martedì 22 luglio 2014
Foto di un viaggio
lunedì 21 luglio 2014
GLI ORFANELLI DI CHAARIA
Mesi fa il Signore ci mandò Camilla Mukomwenda, che morì dopo il parto nel nostro ospedale e ci regalò la piccola e bellissima Mary-Rita, che è ancora qui con noi. Mary-Rita è una bellissima bambina di circa 6 mesi. La sua mamma si chiama Camilla Mukomwenda e fu ricoverata da noi
in dicembre per malaria cerebrale. Abbiamo tentato a lungo di salvarla, ma il coma è diventato sempre più profondo. Per un mese e mezzo è stata ricoverata senza che nessuno venisse a visitarla. Un giorno abbiamo deciso di andare in macchina a cercare qualche parente. Abbiamo viaggiato per 40 Km lungo una strada terribile e siamo giunti in una isolata capanna di fango, dove abbiamo trovato un uomo completamente pazzo e violento. La capanna era così mal messa da farci
temere che sarebbe caduta da un momento all’altro. Da quel giorno abbiamo perso ogni speranza in un possibile reinserimento di Camilla o della futura creatura. Quando ormai il coma di Camilla sembrava irreversibile, abbiamo indotto il travaglio ed abbiamo estratto una piccola bimba di circa 1
Kg. L’abbiamo messa in incubatrice per 2 mesi … ora la piccola è stata battezzata, è sanissima e pesa più di 4 Kg. L’unico punto interrogativo è il futuro: che cosa faremo di Mary Rita quando
crescerà? Camilla morì pochi giorni dopo il parto. Altro bimbo che abbiamo seguito in questi ultimi sei mesi è Mark Mwenda. Anche lui è nato qui da noi da una mamma psichiatrica che un po’ tutti conosciamo perchè è una senza-fissa-dimora che vagola nei villaggi attorno a Chaaria. L’abbiamo fatta partorire gratuitamente e poi il suo spirito libero l’ha spinta a scappare di notte dal nostro
ospedale di notte, dimenticandosi completamente del suo piccolo. Lo abbiamo battezzato noi, e noi abbiamo scelto il suo nome perchè la mamma non sa neppure di essere al mondo, i familiari non si curano di lei, ed il padre deve essere qualche approfittatore che l’ha violentata dietro a qualche cespuglio. Con noi abbiamo Victor, di tre mesi. Ce lo ha portato la polizia. Viene dalle zone montagnose al di sopra di Meru. Un giorno alcune donne che raccoglievano tè hanno udito dei vagiti tra le frasche; si sono avvicinate ed hanno trovato questo neonato ancora coperto di sangue e con il cordone ombelicale legato da un pezzo di filo di lana. E’ stata molto dura all’inizio perchè Victor pesava solo 1500 grammi. Lo abbiamo posto in incubatrice ed abbiamo iniziato a nutrirlo con
latte in polvere. Ce ne siamo presi cura con tutte le prestazioni sanitarie che avremmo riservato ad un pretermine, curando le sue infezioni respiratorie ricorrenti ed aiutandolo con vari farmaci. Ora
Victor è stabile ed è fuori dell’incubatrice. Al momento pesa 2500 grammi ed è in grade di succhiare benissimo con il biberon. Abbiamo poi Jedida, un’orfana di entrambi i genitori rimasta gravemente cerebrolesa; dopo un attacco di meningite, i nonni, invece di portarla all’ospedale la portarono dallo stregone. Quando ormai era in condizioni terribili (la bimba ha 2 anni e pesa 4 Kg), ce la lasciarono qui dicendo che sarebbero venuti a vederla regolarmente. Da otto mesi però nessuno è mai venuto, e Jedida è completamente a nostro carico. La nutriamo con sondino naso-gastrico, le curiamo i decubiti, la teniamo calda ed umidificata in incubatrice. Non so se ce la faremo a salvarla ma certamente ce la terremo fin quando morirà. Zawadi è invece una bimba un po’ più grande. A vederla sembra avere circa un anno di età. È stata abbandonata nella sala di attesa del nostro ospedale e non sappiamo chi siano i genitori. Sembra una bimba nornale, senza particolari problemi di salute. Certamente la madre l’ha abbandonata qui da noi perchè pensa che ce ne prenderemo cura, ma
è tristissimo per me pensare che un genitore possa avere il coraggio di abbandonare la propria creatura. Non vorremmo tenerla a lungo e con la polizia stiamo facendo ricerche dei genitori, perchè, se iniziamo ad accogliere tutti i trovatelli in questo modo, di sicuro favoriremo comportamenti irresponsabili come questo anche in futuro. Vorremmo trovare la famiglia, capire perchè hanno abbandonato la bambina e vedere se si può dare una mano a risolvere i problemi che hanno
portato all’abbandono. Zawadi non è un nome di battesimo, perchè non sappiamo come si chiami la bambina. Zawadi in kiswahili significa dono, ed è così che la chiameremo finchè non risolveremo la sua situazione, perchè per noi anche lei è un dono di Dio.
