by Neely Tucker
I mumbled that this was good news, but added I was there to cover the bombing, not to go on safari. I couldn’t sit in my hotel. He shrugged. “Carry a plastic bag,” he said. “Because you’re going to be one very sick man.”
In the days ahead, as the fever worsened, I reported the major events of the story like everyone else. Rose, the woman trapped in the wreckage, died just hours before she could be rescued, while her husband stood by the mound of rubble, praying in vain for a miracle. FBI agents swarmed into the Hilltop Hotel, an $8-per-night, all-male residency hotel in a hardscrabble district of Nairobi, where the bomb was apparently put together. Six or seven men had stayed in rooms A-107 and B-102, assembling part of the bomb, then hauled it downstairs and onto the back of a flatbed truck. They had finished the bomb there, then drove to the embassy. Three of them apparently died in the explosion. (Four men were later arrested and convicted in a Manhattan trial.) Osama bin Laden’s World Islamic Front Against Jews and Crusaders issued a warning through an Arab newspaper: “The coming days will guarantee, God willing, that America will suffer a black fate.”
Meanwhile, I lost eleven pounds in four days. I was so dizzy I took to writing stories with one eye closed and the other squinted nearly shut to keep my equilibrium. And more and more often, I found my mind going back to an incident that had occurred the second day I was in Nairobi.
I had stopped back by the morgue. There were families lingering about, those who had hope and those who had resigned themselves. At the entrance to the unit where they were bringing the mangled remains from the bomb site, there was a man I recognized from the day before. He was wearing a black suit, white shirt, tie, and vest, with a carnation in the lapel. Amid the stench and the flies, curious, I introduced myself. He said he was John Mungai, pastor of Nairobi’s Apostolic Faith Church. I had no need to interview a man of the cloth at that point, and as I prepared to take my leave, he said quietly, “I am not here as a pastor. I am here only for Margaret,” he said.
I told him I did not understand.
“My daughter.” He paused, fumbling with his wallet. He produced a picture. It showed a young woman with a radiant smile. She was wearing a white blouse with a lace collar. She had her hair neatly pulled back in braids, a good complexion, and cheerful brown eyes.
“She’s very pretty,” I said.
“She is, yes,” he said. He began talking in the present tense. “She is our daughter. She is twenty years old. She is studying at the secretarial college there at Ufundi House. I believe it is on the third floor. She takes the bus each day, and then she takes the bus home each night. She lives with her mother and me.
“She took the bus last Friday, and there was the bomb. We waited at home. We were sure she would come, but she did not. We went to the hospital, then the clinics. Then we came here.”
He inspected each load of carnage for something that might have once been his daughter, even detached limbs. He toured the room of corpses each day to make sure he had not missed her.
“We pray and have hope for her, of course,” he said. “But I only wish that she will be found now, so we can give her our final love and goodbyes.” He grasped my hand to shake it, and then he leaned closer and whispered, “She comes to me every night in my dreams, my brother, and she is crying for help. I see her trapped under the rubble. She is crying for help, but no one can assist her. I can hear her but not find her, cannot get to her.” He stared, not more than a few inches from my face. I didn’t know what to do. We were in a crowd of neatly dressed men and women, whom I assumed were members of his extended family, as well as a few reporters and photographers. It was an oddly personal moment in a public setting, and Mungai seemed to be suddenly aware of this. He let go of my hand.
“Do you have children, Mr. Tucker?”
The question caught me by surprise. It was the day after Vita had called with the news about Chipo.
“Yes,” I said, at last. “Well . . . yes. I do. A daughter.”
“How old is she, may I ask?”
“She’s not even one.”
“She is well?”
“She is beautiful.”
“You should love her, every day,” he said softly.
7
VITAL SIGNS
I HAD BEEN gone nearly a month by the time I staggered home to Harare. What I found was alarming. Vita had not slept much more than an hour at a stretch for weeks and had a thousand-yard stare worthy of any combat-weary Marine. Chipo would seem fine for a few hours, then her breathing would turn ragged and desperate. Her breathing was so uneven, and her crying and thrashing so fierce, that during the nights Vita put her in that infant-carrying basket and then placed it on the bed beside her. The basket prevented Vita from rolling onto her during the night, but it also kept Chipo close enough so that she would know, even by smell, that someone was with her. When I returned, we slept with Chipo between us in the basket. The crib we had bought went unused.
