The loss of a child....

So after months of being told that the Nigerian licensing department was not issuing new expatriate licenses and carrying a photocopy of my New Zealand license around with me in case I was stopped at a checkpoint, I finally heard they had recommenced the issuing process. Off to the office I went to try and make myself legal. I shouldn’t really have been surprised with the outcome, but after talking to four different people, all telling me different stories about the steps I would have to take to acquire said license (one of who insisted on me paying for a learners permit and sitting a test…um I don't think so!) I wandered back to the compound disheartened and about to give up on the whole thing. Then, in passing conversation a missionary friend mentioned he had a Nigerian friend in Lagos who could get us past the red tape and get us licenses from there. I didn’t ask questions…supplied the passport photos, details and 6000 Naira and crossed my fingers! 3 days later I had in my hand a very forged looking laminated license (which I was assured was just an older version and perfectly legal) first issued in Feb 2011! They spelt my name correctly so that was a bonus. They can’t say I haven’t tried to play by the rules. 

Last week was one of the most hard I’ve had in Nigeria to date. At 830am Wednesday morning I received a call from one of the Aunties out at Gyero orphanage to come quickly as they had an emergency with a child. I drove out there immediately to find Grace, a tiny 7-year-old girl, unresponsive, having intermittent seizure like activity (and associated symptoms) and general body rigidity. We bundled her into my car and drove to the hospital where I had arranged one of my colleagues, a missionary doctor here in Nigeria, to meet us in the ED. I have never driven so fast in my life, like a true Nigerian you could say. I took risks on the road that day I don’t plan to again, but when you have a dying child in your car, the sheer frustration of being stuck at a stand still while other traffic is waved through is just unbearable! Unfortunately the ambulances here are used to carry corpses and therefore do not have the privileges given to ambulances back home that can put their sirens on, clear traffic and go through red lights to get to their destination. That being said, had I arrived any sooner, the care we received once in ED would not have been given any faster, as speed and urgency is not a concept that Nigerians really put value on in their culture.

Anyway, Dr Sheppard gave Grace an injection of diazepam to stop her seizing, then after all the paperwork was completed (after I had run around like a headless chicken to 4 or 5 different places getting admission cards stamped and billing sorted) we (Dr, Sheppard, two aunties from Gyero and myself) finally got Grace admitted to the Paediatric ward where we were met by the Nigerian Paediatric registrar. She thought it could have been either Cerebral Malaria or Meningitis, so did a lumbar puncture in the treatment room, placed an IV line and commenced medications for both. The whole process took a few hours and it was about 230pm when we moved her into the Paediatric ICU (not what you imagine believe me, there was no monitoring of vitals, no oxygen available and no resuscitation equipment nearby). I left the hospital to take the aunties back to Gyero, pick up some clothes for Grace and to get another auntie who would stay the night with Grace. On our return Grace  didn’t look good, her breathing was more laboured and her respiration's had significantly reduced. But the two Paediatric doctors were sitting right next to her bed at their desks, so I assumed they would act if she continued to deteriorate.  Two hours later a got a text from the Auntie at the hospital to say Grace had ‘given up’. I was shocked. Apparently they had attempted CRP, but the only oxygen they were giving her was through a bag mask (it’s expensive for bottled O2). I raced back to the hospital to be with the auntie (who had been Grace’s mother for the 2 years she’d been with the ministry) and find out what happened. By this time we had the labs back (which takes several hours as top priority) and Dr Sheppard soberly explained her acidotic state on admission; patients with lab results like that do not survive in Nigeria. It made me feel so helpless, angry, devastated and confused all at the same time. We still had no idea what had killed Grace because the hospital was ‘out of stock’ of the test that would diagnose meningitis from her CSF, but we ruled out malaria.

There was another 7 year old out at Gyero who slept in the same room as Grace and had the same symptoms of tummy pain and fever, and I was not about to take chances so I called for the Aunties to bring Josephine in for testing. It was 9pm at night by then, but I didn’t want another dead child on my hands come morning. The doctors sent Josephine home to continue on the anti-malarials and antibiotics I had already commenced her on and her lab results revealed in the morning that she did indeed just have malaria, so it was a relief we didn’t have an epidemic out at Gyero.

I struggled a lot with this situation, asking myself if there was anything I could have done differently. Could I have recognised Grace’s illness quicker perhaps? Grace was at school the day prior to waking up unresponsive and it all happened so fast that it is really hard to process. Her only symptoms were a headache Monday, mild tummy pain on Tuesday, and then she died on Wednesday! Hardly textbook Meningitis or Malaria! Because there is so much dehydration, I tell the kids to drink water, give them some paracetamol and only treat for malaria if they start to get febrile. And as far as complaints of stomach pains, 90% of the kids out there at present tell me they have tummy pain, but it’s mango season right now and they’re eating so many mangoes each day and don’t have a lot of fresh food in their diets normally so their little bodies aren’t used to it!

Anyway, because they don’t embalm their bodies here in Nigeria bodies need to be buried a day or two after death, so preparations for a casket were made and the Father’s village was informed to dig a hole for burial the next day. I was at the hospital at 8am sorting out the bill and arranging the paperwork and death certificate for the release of the body. It was a long morning as we waiting for transport and for the casket to be made (yes they made it the day of!) but the aunties washed and dresses wee Grace and she looked just gorgeous as we prayed and put her inside. At midday, we left in convoy out to Grace's Father's village in Kagoro (often out 'orphans' are not actually bereaved of both parents but are removed from their homes due to the abuse of their parents inability to care for them) which is about an hour and a half out of Jos City. We were stopped at one check point by an officer who wanted us to open the casket for him to look inside. I was horrified. But the Nigerians assured me it was a perfect place to hide bombs and rifles and it had been tried before. I knew they were right. We arrived and were greeted by the mourning villages (Grace had lived in this village for the first 5 years of her life) and had a small funeral ceremony where the pastors of the village and City Ministries spoke. Some of the girls from Grace's compound at Gyero sang a song, which was really tear jerking, then we walked to the burial plot to lay Grace to rest. It was a beautiful day and many amazing words were spoken and comfort given. 

I still struggle with how easily Nigerian accept death, even that of a child, and am so amazed at their seemingly automatic response of assuming "God is in control", "it was God’s time for Grace" and that "it was all part of His plan". I wish I had that kind of faith all the time, but there are still so many unanswered questions for me. I guess it’s all a part of growing and leaning to trust more. I had lunch with a good Nigerian friend and was able to talk about the whole situation with her and debrief a bit. She said something that helped me a lot. She said “don’t expect to be able to process and deal with the situation the same as the Nigerians, you’ve come from different backgrounds and have grown up with different life experiences and perspectives of death and the world”. She said, “Some Nigerians grow up never having anything bring them joy or happiness in life and so expect sadness, disappointments and death, hence their level of acceptance. Although it may look like they’re hard hearted, they have just adapted as a way a coping because of the frequency of which it happens”.  That made sense to me and took some self-imposed pressure off.

The SIM team

On a more happy note, I attended my second wedding today (seems I can’t escape weddings no matter what continent I live on!). I managed to catch the bouquet at the end of the reception and then had multiple Nigerian mama’s congratulate me, came to shake my hand, then offer to introduce me to their sons!