Feb 13 - The Death March

February 13

Staring into the fixed, dilated pupils almost popping out of the skeletal features of yet another malnourished child as he takes his last breath. Nonchalantly reviewing patient after patient, comatose or fitting from malaria. Hearing the all too common death statistics from the last twenty four hours in our department. There’s some things about working here which, rather bizarrely, become routine. The piercing wails from the mother of a recently deceased patient, accompanied by the rhythmic African consolations of the singing group behind them as they move slowly down the hallways, the small lifeless body covered in a sheet, is not one of these. Every single time you file respectfully past a makeshift funerary procession in the hospital corridors, the other mothers from the ward walking behind the deceased and their family as a sign of respect, a chill runs right down your spine.

Many who haven’t worked here, haven’t seen the hardship and loss that these people endure on an alarmingly frequent basis, often think life is cheaper here than in the developed world. Yet you watch a mother scream helplessly until she collapses with exhaustion at the death of her 4 year old son, or the tears that gradually well up in her eyes as the hopelessness of a resuscitation on her 2 year old daughter slowly dawn on her. You will very quickly learn that life here is every bit as important, every bit as sacred and special, as each and every one ‘at home.’ Yet the pain so many here experience so often is nothing short of numbing. HIV, tuberculosis, malaria, malnutrition. These foreign conditions for many reach so often into the lives of countless ordinary Malawians that one cannot be shamed for thinking that they could be somewhat taken for granted, yet more wrong you could not be. The educated, the wealthy, even the health workers themselves; no one is immune. It is most certainly not a case of ‘it only happens to them.’

And for the most part death, burial and the ceremonial processions that accompany these are of utmost importance to most traditional Malawians. Much money is spent on coffins, a village halts for a funeral and anyone involved in the life of the deceased moves heaven and earth to visit and pay their last respects to the deceased. In the adult world, for Heather in her palliative care role, getting a patient home before dying is highly paramount given the emphasis placed on the village-based rituals that follow.

Despite all this death, despite the under five mortality continuing to sit somewhere around 1 in 8 or higher, despite the average life expectancy in Malawi floating at an abhorrent 40 years of age, and despite the morning death statistics becoming an almost cursory routine, life is never cheap. Nor, despite all this, does that chill down the spine become any less haunting with each and every death march.