5 February 2020

For the past several days our hospital compound has oscillated between light and dark, between the gentle distant hum of a diesel motor and silence, between running water and dry faucets. After months of relying on two large generators and neglecting the smaller ailing backup generator, with one small difficult-to-replace part now broken on both large generators, we suddenly have no working generator. Our mechanic is finally scrambling to find out what is wrong with the small generator and how to fix it. The improvised patch-up fixes work intermittently--transformers click to life, refrigerators start humming, trying to get cold again, and water starts flowing again as the well pumps catch up on their work and refill the water towers. We want to celebrate every time we see a lightbulb brighten to life again. But each time the electricity comes back, someone will caution, as we rush to plug in chargers and refill waterbottles, "Don't celebrate yet--it'll go out again soon."

Last night a different kind of darkness descended on our little community. We sat in the dark and mourned with our friend and fellow hospital worker, a nurse in our OR. He brightens our work there every day with his positivity--quick to laugh, always smiling, often singing or whistling--and his competence, whether scrubbed into a large surgical case along with the surgeon or preparing kits to be sterilized and operating the autoclave or directing the nursing students in their work and keeping everything flowing smoothly pre-op and post-op. The little light who brought joy to his evenings--his youngest child, his sweet, almost-14-month old daughter, died yesterday evening.

Sick, but hadn't seemed to be as sick as when we hospitalized her last fall. Now with malaria, already carrying the diagnosis of sickle cell disease. Already admitted and on appropriate malaria treatment, but the call came from the family--she suddenly wasn't breathing. Didn't come back with resuscitation. The tears were flowing long before we declared our efforts futile and stopped trying to bring her back to life. But as the fabric was wrapped over her, the wailing and mourning really began. The family carried her home, and we followed a few minutes later to join the gathering which evolved gradually throughout the evening. Neighbors, family, and friends poured into the house and compound, knowing exactly what was expected of them. Everyone here is experienced at funerals, professional mourners. Initially the women mourned wildly and frantically, constrained with some effort by the men who held them down or carried them out into the fresh evening air as they flailed or went limp, crying and wailing all the while. This soon shifted to hymn-singing mingled with wailing, and gradually to quiet singing punctuated by occasional cries of pain and disbelief that this could have happened--that their baby who had been bright and alert and active in the morning was now irretrievably gone this evening.

We still lose many babies and young children to malaria here. Too often a motorcycle taxi arrives from hours (and many kilometers of terrible roads) away and unloads a limp bundle--near death, severely anemic, comatose, or even--occasionally--already dead. The family waited too long, contemplating such a long trip, the time away from the other kids at home and the fields, the potential financial investment. They waited too long, hoping this was going to resolve with traditional medicine, treatment at the local health center, or time.

In contrast, we see many babies and kids do really well after a couple of days of quinine when they present early enough--before coma. Even the cerebral malaria cases who were already seizing at home before they came in often walk out of the hospital a few days later.

But this case was different. There was no long journey, no waiting until it was too late. She arrived early, our neighbor from just across the dirt road, over the wall. Still, somehow we couldn't save her. This also wasn't an anonymous child from the other side of the country. This was our friend. This was the baby we had welcomed and celebrated with them and watched as she grew and knew the love between these parents and their child. But this bright light also went out, after shining for much too short of a time in the life of her family and our community.

Another nurse at our hospital had a baby recently. We heard that the baby had had a fever, but was doing better and went home and hadn't come back to the hospital. I decided to stop in and check on her. We visited in their home, held the baby, chatted with the mom and the dad and the extended family. I couldn't help but think that this whole scenario could repeat itself again. This is still Tchad. We're here to improve the stats for moms and babies, but it's still one of the worst places in the world to be a woman or a baby or a child under the age of 5.

"Don't celebrate just yet! The lights will just go off again."

But we have to enjoy and celebrate the light while we have it. We have to be prepared for the dark, too, but part of preparing for the dark is making the most of the light while it's present.

Each time this darkness falls, we are reminded to look forward to eternal light, to life in a city illuminated forever without dimming because "the glory of God gives it light and the Lamb is its lamp" (Rev. 21:23).

Tonight we sit in the dark and ache to live in that invincible light.