Bad Things Come In Threes

If you asked me outright I would probably say that I am not a particularly superstitious person, but in reality that is not really true. There are certain superstitions, ingrained into my psyche through Maltese culture, a childhood in the theatre and a father’s compulsion from which I still cannot escape. I knock on wood, will walk round ladders and wince if I break a mirror. I won’t open umbrellas inside or name the Scottish play in a theatre and as a child I went through great pains not to step on cracks in pavements lest my mother should have an accident. It still sets my teeth on edge if someone puts new shoes on a table and my friends have often commented on the fact that I will actually move them as soon as other people leave the room. These are all subconscious reactions, small things that do not really affect my life- but there are two superstitions which I feel much more deeply than all the others.

The first is to perform the ‘sign of horns’ any time I have a bad thought or say something which, if it came to pass, would have a negative impact on soemone’s life or if I have the feeling that someone else is wishing someone ill. I also force my partner to do the same and get quite distressed if he is not so inclined. Since starting work I found myself embarrassed by this compulsion but I fight a strong sense of guilt and responsibility for negative outcomes if it is not done and so now I wear it the sign of horns on a bracelet round my wrist. The sign of horns is something I remember being a huge part of my childhood in my village in the South of Malta. I was told to do it, quite seriously, when a certain woman from the village, who apparently possessed the evil eye, walked by and if she addressed me directly the other women would actually do it while she was speaking to me so as to protect me. This feeling that I would somehow be responsible for the results should I fail to perform the ritual is surely a part of my compulsive and guilt-burdened personality, but nevertheless it has manifested itself as a need to satisfy this curious tradition.

Sign of Horns

The final belief to which I still hold strongly, and I think this one comes from my dad, is that bad things come in threes. I do not usually start worrying about it if one bad things happens, that I dismiss as happenstance, but if a second thing happens in quick succession to the first I will be almost certain that a third will follow. I will almost wait nervously for the third to raise it’s head and when/ if it does come about I feel a sense of relief knowing that the three have passed and we are ‘safe’. I am a 26 year old woman, relatively highly educated and a realist in almost every sense of the word- but some rivers run deep and whether I acknowledge the futility of these beliefs or not does not change the fact that I am compelled by them.

This week bad things came in threes. And the three came superimposed upon a backdrop of political instability, civil disorder and epidemic illness in a country which isn’t equipped to handle any of the three. I am tired. Through my bones, to my soul, I am tired. I feel like I have not been free from worry and distress since the new year rolled in and I am struggling to tread water while the realisation dawns that I may well be out of my depth.

The rainy season has brought illness to the North. In my city outbreaks of Dengue, TB, Malaria and the Plague have caused chaos in the prisons and hospitals where I work. People are sick and frightened. My children at the house have been constantly in and out of hospital for months which has put a strain on the staff and brought the morale of the house down low. I know though, how luck we are that although our babies have had to be hospitalised, they have all come home to us alive and well- for many others here that is simply not the case, if they even make it into hospital at all. Did you know that in Madagascar a woman will hide a pregnancy and birth until at least 2 weeks after a child is born and that even then until the child gets it’s first two teeth (at around 10 months) the child is not acknowledged as a human being nor assigned a sex or an identity- and it is only then that Malagasy children start wearing clothes rather than swaddling. This is because with the incredibly high rates of child mortality here such practices protect again constant disappointment and public grief.

The elections have changed nothing as far as I can see. I continue to be bribed and exploited at every official turn. The new President came to Diego in a convoy of 4x4s. They are so self-important and think themselves above the law. They hurtle through the countryside on red mud roads at 130km/h and other vehicles literally have to drive off the road to avoid a head on collision. While driving into Diego the convoy hit a 6 year old girl and she died in hospital 2 days later. I didn’t see it in any of the papers. The students are rioting because some serious security breaches on campus called into question the government’s commitment to student welfare- the resulting protests have become violent and the entrances to campus have been barricaded. Friends of mine who lived and worked there have been evacuated and have spent the last few days struggling to get their students off campus and to safety. Children have been going missing here in an eerie echo of happenings in Nosy Be and Ambanja last year and a few weeks ago one of the little girls turned up in town with her eyes gouged out, her tongue cut off and her organs missing. The police appear to do nothing and the public take it into their own hands which led to a group of vigilantes storming houses in the outskirts of the city and destroying several police cars. The gang violence stirred up by the elections at least seems to be dying down here but whispers of violence and bombing in the South reaches us over the local news and through snippets of gossip from those with family elsewhere.

Election campaigning in Madagascar

We work against this backdrop. These things are by no means all that Madagascar is. It is also beautiful and majestic with a generous people and awe-inspiring potential. I love this country. Its redeeming features by far outweigh its sharper edges. This fact, however, does not make the other aspects of life here any less real, or make them bite any less hard.