Under the moon of Chaaria
Under the moon of Chaaria
It is the dead of the night. I’m really
exhausted. I look at my watch. It’s almost 2 a.m. I feel bad when I think that in
4 hours I will have to wake up for the Mass. At the same
time I know that I could not sleep if I went straight
to the bed because my head is
almost bursting with thoughts. Perhaps this would be the right time for a cigarette, but since I do not smoke I chose to wander to the banana
plantation, away from the lights of
the hospital, to contemplate the
sky full of stars. Tonight there are thousands of stars that
shine even more because the moon
is just rising on
the horizon and looks like a
huge orange disc.
What a day! Here, it’s a constant battle between life and death. Sometimes life
wins, but often the death reminds us that we are not omnipotent and that the final victory will be only
at the end of time. It seems as if the Lord kept on
sending us messages that make us
feel humble: maybe we were pleased with ourselves
and thought we would be able to
cope with many health problems that
decimate our poor people. Sometimes the temptation to be proud of ourselves can peep
in our hearts, but then some disaster happens and you seem no longer able to do anything; you just feel like leaving
everything and submerge in discouragement.
The
day started early. It was 5 a.m. when Concetta
knocked at the door of my room. I could
not wake up, taking into account the fact that
the previous Cesarean section finished after midnight. Concetta continued knocking like the importunate friend from the Gospel. I finally overcame the tiredness and responded.
She told me to
run because there was a case of a mother in coma in the maternity ward. She said that the patient was in a very poor condition and she could
die at any time. It took me 3 minutes to get dressed and
I ran to the hospital, even forgetting my glasses. It was not what I expected. I surmised it could be a case of
gestosis, and I thought of doing another Cesarean. Instead, I found a young woman in a state of agony. She barely breathed. We, doctors, tend to say that a
patient is ‘gasping’, which in simple terms denotes the last minutes of breath.
She had a retained placenta and was bleeding all night long. In fact, she gave birth on the street while trying to reach the maternity in Tharaka.
Women of good will had helped in childbirth, but they were inexperienced and perhaps did not tie the
umbilical cord well. When the mother reached the abovementioned dispensary, she was told that they could not handle her
case because they had no possibility
of giving anesthesia to remove the placenta manually,
and that they could not transfuse. That dispensary did not provide
neither the car nor the driver, so the husband had to put his wife in
the back of the bicycle. She delivered around 10 p.m.
and arrived to Chaaria at 5 a.m., almost completely bloodless. We acted immediately. We found the femoral vein and rapidly
transfused the blood. We removed the placenta and the mother slowly
started to recover. She even began to speak
and seemed completely out of
danger. She asked about the baby
and was happy to know that the baby was in
perfect condition. She began to
eat something and continued to tell us how she had
first been transported
by bicycle, then a
wheelbarrow and then a ‘matatu’ rented by the spouse. I
was full of joy. The eyes were closed for
a very short night's sleep, but my heart was full
of human satisfaction. I wanted to go to get some snack and then some sleep before returning to
the new day of service. Instead
of this I was called urgently to the delivery room. A mother gave birth apparently without problems,
but the baby was not breathing: once again the events changed
my plans. Once again in turmoil, I had to try to fight for the life of that little baby who was not able to breathe. Here too,
the Lord has given us a moment of human satisfaction. Our efforts
bore quick results and improved the condition of the patient. After 45 minutes
the baby began issuing the first cries and then cried vigorously.
Thank goodness! It went well again.
