Malaria by Moonlight Part II

“It’s twelve.” Abu’s father woke us up three minutes before my alarm. Bori was instantly on his feet, and I followed suit, grabbing my headlamp. Actually, the strap of my headlamp is broken, so it’s just an oddly shaped flashlight now. Nonetheless, I’m glad we had it. It was dark; no moon yet.
First was Fanta. The medication schedules for each patient were written in pen on A4 paper. There were three ruled columns: time, medication, and signature. Fanta’s treatments were scheduled at 4, 8, 12, 4, and 8, alternating between quinine and glucose. This one was quinine. Abu’s treatments were at 4:25, 12:25, and 8:25, only quinine. Fatmata’s treatments were at 5, 1, and 9.
We moved the lantern on to the bed. If I hadn’t been there, that would have been the only light. Bori said, “Shine the light,” and motioned to the plastic bin containing the medications for Fanta. I complied.
A bug landed on my leg. Then, another bug. Another one. I looked at the lantern. There wer bugs everywhere. Big, stupid flies, dropping out of the darkness and flying straight into the light with sickening insectile crunches. Then they crawled around stupidly on the bed. And they were on the floor too. And not just big flies, but small, biting ones too, like large fleas.
Fanta stirred a bit while we changed her medication, but not too much. Bori kept passing me things to hold, and summoning my light around. Fanta’s mother watched silently. I checked Fanta’s pulse, and gave an encouraging murmur and nod to her mother. It was mostly so that she believed her daughter was in good hands.
We moved over to Abu. Bori wasn’t moving quickly, but the shadows from the lights gave the jars of medication a surreal cast. The needle on the end of the syringe was very difficult to see in the dim light, even though glints off of its metallic surface bounced around the room. I think the soft but distressed noises Abu was making also contributed to the tense atmosphere. Bori himself was quieter, concentrating very hard.
Bori gave Abu an injection while I held Abu’s shoulder. Through my hand I could feel Abu respond to the bizarre and painful feeling of having fluid injected. First his shoulder shuddered, and then it switched to rhythmic attempts to get free. But he didn’t cry out very loud.
“You’re very brave, Abu.” I think I was the only one in the room who knew what the word brave meant. But I hoped that my tone would communicate enough.
“Shine the light here.” Bori gave me a curt command. He was looking at the small chamber beneath the jar of medicine. I shone my light straight down into it, taking care not to flash Abu or his father in the eyes with the light. Bori and I looked at the droplets forming. I fumbled in my pocket for the watch; in France we always timed these; but Bori was already convinced it was okay. We headed back to our beds for a twenty minute nap.
We lay down. Abu was crying, louder. I thought about getting up to see if he was alright. Abu kept crying. I thought again about getting up. Then Bori got up, so I followed him.
We looked around for a moment with the flashlight. I stopped on the medication jar, which had been full of neon yellow fluid ten minutes ago. It was empty. Bori breathed in sharply. “It’s too fast, too fast.” I flicked the flashlight down the line. No leaks. So I guessed that the medication had drained into Abu too quickly, causing him pain. I can only imagine what the quinine feels like, coursing through his veins. A grown adult has only a few liters of blood; a thirty pound three year old has far fewer. There wasn’t a lot to dilute the quinine. I could feel it burning in my own veins, just thinking about it. I wiped his brow with my bandana.
Bori unhooked the line and Abu’s father gathered him up into his arms. We checked on Fanta’s drip. It wasn’t empty yet, but not much remained. Bori instructed Fanta’s mother in Krio, and she nodded. Then Bori strode back over to Fatmata.
“Why so hot? We faut open de windows so le’ cool some.” I agreed. It was a gorgeous cool night outside. The instant I pulled back the window, the sound of crickets filled the room. I noticed that the moon was climbing in the sky. “Dere a net?” Bori was referring to the screen, which was in place.
“Yes.”