My Melodie has been sick. She went into hospital twice in the last couple of weeks. She hates it and it makes her miserable. I feel for her but I am also acutely aware that she, unlike many of the other babies she shares the ward with, will receive all the help she can get and will come home when she is better. While visiting her the other day I approached the ward and saw her miserable face peeking over the patio. When she saw me her eyes lit up and she opened her mouth wide in a surprised smile, then she reached out her tiny hand, waiting for me to give her my car keys- such an easy pacifier. I was chatting to the nanny and waiting for the nurse to update me on her status when the paediatrician arrived and motioned me to one side- he had a mother with a baby whom he said was always visiting the hospital for help because she was poor and could not feed the child. I agreed to visit the child and talk to the mother, but I admit I was sceptical as poverty here is high and I constantly have people asking me to take their children because raising them is a struggle- something we simply do not do unless there are additional circumstances which make is appropriate.

I wasn’t prepared to see this woman, so thin she looked sunken and wasted- in her arms she held a baby and words cannot describe the condition he was in. Eyes unfocussed and skin sallow this 9-month-old child must have weighed less than 4kg. The mother is too malnourished to produce milk for the child and so she has nothing to feed him. I am familiar with malnutrition and all the pitfalls and complications of re-feeding with a child as far along as this one- it will never be an easy road to undo the damage that has already been done. I spoke to the woman, she wants to keep her boy, and I offered to design a feeding program for them both and provide the formula on a weekly basis. I discussed with my boss having them live with us for a few days to teach her about feedings and how to care for her baby. We agreed they should come to us last Friday to organise a program and start re-feeding. I waited all morning and she never came. I thought maybe it had all been too little, too late. However since then I found out that the baby had been admitted to a different local hospital as his condition had worsened. I hope she will come and see us if he recovers enough to be released. I have heard no news since, but her presence upset me deeply. In a world of excess this woman couldn’t find anyone to help her feed her child.

A few days went by and the shadow of this baby was passing as I was kept busy by my own brood- broken bones, school exams and an endless stream of antibiotics joined the chorus of audits, annual reports and funding applications in my exhausted mind. Then I got a phone call from a friend. A new intern midwife at a local clinic, she had been attending and assisting at births for a few weeks and everything had been going well. That morning, however, the mother was a little older, 42, and had already had 11 births before. The labour became complicated and the clinic passed her on to the local hospital where one of my children was at that time admitted. I passed by to see her on my way to visit my Kimi. By the time I arrived she had given birth and begun to haemorrhage. The family had nothing, no means by which to help this mother of 11 children. She continued to bleed and the drugs wouldn’t stop it. I waited with her daughters as the staff tried to get control of the situation. In the end the only option was for her to have a radical hysterectomy to try and stop the bleeding. She barely came through the operation and was still in the reanimation room when I left. I hoped the worst was over. At 2:30am I received a phone-call to say she had passed away in recovery. Despite our best efforts she left 11 children motherless because of inadequate prenatal care and insufficient social support.

And so began the wait for number three. I could feel it coming. I knew these two incidents, sent to test my mettle and put my life into stark perspective, would soon be joined by a third. I thought it may have come when one of the 2 week old babies born in the prison, for whom we were involved in prenatal care and the birth and who is now waiting to be a little bigger and stronger before coming to live with us until her mum is released, began to get sick. The prison is full of TB and HIV and there are even reports of the plague and as she got sicker, even with several doctors visits and medication, I got worried. But then my stepdad and boss, a paediatrician and all round genius, suggested I have her tested for syphilis- and there we had it- maternally transmitted syphilis, easily cleared by a course of penicillin and a good dose for mum too. A potentially lethal crisis averted. So I went back to waiting for number 3.

Eugenie, getting better on her meds.

And then it came. The phone call during the night. The getting dressed in the dark and running out into the blackness. One of my prison women had gone into labour and been taken to hospital, and what should have been a delightful piece of news fell with a dull thud as they said it was Lilly- Lilly who has been ill, Lilly who is taking medication for a nasty infection, Lilly who is barely at 22 weeks pregnant. I arrived at the hospital and the situation was clear. Her waters had broken due to the discharge caused by an infection for which the inept medical system here had been mistreating her. She had already dilated 3cm and they could not stop the labour. We will have to wait for the baby to be born, knowing that even if it is born, by some miracle, alive, the local hospital would be able to do little to sustain its fragile life.

I left Lilly in the hospital last night with the prison guard standing over her. She asked me questions that were difficult to answer- if I can keep it in longer, will it have a chance? If it is dying, why can I feel it moving so much? Why can’t you do something that will give the baby a chance?

It has been almost 24 hours since her waters broke and she is still only 5cm dilated with no contractions and no idea what is going on. We have spoken to every available physician and midwife and the response is always the same. The situation is now ‘inevitable’ and the birth must go ahead naturally. All we can do is wait. But the baby will not be ‘viable’ so she must prepare herself to either give birth to a stillborn or to give birth only to watch the baby die over the next few days.

It always comes in threes and the third one is always the kicker.

There has been no change all day today and so still she waits. I sit by my phone in the office unable to concentrate and wishing there was something I could do to provide comfort to this woman. All I can say is that in this house she is at the forefront of our minds and the intensely religious staff will be sending fervent prayers into the ether as I sit here and wait to be called back in.

My life is so charmed. I see things here that are beyond our concept of living. May these experiences in my life make me a more grateful, gentle, generous person, may I learn these lessons well and may I never forget those who have touched me so deeply, no matter how far I find myself from this life.