It seems finally the time has come for a breakfast and at least
a little prayer in the Chapel- to repeat to myself and to Jesus that I want to live and work for Him. But once I tried to leave, I was called again for another two C-sections. I was told
these are urgent because the fetus is in danger. What
to do! Better to have a cup of
coffee in my office and be ready
as soon as the theatre is cleaned and prepared. The Lord guided my hands and
about 12.30 we had already finished the second C-section and both mothers and
their children were in good
condition. After leaving the room, full of heat and sweat,
I got hit by a
queue of angry patients who were complaining that
they had been told
to wait with a full bladder for
an ultrasound of the abdomen. Many of them were from
Isiolo, which is really far away, and worried about not being able to find
public transport to get back home.
It therefore required a new sacrifice: after lunch,
forgetting the little siesta, we began another adventure in the ambulatory, trying to give the maximum attention to the problems of each. The problems we encounter here are
often complicated, requiring
much attention and patience. It is especially difficult with women who are unable to have children. So often there is nothing to do for them, because
their problems are chronic
and practically insoluble. But how to tell them that? An adoption is not
accepted here, especially among the Muslim community of Isiolo. The husband is usually considered
immune to sexual problems
in the area, so it's always the woman to be held responsible for any type of infertility. If
a woman is unable to have children, there are two options: either
she becomes a second wife and has to accept that her husband has another partner to have children
with (and therefore that second partner will receive far more attention), or is simply sent away (it
seems like in the Old Testament!).
Bearing in mind the local traditions, we know that
only men can inherit and the woman must receive the support from her husband. It means that
a woman rejected because of infertility is actually
left with no chance for a happy life. Nobody is going to marry
her and she has no right to inherit neither the money nor the ground from the
husband who had repudiated her. The ambulatory is then
made even more stressful by the continuous arrival of children in bad condition who often come to us when
it is too late. As in the
case of Joy, who had been treated
for 4 days with an
antibiotic syrup at
the dispensary of the village:
the mother was told that the child had pneumonia and that this was the reason of his panting. In fact, when Joy came to Chaaria, she
had a hemoglobin level of 3 grams (his blood
was almost as water). She was so collapsed
that the veins were not visible and I
had troubles with inserting a jugular vein cannula. A race against time began. Her
blood group was 0 positive and
we did not have compatible blood in the hospital. We
asked the mother to donate,
but she said she was pregnant again. All that remained was to find
a donor elsewhere. We asked the volunteers, but nobody was 0 positive.
We were therefore forced to ask Mururu (our mentally disabled friend from Buoni Figli Center) who agreed
on giving his blood provided that we allow him to go home for some days. We collected the blood, but right after connecting it to the Joy’s vein, the
girl passed away. We did not
arrive on time. Once again, the death was stronger.
The mother’s despair
gripped our hearts, but we could not stop. Other
patients were waiting for our
help, so we left the mother with
Judith who has tried
to console us while
we continued with other outpatients. It was 6:30
p.m. when I decided to take a
coffee. There were no more patients
tonight so maybe I
could go and pray with the community. But here again the situation changes. The
condition of a mother with retained placenta rapidly changes. She begins to bleed
from all sides: from the gums, from the catheter... Oh
no! She’s got the complications by CID. Patients with CID bleed from all over
the body and we don’t have here any therapy that can stop this complication. The only hope lies with keeping the patient
alive by using transfusions
and vasopressors. It started again with a
gasp. We rapidly transfused three bags of blood, stayed with her, but she did not regain conscience and started to
pass away. We turned the monitor on and this increased our sense of powerlessness also visually, as we
saw the heartbeat gradually
decelerating and the ECG indicators becoming more and more abnormal. We could only shrug and say to each
other: ‘Also this time the patient
arrived at the terminus. How unfortunate for her to be born here! If she was born in Turin,
this would not happen.’ The patient had given her
last breath at 9 p.m., and
on the bed next to her, her baby started to cry because of hunger... Now we are
here with a corpse, a newborn orphan, and the inability to contact
the relatives. We only hope that
they will come tomorrow. Otherwise we
will also have to think about the burial. We go to grab a bite to eat, but again we are called as 3 pregnant women arrive, all with complications. I shrug and say ‘This is really the sacrifice of life.’
But how can I choose
which Cesarean should be first?
