I am walking fast. I am in the middle of a motley of humanity typical of Nairobi City, the city in the sun.Wabera Street. Time 4.30pm. I meet a few children from the street family. Their eyes are inviting me to their world. The tiny little world of uncertainty. One of them stops me, “Uncle, nisaidie.” I bend to her, her eyes are sunken, skin wrinkled and face suggests of nothing but hopelessness and despair. This is what I would clinically call severe acute malnutrition. Oh my ! how unlucky were these children to be born poor. I drop them a 20 shilling coin and my journey continues…
Kenyatta Avenue. My eyes lock themselves up in a man. He is coming my way. He is in tartars but walks majestically defying all odds and believing someday his star is going to shine. You know in my country, poverty is a crime punishable by persecution till death. The poor are getting poorer and the rich richer. In other circles, they call this capitalism. This was a western idea. Nonetheless, life must continue. the guy is getting closer, his eyes are deep yellow in color. Lips tobacco stained and skin wrinkled too. He must have had a little too many. A scar is on the left side of his head. The scar stands prominently above the skin as if it is not part of it. The scar looks like that of a suture done by a medical student. They never look good unless one has gathered a bit of experience. Somewhere in the middle between us, he stops at a book vendor. I stopped too. this time I had a chance to examine him closely. A fairly young man. No obvious respiratory distress. Not so well nourished. Wrinkled skin. Clubbed fingers. Funny nails. In that moment of medical ritual, I get the impression that this guy stands on a time bomb. Alcohol is having a field day in the liver cells. And that guy cirrhosis is coming soon. With the tobacco, lung cancer will even exaggerate the clinical picture. More reasons why i should finish medical school tomorrow. I leave wishing I could warn him of looming danger.
I am running late. I am walking yet am in my clinic. My lab coat is on . Stethoscope completing the picture. I am not a butcher. I am a doctor, yes a doctor. A doctor I shall be. Suddenly, the traffic jam on Kenyatta avenue opens. The first car that passes is a Toyota Mark X, my favorite car. It is branded UN. This guy must be rich, I mean he works at the UN. If he fell under my knife or my care, I would charge him twice the amount of normal consult. This is unethical by the way. However, it is the only way to give a man from Kibera a fair chance to enjoy my clinical expertise. By the time he comes, his bills are already paid. I was doing what nature had unsuccessfully tried to do. Redistributing resources. “We hold together the truth that all men are created equal…” the American creed sounds in my mind, faintly though, obscured by the many other thoughts crisscrossing my mind.
In my reverie, I almost knocked a pregnant woman on the way. This time it’s on Moi Avenue. Her belly is massively distended. I remember the aphorisms I had been taught by my professor two weeks ago, ” A distended abdomen in a woman is pregnancy unless otherwise proved.” This one needed no proof. Her blouse is tight revealing the contours of her uterine extents. She is at term. Anything can happen anytime. i hope it doesn’t happen here. I would be forced to act in good faith and help her . The umbilicus proudly stands somewhere in the middle of her belly. Life behind it. As we pass each other, I feel proud to be a man. This is what we can do. I am glad her water did not burst suddenly.
Sizzling Grills. This is my favorite restaurant in Town. The security officer is already intoxicated and a bottle half empty is on his right hand. He has prominent veins on his hands. These ones are really good for fixing iv lines. Obesity by the way is not only a patient’s problem but a doctor’s too. Finding a line in this people is like looking for a needle in a stack of hay. Now I know where I would fix a line on this man. If here comes to the casualty intoxicated I would rehydrate him and give him some IV dextrose.
I am coming to the end of Moi Avenue. On the other side towards railway station, two men are fighting. The blows are heavier than those of Mohammed Ali (Tribute) or Mayweather. I am not worried that they are fighting. I am worried because the head injuries that I foresee would sometimes be severe. So severe that it would change the course of their lives. Have you ever been slapped until some saliva spew out of your mouth with no will of your own but their own? Now these blows came with blood and saliva combined. This picture only reminded me that poverty brings bitterness. Bitterness that you were promised more and not what you have.
Railways Bus Station. The touts are making noise. Their noise effortlessly coalesce with those of hooting cars, hawkers, bitter men, scorned women and mad both to form a condensation of frenzy. This would go till sometime before dawn when they will retreat to their dungeons. I got a bus and am headed to The Hospital. Remember it is a Friday. casualty Friday.
I arrived ten minutes later. City Council ambulance followed later. It has a characteristic wail that is very atypical. Sometimes it exaggerates what is otherwise trivial. Dr Omondi is a bit preoccupied so I received the patients together with the casualty nurse. She is a very beautiful lady. What brings us together most of the time is usually emergencies. I had never found her alone in some alley to wink at her or tell her she was beautiful. I longed for such a moment. The way the caged bird longs for freedom. So like the caged bird, this moment remains a hope rather than a reality.
As I removed the patients from the ambulance, I was taken aback to realize that it was the two men that I had left before in town, thirsty for each other’s blood. One had suffered severe head injuries and the other had a deep cut on his forehead. I felt guilty that I did not stop them from fighting. How could I have done it without a few blows landing on my jaws?
The theatre nurse prepared the minor theatre for suturing. I was going to suture for the first time. I had not learnt of horizontal mattress or vertical mattress but I knew of that simple one that I have forgotten the name. I knew when it was indicated. To do this, I was supposed to go once with the suturing needle, then I pull, afterwards I wind the stitch three times around the needle hold, then I pick the free end of the needle and pull, then wind again twice and pull then once and pull. What else! I cut. This suture was a magic one. It was the first of the many that I would do. This moment was stored in part of my heart that my mother and that girl, Faith lie.
This event reminded me of the paradox of life. A simple fight in town made me have my first suture. Another fight will soon come and give me another chance to perfect my skills. I don’t know whether to be happy or sad for adversity are the only times that make me thrive. It is certain to me now, that the only certain thing is the uncertainty of life. Life is hard to understand. The more the varied lenses you have, the more obscure reality becomes. What is reality anyway?