran up the stairs because the baby was now screaming to be fed. 

I wasn’t prepared for what I saw next.  I had met José before but I didn’t recognize him this time.  His whole body was swollen, head to toe.  The doctors had tried to insert an IV, but struggled to find a vein because of all the swelling, so they had shaved the sides of his head to look for a vein.  I brought one of Elio’s cars for José to play with, but his eyes were swollen shut; he couldn’t see.  ‘Tia trouxe um carro para ti… I’ve brought a car just for you,’ I told him, but he couldn’t see it.  I pulled out his small bloated hand and placed the cars inside.  He didn’t grasp it, so I closed his hand.  He sat up and started spinning the wheels around.  This was good.  There was blood coming out of his nose, and his eyes were completely bloodshot.  His mother said he had been vomiting blood, and also pooping blood.  He had had two transfusions in 2 days.  I kept asking Jorge and Lidia what the problem is all they could say was ‘anemia.’ 

The atmosphere in the hospital during visiting hours was like another macabre party.  It reminded me of Oscar’s funeral.  All these sick children lying listlessly on beds surrounded by relatives toting food, juice, and chatting and laughing.  I told Jorge that he needed to give José as much carinho as humanly possible…. To help him recover more quickly.  Carinho is love, affection, sympathy all rolled into one, but Jorge didn’t seem to know what to do.  He just looked overwhelmed.  Later, Lidia told me that Jorge had broken down from the whole ordeal and cried.  Mozambican men never cry. 

I know that I need to distance myself from these things… I can’t save the world, nor can I help everyone.  I am fully aware of this. But I can’t watch a child suffering when there’s something I can do to help. So I talked to some Mozambican friends who are nurses and doctors.  They told me I had to talk with José´s pediatrician. 

So I went this morning.  I wasn’t expecting much… I was expecting a curt, cold doctor, numb to all the suffering-- if I was able to see the doctor at all.  Not having the força, the strength, to go at it alone, I asked a friend to come with me.  Ask for help when you need it. I am learning slowly.

  

We had to wait for Dr. Simple (sim-play in Portuguese) for awhile.   She was giving a visiting doctor a tour of the ward.  The visiting doctor looked American, and when I got a closer look, I read UCSD on his jacket… a doctor from the pediatric department at the University of California, San Diego. 

‘This is where we treat with chemotherapy,’ Dr. Simple explained.  When they left, I looked inside the room, and there was nothing.  Nothing.  Just two beds with sheets. The California doctor looked totally shell shocked… from everything.  He was barely speaking.  If you have been to a hospital here and also in Europe or the U.S., then you will understand why.  The disparities are too wide to be described in words.

Then Dr. Simple called me in.  She was warm and attentive right away, but professional. She asked if I was a relative to José… I told a bleached-white lie.  Because I knew I had to.  ‘José’s mother is from Chimoio, where my husband is from…they are distant cousins.’  Not so much a lie… we are all related, right?

She sighed and opened the file.  First she told me that José is severely anemic.  His hemoglobin was 2 when he was admitted to the hospital.  I have seen blood smears with hemoglobin of 6 and the blood was so light that it looked yellow when I put it up to the light.  I can’t imagine that José´s blood was even red.  I gasped. From what I know, many people with hemoglobin this low are dead.  She then asked me if I knew what platelets do.  I had to admit that I had forgotten my biology lessons.  ‘Platelets are what keep the blood coagulating, and stop us from bleeding to death.  The low range for platelet count in a child is 150,000.  When José was admitted, his platelets were 1000. We almost lost him the night came in.’ 

‘So this is why there is blood streaming out of him all the time?’  ‘Exactly,’ she explained.  ‘I need to give him platelets, but we have a shortage of platelets in the hospital now, so I do a five day plan and ask for 2 times as many platelets as I need.  Usually I can get him platelets once a day. Yesterday his platelets were up to 70,000.  His hemoglobin is up to 8. The swelling is kwashiorkor.’

I know what kwashiorkor is.  It’s a form of severe malnutrition.  The body swells up, becoming incredibly edemic, and the child usually gets scaly open wounds around the body, especially on the limbs.

But what is causing all this? This is the question that kept burning circles through my head. I knew she was getting to it, but I knew to be patient. 

She flipped the page in José’s chart.  ´José has AIDS.´

I couldn’t contain my tears.  José is THREE years old.  He will be on medicine the rest of his short life, if he’s lucky.  He will never have children, probably never fall in love.   So many nevers.  It was too much for me.

‘We should get his CD4 counts back tomorrow,’ Dr. Simple explained, ‘and then his hematology report.  After that, we will know if we can put him on antiretrovirals (ARVs).  I am pretty sure he can start on ARVs soon.’ 

My mind immediately shot to the baby.  If José is HIV positive, so is Lidia, and the baby is breastfeeding, so at risk of contracting HIV through Lidia.  But formula is beyond the means of most people here, and when that is the case, the advice is to exclusively breastfeed up to 6 months… but Lidia could not do this because she was taking care of José. 