Another tragic moment. It reminds me of the book ‘Emergency’, in which Gino Strada speaks of the enormous responsibility of the physician, when he has to decide to do one intervention and leave another, which is considered unnecessary as the patient is already in too serious condition. I visited the mothers. I have no doubt about who should be the first, because one is a primipare with a breech presentation and a dilation of 6 cm, so it is urgent. The question is between the second and the third, because the first one is pregnant for the first time and the baby is in breech presentation. The second is a mother of 3 other children and seems to have prolonged labor from few hours because the dilation of the cervix had stopped, although the fetus was in excellent condition. I decide to do the second cesarean for the mother with breech presentation, thinking that perhaps the last mother would finally give birth without our help, or at least could wait and be operated if she didn’t deliver before midnight. We worked well and around midnight we finished the first two C-sections. We were very tired but also satisfied. The last mother still hadn’t given birth. She was confused and complained on severe headache. The abdomen was huge and hard and the mother sweated. I felt a shiver of discomfort and I told the personel to accompany her to my office for an ultrasound before starting the operation. What a pain! Ultrasonography left no hope: there is no heartbeat. The fetus is dead. And the mother is going to have complications with the uterine rupture. One day someone has given me an ashtray with an inscription on it: ‘The mistakes of the doctors are buried in the soil.’ I feel bad and try to overcome the feeling of guilt by making efforts to save the mother. We have to use forceps to pull the lifeless creature, a female of almost 4 pounds of weight. This maneuver is never nice as the mother has severe bleeding due to internal wounds: we transfused, sutured, and eventually the situation seemed under control. The mother leaves the room and accepts the loss of her baby in a stoic way, not accusing us of anything. But that weight on my heart remained! If I changed the list of operations, maybe that child would be alive... I feel guilty and want to spend some time alone. I make my way towards the banana plantation in the dark of the night. How many stars! And the moon? It 'really beautiful and it takes your breath away as it appears on the horizon among the papaya trees. I try to pray, and as I do, the well-known question comes to my mind: ‘Why, Lord?’. I want to console myself thinking that today there were many more who left the hospital completely cured, but it's hard to detach my mind from those who passed away. I ask the Lord to help me get some sleep because in few hours I’ll have to start my daily struggle between life and death again.
Another tragic moment. It reminds me of the book ‘Emergency’, in which Gino Strada speaks of the enormous responsibility of the physician, when he has to decide to do one intervention and leave another, which is considered unnecessary as the patient is already in too serious condition. I visited the mothers. I have no doubt about who should be the first, because one is a primipare with a breech presentation and a dilation of 6 cm, so it is urgent. The question is between the second and the third, because the first one is pregnant for the first time and the baby is in breech presentation. The second is a mother of 3 other children and seems to have prolonged labor from few hours because the dilation of the cervix had stopped, although the fetus was in excellent condition. I decide to do the second cesarean for the mother with breech presentation, thinking that perhaps the last mother would finally give birth without our help, or at least could wait and be operated if she didn’t deliver before midnight. We worked well and around midnight we finished the first two C-sections. We were very tired but also satisfied. The last mother still hadn’t given birth. She was confused and complained on severe headache. The abdomen was huge and hard and the mother sweated. I felt a shiver of discomfort and I told the personel to accompany her to my office for an ultrasound before starting the operation. What a pain! Ultrasonography left no hope: there is no heartbeat. The fetus is dead. And the mother is going to have complications with the uterine rupture. One day someone has given me an ashtray with an inscription on it: ‘The mistakes of the doctors are buried in the soil.’ I feel bad and try to overcome the feeling of guilt by making efforts to save the mother. We have to use forceps to pull the lifeless creature, a female of almost 4 pounds of weight. This maneuver is never nice as the mother has severe bleeding due to internal wounds: we transfused, sutured, and eventually the situation seemed under control. The mother leaves the room and accepts the loss of her baby in a stoic way, not accusing us of anything. But that weight on my heart remained! If I changed the list of operations, maybe that child would be alive... I feel guilty and want to spend some time alone. I make my way towards the banana plantation in the dark of the night. How many stars! And the moon? It 'really beautiful and it takes your breath away as it appears on the horizon among the papaya trees. I try to pray, and as I do, the well-known question comes to my mind: ‘Why, Lord?’. I want to console myself thinking that today there were many more who left the hospital completely cured, but it's hard to detach my mind from those who passed away. I ask the Lord to help me get some sleep because in few hours I’ll have to start my daily struggle between life and death again.
I am reminded of the words of my confessor: "Life will
win, but only after, only in
Paradise." I walk towards my room hoping to get some sleep.
Br.
Beppe Gaido
domenica 20 luglio 2014
foto di un viaggio stupendo
Gli occhi delle mamme
GLI OCCHI DELLE MAMME
La mamma è in piedi alle mie spalle ad una manciata di
centimetri da me.
