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Journals from Africa by Gloria Simoneaux
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Journal Nine

July 17, 2007

Kenyatta Hospital of Nairobi, Kenya

Kenyatta National Hospital is an eight story, enormous maze of cement block walls that also serves as a teaching center. It took me close to half an hour to navigate my way from one end of the hospital to the taxi stand at the other end. Getting lost in the crowded halls and stairways is easy. The halls are bustling with medical and nursing students walking this way and that, and with visitors coming and going. There are constant throngs of visitors walking up and down the stairs, five abreast, and long lines waiting outside the accounting offices (of which there are many). Outside, the grounds are also crowded with waiting visitors and patients. Sick and weak people are regularly carried, or dragged in and out, with their arms around two family members.

The first time that I visited the hospital I learned many disturbing facts: There are a large number of abandoned children who live in the hospital, some of them have been there for more than six years. Parents can’t pay the fees that would enable the child to be discharged. In other cases, children with chronic or life threatening illnesses are too much of a burden and the family does not have the ability to care for the children at home. Many children with HIV are abandoned, and a number with cerebral palsy and other tragic conditions, as well. They lie in bed alone all day long, (I saw them) and no home or orphanage will take them. Institutions don’t have the capacity to care for the children…they can barely feed the healthy ones. According to the nurse who described the situation to me, “It’s a nightmare.”

Aside from that, the hospital is dirty, lacking the very basics (medicine, for instance) and in the pediatric wards children sleep as many as three to a bed. The infant ICU has four babies in each incubator and a wire basket in the corner where the dead ones are placed, “waiting for transport.”

Emmah (from the International Child Resource Institute) and I walked directly into the pediatric oncology unit without asking questions or permission…I wanted to paint with the children. Ward 1E was packed…60 or more children and lots of activity. I was surprised. The children were all dressed in light blue hospital uniforms with 1E stamped in various places. The ward consists of one very large room with cartoon characters painted on the walls, and many beds, side by side (some of them occupied by miserable looking children). There is also an ICU area and another room with large windows all along one side, filled with small chairs and tables where about 30 children were sitting and watching a cartoon video.

Some of them smiled warmly…some had a large protruding tumor on their face…I had never seen anything like it before. (Burkitt’s tumor, a hideous disease endemic to Central Africa and responsible for 50% of childhood cancer deaths. It is characterized by a huge protruding tumor of the jaw, maybe eight inches long and 4 inches wide, accompanied by loosening of the teeth and protruding eyeballs…or extreme swelling in the abdomen. Many HIV patients develop Burkitt’s. It’s not fair). Kenyatta is the largest public hospital in the country and the only one that treats childhood cancer. Many of the children arrive after it is too late to save them. Nonetheless, the ward was open and airy with lots of light and it felt surprisingly good.

I talked with Julie, a young student nurse who said that she was really interested in art therapy and she thought that there would be interest among her colleagues. She suggested that I organize a lecture for nurses and other staff about the benefits of art therapy to deepen communication with the children. “That’s a great idea,” I said.

First step was to meet with Herman, “Chief Public Relations Officer” in his large stuffy office with an April 2006 calendar displayed above the desk (just one year too late). He had the widest nose and thickest glasses I have ever seen. Herman is a BUREAUCRAT. He could easily win first prize in bureaucracy if there was such a contest. I think he should give seminars (maybe he does). As I talked animatedly about my work, he sat behind his desk…expressionless. I imagined him thinking to himself, “OK. I will have her fill out 50 meaningless forms and spend hours traipsing around and meeting with 25 other important officials…that should be enough.” So, he sent us to see the “Chief Nurse” who after sitting through a half hour explanation of my project goals said, “I’m the wrong person. You must go and talk with so and so.” We spent almost an entire day moving from one office to another in that enormous building. Finally we spoke with the “Pediatric Chief Nurse” a smiling, warm and sympathetic woman. We were told to return the next day at 8AM with a letter written on letterhead describing the proposed lecture and ongoing work with the children.

After the letter was received and approved by many nurses and chiefs of various things and Herman himself, I was ready to work. Ann, (my young Kenyan assistant) and I were given a tour of all of the pediatrics wards, which ended up being an immense number. The pediatric oncology unit is more or less hidden in one corner of the hospital, but the main part of the hospital includes at least a dozen LARGE wards FILLED with children. In addition, gangs of children in hospital uniforms roam the halls playing with guns and airplanes made out of paper, laughing, and running around. Those children seemed happy and relaxed and it appeared that they were free to wander anywhere, running up and down the stairs chasing each other. I couldn’t make sense of what was going on but I instantly fell in love with many of them.

Once approval was granted, (I found this absolutely astonishing) nobody ever questioned me again. I was free to do anything (similar to the gangs of children roaming the halls). When I arrived at the hospital in the morning, carrying bags filled with colorful art supplies, puppets, treats and other surprises, I was greeted by large numbers of children who led me to a room or a corner of a room where they helped me set up my materials. Every day we went to a different meeting place. It was as though we were invisible…no one ever came to observe or even pay us the slightest bit of attention. As the days went on, a nurse would occasionally nod or smile in my direction, but I could have done anything in that hospital. I really felt at home.