‘Does Lidia know that she and José have HIV?’ I asked the doctor. 

‘She knows that José is positive, yes, but I did not discuss her own status with her.’

I talked it over with my friend.  I didn’t mention to Lidia all I knew.  I will explain tomorrow what the doctor said about the platelets and the anemia and malnutrition, but will not mention HIV.  Matias, because he is a Mozambican and a man, will talk to them about the HIV.  That is the best way to go. 

Tomorrow Jorge is coming over and I will show him how to make formula, cleanly and hygienically, and explain that the baby should be weaned to formula, but not abruptly, over about one month.  I will buy the formula.  My mom wrote me an email asking what I wanted for my birthday yesterday.  All I want is formula.  That’s what I’m going to tell her.

I am praying with my entire core that someday I will see José smile.  I have never seen him smile.  He is three, but he looks like he’s not even two.  I have never heard him speak, but his mother says he does.  I have visions of the day he comes to our house to play in the dirt and eat cake and chase the dog with a stick… of the day he can be a child.  

Sushi in Nairobi with Abigail

This week, I was invited to a conference in Nairobi. I don’t get out much, especially to bigger cities, so I was pretty excited about this one.  Usually, when I go on work trips, I sleep in health posts in the middle of nowhere, and I get to eat gazelle meat, because that’s the only thing available on the menu.  When you live in a place where you don’t have much access to the usual elements of American life, you tend to yearn… obsessively …  The exact definition of these yearnings is pretty indiscriminate, and in my experience, depend entirely on the person.   For me, Nairobi is the big city, so when I woke up the night before with something threatening the chances of making my trip to the land of plenty, I was pretty freaked out.

The night before we left, we all went to Matias’ cousins’ graduation party, and I must have eaten something…  really, I have no idea, but I woke up in the middle of the night, and the whole left side of my face was swollen.  There was no pain. Allergy?  But I have never had an allergic reaction to anything in my life.  Stress? Hives?  Maybe.   The left side of my face swelled up so much that  it looked like I had cached a gigantic gumball in my left cheek 24/7.  It was pretty bizarre.  But, as usual, Matias was not worried.  Há de passar.  This is the Mozambican answer to every problem.  ‘It will pass.’  When I woke up in the morning, it was at least getting better and not worse, so I decided to go to Nairobi.  I took an antihistamine, prescribed by Matias’ cousin… everything is bought over the counter here (valium included), turned into a zombie on the plane, and arrived in Nairobi pretty much a-ok. 

And tonight I was having sushi at the West Gate mall with Abigail.  Imagine.  Abigail is the Maternal and Child Health Specialist for PSI (Population Services International) in South Sudan, and she and I ended up enjoying salmon and avocado rolls, and salmon sashimi over a nice glass of wine in the mall in Nairobi.  My Mozambican colleagues were talking about going out for chicken, and had even discussed a trip to Carnivore, the Nairobi restaurant where you can eat ANYthing (ostrich, alligator, gazelle, kudu) and I just couldn’t stomach it.  I felt like another dose of chicken and chips would be the knife in my heart. I told them I was sorry to be a non-conformist, but I had to have sushi.  Sorry.  Over dinner, we found out:  Abigail grew up in a military family just like me, and her parents now live in Germany, where I also have family.  She’s the oldest of four, like me, and her sisters live in Utah, where I was born… not many people are from Utah.  We shared all of this over our sumptuous Nairobi sushi (a critic would scoff at calling sushi sumptuous, but its true).  The food was like going to heaven and back, but the best thing was just talking with Abigail.  Sometimes the most comforting thing in life is finding someone who has something in common with you. 