“Shine the light.” Bori was peering at the medication instructions. The columns on this form were a little crooked, but the instructions were clear. Bori filled three syringes with the three different antibiotics. Fatmata’s mother secured her baby on her lap. Then Bori held out the capped tip of a syringe to me. I pulled the cap off. “No.” Oh, he wanted me to take the cap and the needle. I carefully replaced the cap and then twisted the cap and needle combination. It came off. Bori opened up the line and injected the antibiotic into Fatmata. We repeated this for two more syringes, and then I handed the caps back to Bori.
“One, two, three.” I dropped them in his hand in order. He replaced them all.
Cooler, drier air was filling the room now that the windows were open. The moon was bright enough now to cast shadows. Before returning to sleep, Bori and I hung the bag of glucose solution for Fanta, so that at 4am all we would have to do was turn on the drip. She was still asleep and rarely stirring. Bori and I lay back down on our worn out mattress. I set my cellphone alarm for 4am.
“You set de alarm?”
“Yeah. For 3:53am.”
Instead of counting sheep as I went to sleep, I counted Abu’s breathing rate. More than 30 breaths per minute. I was worried about him, but I knew his pulse was still normal. I didn’t know what I could do; so I drifted off to sleep.
When the alarm went at 4am, I experienced a vague moment of haughty dislike for the owner of that annoying cellphone ring. Then I realized it was mine, and that it was in my pocket.
“Do we get up now?” Bori asked. I thought, no, we’re done. A sleepy thought.
“Yeah, it’s 3:57.” Bori was on his feet, fumbling them into his flipflops. I followed with my light.
“Shine the light.” Bori motioned to the highest drip chamber on Fanta’s IV. We watched a few drops fall. “Okay.” I checked Fanta’s pulse. Abu’s breathing had lessened in intensity and decreased in speed. I carefully shone the light on Fatmata, and I could see her stomach rising and falling. Then we went back to sleep.
In the morning, Sasseko woke me up with his cleaning. The sun was coming up, and it was 6:36, according to the cellphone. I sat down and wrote most of this, before the new patients for today arrived.
By 7:30, Fanta was awake and laughing. Abu was awake and silently staring out at the world. His belly was still distended and round, with his belly button protruding. I spent a moment with Fanta because I was amazed at how fast she had gone from semi-conscious at 4pm the day before to laughing and alert at 7:30am.
“Good morning, Fanta. How de body?” I sat on the edge of Abu’s bed, facing Fanta. She was standing beside her bed.
“E’ done greet you now,” said Fanta’s mother, to Fanta. Fanta didn’t look scared, but she looked wary. I reached out and shook her hand with my thumb and two fingers.
“You de get welbody, Fanta. A proud.” You’re healthy, Fanta. I’m proud.
A few minutes later we gave Abu his final round of quinine. He whimpered a bit at first, when the quinine started coursing in his veins, but his dad whispered, “Abu, Abu, be man, Abu, hush...” and Abu was quiet.
On the other hand, Fanta was making up for her silence the day before. I carefully kept her legs in place, and her mother kept her shoulders and arms still, but nothing was stopping her impressive cries. I took that to be a very good sign; she was healthy enough to throw up such a spirited resistance.
Fatmata was also awake, and very suspicious of me. However, she too looked much better. Soon she went home with her family.
Fanta had another round of glucose solution maintenance for her hydration, so she stayed around until about 1pm. Abu’s father was 2000Le short on payment, so Yusuf refused to take out the IV line from Abu’s hand until the dad found the money. As both Bailor and Allan have told me, although there is plenty of poverty in the Kono District, there is also plenty of family support. If someone really needs 2000Le for health, they can almost always find the money somewhere in the family.
Soon the clinic was back to being hot and sweaty. When Abu said goodbye, he didn’t take my hand, he only looked intensely at me, as if he hadn’t noticed I was expecting him to greet me back. But I didn’t mind. It was much better to see the three pikin (Krio word for children) walking around than sweating from malaria under the moonlight.