Sento sul collo il suo respiro pesante e avverto addirittura
il calore che emana dalla sua pelle. Mi guarda ansiosa ed implorante: i suoi
occhioni neri compiono una continua gimkana tra me ed il suo bimbo che sto
cercando di rianimare sul fasciatoio. Qualche volta lascia che la sua spalla
sfiori delicatamente la mia, quasi a darmi una spinta per incoraggiarmi a fare
di più.
Ha nel cuore una fiducia illimitata nei miei confronti,
perchè io sono il dottore bianco, e quindi, nel suo immaginario, io sono più o
meno un semidio che sa e può tutto.
I suoi occhi esprimono terrore alla vista del loro piccolo,
speranza quando carpiscono dal mio volto qualche segnale di speranza, e totale
abbandono nelle mie mani che si muovono veloci sulla sua creatura: dove
potrebbero andare se non da me? Chi potrebbe aiutare il suo piccolo se non il
medico bianco?
Segue le mie dita mentre pompo ossigeno nei polmoni del suo
bimbo; accompagna le mie mani mentre iniettano un farmaco in vena o premono
ripetutamente sul piccolo torace per il massaggio cardiaco.
La mamma sta sempre in silenzio: non parla e non chiede,
quasi a non rovinare la sacralità delle mie azioni.
Quando ce la faccio a salvare il piccolo, la mia gioia è
tutta interiore: vorrei abbracciare quella mamma che si è fidata di me così
tanto, ma la cultura locale me lo impedisce. In quei momenti di gioia solenne, mi devo aspettare un grazie
fatto di un timido sorriso accompagnato da uno sguardo pieno di affetto. Poche
volte dalle sue labbra affiora la parola “grazie”, ma la riconoscenza la avverto
in tutte le sua membra, mentre le cosegno il piccolo e lo deposito tra le sue
braccia accoglienti.
Quando non ce la faccio nella mia battaglia per la vita e
vince la morte, gli occhi della mamma dapprima vagano sperduti fissando
dapprima il mio volto e poi quello del bimbo: non riesce a capire come possa
essere successo quanto in cuor suo già percepisce! Io snono il dottore bianco e
quindi nel suo immaginario io sono onnipotente: non può quindi essere vero
quello che l’evidenza le suggerisce. Il bimbo non può essere morto!
Cerca di catturare il mio sguardo per cogliere la verità nei
miei occhi: normalmente mi basta guardarla
intensamente per un attimo per trasmetterle tutto il mio sgomento ed il
mio senso di fallimento. Lei capisce anche prima che io parli. Qualche volta ha
il coraggio di abbozzare la tremenda domanda: “è morto?”, ed a me basta annuire
con il capo, senza proferire verbo. Solitamente piange e singhiozza in modo
sommesso: non urla e non fa scene. Capita che voglia toccare il bambino e poi
si ritira chiusa nel suo dolore.
Poche piangono forte e si disperano. Per lo più c’è una
disperazione silenziosa e colma di dignità.
Quanto affetto passa tra i miei occhi e quelli delle mamme
da noi ricoverate!
Quanto dolore e quante gioie riusciamo a condividere in
silenzio attraverso i nostri sguardi!
Quanto rispetto vorrei essere capace di trasmettere a questi
giganti d’umanità che sono le nostre mammine, così fragili ed indifese, ma
anche così forti e dignitose!
Fr Beppe Gaido
sabato 19 luglio 2014
LA SCUOLA DI NAOMI
Dopo aver
terminato l’ultimo anno di scuola superiore che essa aveva voluto ripetere,
Naomi ha ottenuto un modesto miglioramento dei voti finali.
Sono seguiti
tempi di giusto rilassamento e spensieratezza, come di solito si concedono tutti
gli studenti che passano la maturità.
E’ però poi
venuto il momento di prendere una decisione circa il suo futuro.
Sentendomi
un po’ responsabile di lei, io ho cercato di indicarle come carriere possibili,
quella della segretaria o della ragioniera, oppure quella dell’insegnamento.
L’ho invitata a considerare la sua condizione fisica, prima di prendere
decisioni accademiche avventate.
Da quell’orecchio però Naomi proprio non ci voleva sentire:
a tutti i costi lei doveva intraprendere una carriera sanitaria...Continua a leggere su donazionicottolengo
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