In trouble with the law

On Sunday morning, I took the kids and Ginger to the beach. We had a great time.  Matias decided to sleep in, so he didn't come, and thus I was driving. 
On the way back, Ginger decided to sit in the front seat and put her head out the window and drink in the cool sea air, like all dogs like to do.  We were driving home on the marginal, the road that hugs the edge of the sea, when I passed the ubiquitous Mozambican...or African police truck--four skinny guys inside toting rifles, with nothing to do, and hungry for extra cash on a Sunday.  I passed them and before I knew it, they passed me back, gesturing out the window.  It looked like they were just saying hello, so I waved back.  They slowed down, so I passed again, and they waved again.
Finally, it was Nalia who said, "Mommy, I think they want you to stop."
When you get stopped by the police in the U.S. or any other country with laws that are remotely functional, it usually means you have done something wrong.  Not here.  It usually means something else.  There are no laws here. 
After I stopped, one of the young skinny guys holding a rifle (these are called cinzentinhos here, which means little gray guys because of their gray uniforms and general lack of respect from the population) approached the car.  He looked serious- ready to accomplish a mission.
"Senhora, you have violated the transit code of the Republic of Mozambique.  This code states that human beings are not allowed to put any body appendages outside the vehicle.  This law also includes animals, such as dogs.  Therefore you will be issued a fine because your dog had his head out the window. And I'd like to see your license."
After 11 years in and out of this continent, I have learned that questioning and getting tense and angry will only make things worse.  But I was also secretly very worried because I had only my American drivers license.  Mozambican law now requires all foreign residents to get international or Mozambican licenses, and I haven't gotten around to doing this.  He took my license, and then I got called over to the police truck to talk with the boss. 
He scrunitized my license and then looked at me.
"This license is not valid in this country, so you have committed two illegal acts," he frowned, "and we will have to impose two fines on you, one for your dog putting her head out the window and the other for driving without a valid license."
I did NOT want to give these guys any money, partly because the police here are all corrupt bastards and I'm sick of it, but mostly because I'm trying to save up all our money to pay off our plane tickets to New Zealand for Christmas, and didn't want to give them a single cent.
I knew my best bet was to play the stupid card.... and be effusively apologetic, playing into their need to feel like they are powerful and important men.  But sometimes I also just can't help myself.  By nature, I'm someone who likes to push buttons and stir things up a little.  And while the mantra in my head may be, "What would Obama do? Be like Obama," I am not Obama, so what comes out of my mouth is often drastically different from my internal mantra.
"I am deeply sorry and do admit that I did something wrong, but I would like to ask a question. May I?"
They nod. 
"What does the law say about goats, because I see them in the back of trucks, on top of buses, with their appendages clearly outside the vehicle?"
They are not understanding the sarcasm.  So this is positive.  I am enjoying the sarcasm, and they are prepared to give me a serious explanation.
"Senhora, e assim.  It's like this:  goats ride in the back of trucks and not in passenger seats like your dog.  Also, the goats have a special permit issued by the Police of Mozambique that allows them to put their heads, legs, etc outside the vehicle."
Again, I can't help myself. 
"So, if I get a permit for my dog, she can put her head out the window?"
They are getting frustrated, but they're laughing.  This is good.
"So," says the boss, "how will we resolve this."
This is a rhetorical question, of course, so there is no question mark.
"You're the boss," I respond.
"You can't drive in this country because you don't have a valid license."
"I admit that I violated the law and will not drive home, so I'll call my husband and he can walk down here to drive the car home.  He can be down here in about an hour."
"But we're working and can't wait around for your husband."
"Then, what's your suggestion?"
The oldest one is primed and ready to respond.
"Senhora should buy us a refresco."  
Refresco means a bottle of soda in Portuguese, but in Maputo it is parlance for a bribe.  The police will usually not sink as low to ask directly for a bribe. 
"Sure, I'd love to get you a soda.  I'll just run into the gas station and buy a round for all of you.  Sounds great."
"No, Senhora, you don't get it.  We need almoco, refresco."  Almoco is lunch.
Now the bribe is getting bigger.
"Great," I answered, "let's got to that restaurant down the street with my kids and my dog and we can have a nice Sunday lunch."
"No, you don't understand.  Just give us the money and we'll buy the food."
"Unfortunately I have no change, but I'd be very happy to take you out. My kids are in the car waiting and they'd love to eat too."
They are all smiling, sighing, exasperated. 
Finally, the old one shows his frustration.
"Deixa-la... vai embora!" This means Just Go Home. 
The skinny young one hands me my license.
I go back to the car, but sit to make sure they leave first.  By this point, they think I'm stupid as nails.  When they pass me, they yell out the window, "We said you could GO HOME.  GO!"

I have won, and am very proud of myself, but I do put up all the windows on the way home. 

Animal House

We have a dog named Ginger.  Her name doesn't fit her personality well.  Ginger is enormous, not fat just powerful and big.  She is a labrador/german sherperd mix, but looks more like a labrador.  Ginger has more energy than a 4 year old boy (we have tried to make comparisons with Elio's energy levels, but Ginger easily wins).  When my mom was here, she tried to teach Ginger not to jump on people, but mom would always come back with huge pawprints all over her shirt.  In the end, she decided it was best to do as the Mozambicans do and just ignore Ginger. 
Ginger also eats anything... I tell people this and they just sort of say, well, whatever, thinking she is like most puppies, but it's true: she eats almost EVERYTHING.  My brother Mark was incredulous when he visited.  Papayas, lemons, and yes, rocks.  Mostly she just chews on the rocks, but sometimes she actually swallows them.  The only thing she rejects is carrots.  But she does give them a little credit-- she chews on them.  My colleague's wife says this is a trait of Mozambican dogs.
We also have a cat named Oscar, and he hates Ginger more than anything in the world.  Ginger has, to her credit, tried to make friends with him.  She'll sniff him and lick him, but when we let Ginger in the house, the first thing she does is eat all his food.  This has not helped to create a friendly amicable relationship with Oscar.  So Oscar sits at the top of the gate and when Ginger gets near, he's ready to claw her face.  It's all premeditated. He's sitting on the gate waiting for her. 
We also had two chickens, but they didn't last long.  Ginger killed one, and when her friend Leo came over to play, he killed the other.  Leo is a bit old and tired, so we didn't think he had it in him, but when he sensed the chicken's presence, he got a resurgance of puppy energy and that was the end of the chicken. 

Photos below of kids, Ginger and her puppy friends at the beach...