November 11, 2010:
Someone lied to me. I was told that mission work was beautiful, that I would receive a blessing from it which I could not describe. I could not describe this, but not because of the beauty. Where is the beauty in holding a dead child in your arms?
~*~
Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period, from less than one day to five days, and produces an enterotoxin that causes a copious, painless, watery diarrhea that can quickly lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients
- World Health Organization
~*~
The week of cholera began on the first Sunday of November. Hurricane Tomas had dashed his way through our lives a mere 48-hours before, so Lala and I were still sopping up water and sleeping off the fatigue from our excitement. We didn’t know until that next Monday morning that cholera had begun for us. School began normal enough, though Tomas had kept most of our children home. Then one of our preschooler’s mamas came in. Her son – Santos Jerome – had taken ill Sunday night. But by the time we found out it was already too late. Twelve short hours and we lost him; a precious boy whose face I cannot remember.
Three of our Kindergarten students came down with cholera that Monday, but only one seemed weak enough for an I.V. We did not know much about cholera then; we didn’t recognize the taunt, hollow look about the face; we didn’t understand the sudden weakness; we barely grasped how swiftly it could take you. We were a uncertain of how best to help when our neighbors started coming; like the slow drift of the avalanche, so minute in its advance that the imminent rush almost takes one unaware.
There were several times the first day that Lala called me out from my classroom to have a second opinion in whether a patient was sick enough to merit an I.V. We stood over them and questioned just what a deepened eye socket looked like. The lack of confidence is almost comic now, knowing that only days later so seasoned we would become that with a onceover scan treatment would be prescribed without bothering a second glance.
~*~
Yolanda’s sister came for help Monday night. She told us that the eight year old had started having diarrhea the day before. Lala decided to visit personally and told me to ‘boot up’; the sodden memories of Tomas had yet to begin their slow seep into the ground causing the usual dust to form thick stratums of muck and mire. When we reached the family’s clay packed shanty ten minutes later, it looked like Yolanda had been sick for months. The skin stood taught over her cheekbones, and her lips were cracked and split like shaggy pine bark. But it was her eyes which were the most gruesome feature. Sucked down deep in the sockets, they gaped mercilessly, the skin of her lids so stretched so tight it was a wonder she could blink. The dehydration is what kills you when it comes to cholera. The bad water you ingest jettisons all that you have stored up inside. It can take you in just a few hours.
Yolanda appeared to be on the brink, but that first night Lala managed to slip an IV into her failing blood vessels and pump her full of liquid life. Having carried her home we had nestled her in our scant supply of blankets on the one mattressesed bed in the clinic. Uncertain if a single I.V. would be enough we hauled a second bed into the clinic and covered the metal framing with cardboard to cushion what would become our uneasy vigil. I remember watching her tiny chest rise and fall under her mosquito netting from my own prone position on that opposing bed. She was already malnourished and undersized from birth. Eight years old, but with the look of someone half her age. We all dozed off around midnight, and when we awoke at 5:30 we found that she made it through that first night. After flooding her system with the salty zest of the saline once more, Lala sent her home with instructions to keep her drinking steadily every few minutes.
We were almost overwhelmed by the crowds that Tuesday. Our school kids were so few in number that Lala combined the classes between Julie and Mr. Watson and so I could keep working with her at the clinic.
How long have you been sick? Do you have diarrhea? Can you explain it to me? What color is it? Do you have clean water at home? Here, drink this. Do you have a bucket at home you can bring for water? Wash your hands after you touch anything. Drink this every five minutes. Is there anyone in your family who can help you? You have to make her drink it or she will die.
I had followed Lala around Monday afternoon, watching her talk to our neighbors, seeing people gather as she spread this message of salvation. Previously I had been shy about speaking in Creole to anyone besides my kids, afraid that my meager attempts would sound ridiculous. But without realizing I picked up the language of cholera and its prevention and started spreading my own good word when I made my rounds visiting our sick students. It’s amazing what putting someone’s life on the line will do to your confidence.
That night after spending forty-five unsuccessful minutes trying to I.V. an 18 day old baby, Lala once again told me it was time to ‘boot up’. Sweaty and exhausted we mucked our way through 10 and 11 inches of standing water back to Yolanda’s home. Because of the impoverishment our neighbors survive in, we knew that most everyone in the house would be asleep – burning much light was too expensive for typical circumstances. But Lala was sure that out of the 13 other family members living with her, at least one would be up with Yolanda.
All was still when we approached the patched wooden door. Lala had to bang for a solid minute before anyone roused to open a way for us. Yet in that one roomed house, there had to have been at least four with their heads less than a foot away from the door. Not a single one even tried to pretend that they weren’t rubbing the sleep from their eyes as we stepped into the room, but the sound of Yolanda’s abrupt heaving centered all of our attention on the small figure quivering precariously on her knees. Lala knelt before Yolanda, her swollen face spotlighted by my hand torch. Her face was still puffy from the excessive I.V. hookups Lala had put her through the day before, but only just.
“Yolanda, have you been drinking?” If she hadn’t of had the puny look to her eyes, the question might have made me laugh. “Yes” was what she could manage, and that in a spineless whisper. Her makeshift toilet was almost full and Lala sternly sent a brother out to empty it into the dark. The situation was heartbreakingly obvious; the eight year old had been awake by herself, left alone to vomit savagely throughout the night.
“There are 14 people in this house, even if you were to sit for thirty minutes each you all could still get a full night’s sleep! This is your sister; do not leave her up on her own! You decide if she lives or dies!”