My lecture was set for the day following letter approval and Herman said that he would inform all of the pediatric staff. He had already heard reports that people were excited and would attend. When I showed up for the lecture, I had to check in with the chief Nurse and other chiefs and then I was accompanied to the room (dirty) where the lecture was scheduled to take place. The room, within one of the children’s wards, was empty, except for two long tables and some benches and people were beginning to arrive.

There were 22 nurses, including one male, and they all worked in oncology or general pediatrics. They were an outstanding group, desperately seeking any tools that would help them in relating to the children they loved. Because there was not much time (they needed to return to work) we started right in. After introductions, I asked them to paint what they love about their work. “Paint what drives you, what makes you show up to the hospital every morning, and then paint your biggest challenges.”

The first part was easy and they were quickly coloring with rainbow colors. After finishing, they were hesitant and uncomfortable, looking around at one another. One of them said, “Is this confidential? Will you share this with any of the other staff?” I assured them that nothing would be shared with other staff and soon they were busy expressing some very personal and touching material.

Some examples:

“I love when the patients are recovered and discharged. The parents and the relatives are so happy. The big challenge is in the ward set up…broken instruments, no thermometers or IV fluids or drugs, no working tools, no hygiene. Parents and relatives are worried about their very sick child and I can’t help. It is pathetic.”

"I love playing with the children as they are getting better. The challenge is very sick children alone and crying for help.”

“I like attending to the mothers who have come to the clinic with sick babies and I make sure that they leave the clinic feeling satisfied that the babies have been given medicine (if we have it) and good care. I hate seeing mothers limp to the unit with tears rolling from their eyes because they have just lost the baby.”

“It makes me very sad that the rich and the poor (disadvantaged) still have to pay the same fees.”

“I love to see the clean and smiling babies when they are feeling well. I love playing with the kids. What I don’t like is the very ill, un-responsive patients. I also don’t like too much the overwhelming work and I hate doing office tasks.”

“I am dedicated to the children and I love them. My challenge is that we are 3 nurses for 90 children.”

“What pleases me is when the patient is discharged and sent home on treatments. What I dislike is when the baby has died and is in the morgue.”

The stories were accompanied by detailed drawings; many included numbers of small coffins and crying relatives. After I heard the stories, I stared at the nurses in disbelief and my hand reached out and grabbed the nearest one by the arm. “How do you do it?” I asked with tears in my eyes. “We help each other and we love the children,” she said to me. In that moment I saw them all as angels with halos.

The workshop was about half over and a five-year old boy, with the face of a Buddha, walked in by himself (the door was open to the corridor and people were walking back and forth) and came and sat on my lap. He stayed there for over an hour, until the workshop ended. I gave him a little puppet to play with and he sat quietly snuggled in.

We did some art exercises in which the nurses drew childhood memories and I taught them some basic exercises to use with the patients. They loved playing with the puppets and doing role-plays. Next, I showed them my slide show of homeless and children with cancer’s artwork. The group was silent and I was afraid that they didn’t understand or worse, didn’t like it. I said, “You don’t seem too excited.” The male nurse said, “It’s not that we’re not excited, it’s going deep in our hearts. It’s very real.” He was crying. Another nurse said, “I’ve really learned something…the drawings are a reflection of what is going on in the children’s mind and heart.”

Since my first trip working with orphans in Ghana in 2000, I always carry my beautiful collection of puppets…African wild animals, children of different races, doctors, nurse puppets and others. Throughout, the trainees have fallen in love with the puppets (they call them muppets) and have begged me to leave one or several with them. Until meeting the nurses I had refused…the collection is really special to me. But with the nurses, that changed and I gave them most of the “muppets” (I later gave the rest to the psychology students and professors at the University). When I returned to California I was puppet-less but inspired and in awe of the people who have so little and give so much of themselves.

I also gave thousands of stickers, of every color and design, to the nurses and to the children themselves. After the nurses workshop, Ann and I left Ward 3A and made our way slowly to the other end of the hospital to look for a taxi. As we walked, we were surprised to see children on every floor, and running up and down the stairs…all with bright colored stickers on their faces. Ann said, “It’s really spread.”

Meanwhile, Branwel, the angel boy who had become my new special friend, held my hand and followed me everywhere. He knew that he was my favorite and I repeatedly gave him extra treats and extra attention (very wrong). I couldn’t help myself, although each and every child that I met at the hospital was spectacular, kind, appreciative and wanting to play and make art. I spent about a week working there, spread out on the floor with groups of children who had sparkly stickers all over their bodies, and art materials everywhere.

When I returned to the University of Nairobi one evening I told the psychology students about my experiences in the hospital and I asked, “Is there a group of fifteen students who would be interested in a practicum situation working in the hospital with children for a period of six-months? You will be trained in-depth and supervised.” Out of 60 students, every one of them raised their hand. Priscilla, the head of the department is excited about the idea. So now, I have to return, because I want to continue the work with the children and with the University students.

The other part of the plan is to start a puppet making business…find a group of women who can copy the African animals etc. and add personal touches…the women will earn money…the puppets will be sold on DrawBridge’s website (and other places) and they will also be donated to schools, hospitals and orphanages in Africa. I love that idea.

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