Lala’s face was dark with vigor as she chastised the girl’s family. Yet despite the force I knew it wasn’t anger, which she proved to me moments after the door was closed. “Do you think that was too mean? I didn’t want to be ugly, but I just don’t think they understand how serious this is!” I remember trying to formulate the sentence that conveyed everything I was thinking They are leaving her alone to die because they do not understand that this could be her last moments while you have literally been saving lives for the past two days nonstop and here we are making house calls. How do you find the words to tell a friend that they are your Hero?
Lala decided that we would make a second visit that same night, to see if anyone had taken her seriously. I couldn’t wait any longer when my wristwatch chimed in at 11pm, so we trudged back through the muck and standing water leading to her house, sending a silent prayer with each liquidly gulp at our boots that we would find at least one person awake with her.
I could see the faint glow of a kerosene lantern shining through the cracks of the door, but it still took a while to get someone to open it up to us. The brother looked a little groggy, but at least cognitive when he finally answered Lala’s “honor” with the usual “respect”. The tradition seemed a little out of place in the context of checking to see whether a family had left one of their youngest to fight through the night on her own, but I suppose one could understand why that would be the least of my judgment calls.
Yolanda was still struggling between consciousness and exhaustion, but she had managed to find a comfortable way to recline. I had to fight the urge to beg Lala to let us take her again. We had discussed our plan of action on the way over and decided that leaving her with her family was necessary. It wasn’t the thought of teaching in the school and working in the clinic the next day that made the decision. It was the unwelcome certainty that it would ultimately have to be her family taking responsibility for her that made the difference. But it was the realization that they might not choose it that turned my stomach as we silently trudged home in the dark.
The clinic was packed from dawn until dusk that Wednesday. I kept trying to catch a minute’s break to check on her that morning, but when we had twelve on I.V.’s by noon, I gave up and just prayed that one of her family members would bring her if she got worse. It was Wednesday, November 10th, and the next day was Lala’s birthday. Mary Wilson pulled me aside and told me of a surprise birthday dinner she wanted to have for Lala that evening. I wasn’t certain how I was going to fill my part and convince Lala to drive into town after she had spent the day single-handedly playing a hospital’s entire staff, but I promised to do my best. We had pizza and cake that night, and the money I gave the teenagers produced some pretty fantastic gifts straight from their beautiful hearts. We laughed and joked and played with pellet guns – for a moment it was as if cholera did not exist.
~*~
I should have known better that next day – Lala’s birthday – when I went to check on Yolanda and found out that they had moved her sleeping mat away from the others and parceled her off under the dismissing sheets draped over the side of her mother’s bed.
I knelt on the packed earth floor and had to use my flashlight to see her, even though the glare of the morning sun was hovering just over my shoulder. She was naked, covered with a scrap of clothe which would not have covered the torso of a normal sized eight year old. Yolanda had the cloth tucked in on both sides. Her older brother told me that they were giving her the serum water regularly, but I wasn’t convinced by the bowl of vomit that lay half full at the head of her mat. I asked her if she had to go to the bathroom and she was just strong enough to clutch my wrists as I held her over the bowl. It sounded like the letting go of her bladder, but it wasn’t urine. Cholera liquefies your feces and it comes out clearish, the look and consistency of rice water. It’s fatal only when the rate of expulsion out wins that of the consumption. I restocked her small bottle with a serum of the rehydration salts and Sweety, the sweet flavoring that was my attempt to lessen the bitter salt taste that I was forcing our patients to drink as their bodies rejected their only chances at life.
The rest of the morning hours are a blur. It was just after one when sister Gerlande came to the school.
“Yolanda is sick.” The bottom dropped out of my stomach. I headed to the house at a slight run; each boot print in the mud bringing me closer to what I was certain would not be pleasant.
Stepping through the gaping entrance into the stick-fence surrounding the house, two of the brothers run up to me and drug us through the mucky yard and into the doorway. Three more of her family members sit huddled to the side of the room, staring at the sheet hanging down from the bed as if it contained a living thing. My stomach lurched as I realized that they still had stowed her away under there, out of sight, out of mind perhaps.
Pulling back the sheet was worse than I had braced myself for. Little more than a skeleton looked back at me. Her eyes fluttered to blink as my light hit them, but the skin was so tight that they barely made it half closed. They must have been preparing to bring to me before the sight of her worried them too much for even that.
~*~
She is dressed in a blue frilly dress, a macabre allusion to all that is wrong with the world- a dying child made up in a party dress. I scoop her up in my arms, her bones so light that I think of the hollow ones found in birds. She doesn’t even try to help; she just lolls back as I take her through the front door and into the yard. She struggles to look at me and I connect brown eyes greyed over in worry with brown eyes glazed over in the state of delusion.
“Come on baby girl, I’ve got you now. I’ve got you. Please, just please.”
Her lips quiver as her spine wretches quietly. And then suddenly, as if it were the most natural happenstance she collapses in my arms. Her head arches back in an unbelievable angle and I stumble to a halt. The child lies dead in my arms and I don’t know where to take her.
~*~
It may have been a minute; it may have been an hour. I watched the mountains in the distance. The mud oozed under my boot as the water slushed its way down the shallow drainage ditch. The frills on the blue dress scratched at my arm as the breeze gently pulled at them. I began to walk, towards school, towards home.
And then, she coughed. Again her body went rigid in my arms, but this time it was life surging through her limbs, jolting her back into the cradle of my arms. We made it back to the school, together. I.V.’s and a trip to the hospital continued the struggle to add strength to her bones. She is back in school now, or was when I left Haiti seven weeks ago. I’m no doctor, perhaps she only passed out that incredible November afternoon, but this is my truth of the story of the week that Yolanda had cholera.
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