Her breath was faint as mist and almost as hard to hear. I would move her about the house with me through the day, carrying her around in an infant’s car seat, setting her by my desk while I put together my expenses from Kinshasa and the bombing. Vita had been trying to get Chipo to eat as much as possible, and showed me how to warm up the formula, hold it for Chipo, and try to coax down every last drop. I took over the night shift, while Vita tried to get some much-needed sleep. In the small hours, when Chipo struggled to draw breath, I held her against my chest and lay back in a reclining chair, pulling a blanket over both of us. I would begin to doze, lulled by watching her chest rise and fall, rise and fall, tiny waves in the ocean of sleep. I was somehow convinced I would be jolted awake if the rhythm stopped. I kept a log of her sleep patterns, in case a physician should need them. A sample entry: In bed at 9 P.M. Awake at 10:45 P.M., 12:10 A.M., 1:20, 1:50, 2:55, 4:20, 5:40, and finally 6:20. At each of these, I would scoop her up, pat her back to clear her congestion, and walk around the house, rocking her back to sleep. I took to going outside and talking to the night guard, Tofa Kachidza. He had two children of his own. He would sometimes carry Chipo for a walk around the grounds, singing softly to her in Shona, while I splashed water from the swimming pool onto my face to stay awake. Just after daybreak, I would be heating water in the kitchen to make her formula and a nutrient-rich infant cereal, called Cerelac, that was her breakfast. I sat her on the kitchen counter in her carrying basket and she would watch me bump around the kitchen, three fingers in her mouth, her other hand curled around a milk bottle that she was still too weak to hold. Sometimes she would try to fit both her fingers and the bottle into her mouth at the same time, a gesture that seemed to combine her need for comfort and her hunger. I would sing whatever came to mind at that groggy hour—vaguely remembered nursery rhymes, jazz standards, even Johnny Cash ballads that popped into my head from my own childhood.
“I keep a close watch on this heart of mine,” I sang to her one morning while the coffee was brewing, thumping my leg with a hand for the song’s chugga-chugga train sound, my face six inches from hers. “I keep my eyes wide open all the time.”
She stared back, transfixed.
Vita came into the kitchen.
“What are you doing?” she asked.
“Trying to get some response out of her.”
“Well, try not to make her scream. Jesus, you’re gonna scare her doing that.”
“I sing that bad?”
“The dogs howl when you sing, honey.”
I was at a loss, as neither Vita nor I had any real experience with children, to say nothing of special-needs infants. Vita had been the good auntie in Detroit, hosting her young nieces for sleepovers. I had changed the occasional diaper for a single-mom friend in a pinch, but that was about it. We didn’t even have a decent baby book. Vita had already bought the only child-care editions in local bookstores, but they were badly outdated. Some friends sent theirs, via express mail, that detailed problems with sleep and malnutrition, and we studied those.
Given Chipo’s
persistent breathing problems, I stopped in town to buy a book on infant CPR. I went to three stores. There wasn’t one. Vita finally got one from Dr. Paz’s office, a 1996 pamphlet produced by the National Sudden Infant Death Syndrome Council of Australia that had been shipped to Zimbabwe. The emergency number to call was 000, which I took to be the Aussie equivalent of 911. I had no idea what it was in Zimbabwe, and Vita’s experience with the paramedics in her car accident rendered it moot anyway—calling that ambulance crew would have been somewhere between useless and frightening. So I turned my attention to the booklet. There were diagrams of how to give your infant heart compressions (you use just two fingers), how to turn the child on her side and clear an airway, how to clear a throat with a finger. You were then to place the infant on her back, support the jaw, give five quick breaths over the mouth and nose, then fifteen compressions (about 2 centimeters, 3⁄4 inch, in depth, the book said). Then you gave two more breaths and repeated the process.
That Chipo’s life might depend on how well we performed such a task gave me pause. I logged onto the county’s agonizingly slow Internet connection and went to the Journal of the American Medical Association Web site. I typed in a search for pneumonia and infants and got dozens of hits—almost all relating to HIV treatment. It turned out pneumonia in newborns and infants was something of the bellwether of warning systems about HIV infection.
I found it disturbing. No one knew anything of Chipo’s biological mother, or father for that matter. But some basic mathematics came into play on her odds of having the virus. One in four pregnant women in Zimbabwe who went to clinics for prenatal exams tested positive for HIV—that was, in fact, the medical test that formed the basis for the country’s estimated HIV infection rate. So Chipo, like any child born in Zimbabwe at that time, had a one in four chance of being born to an infected mother. The nature of her discovery, however, suggested that her mother had been in difficult circumstances, therefore making the odds higher.
There weren’t many definitive studies out there on mother-to-child HIV transmission in sub-Saharan Africa, so it was difficult to tell what Chipo’s chances were if her mother had been infected. The studies available seemed to show that about 39 percent of infected women passed the virus to their children. There were three ways this happened.
The first was when infants were still in the womb. The virus could breach the placenta under certain conditions, particularly if the mother had vaginal or cervical infections. Such infections were rare in Western countries but far more common in the Third World, where women’s health issues do not receive the same priority. In Zimbabwe, the preference for “dry sex” further increased the odds for inflammations and infections in the vaginal wall. (Dry sex is a manner of intercourse in which the vagina is kept as dry as possible, mostly with the insertion of various sachets or douches just prior to intercourse.)
The second and much more common method of transmission was during the trauma of delivery. The amniotic sac ruptures, labor starts, the child begins to move through the birth canal, perhaps aspirating blood and other fluids. The longer the exposure to the mother’s blood, the greater the chance for infection. Chipo was delivered to Chinyaradzo with her mother’s blood and parts of her umbilical cord and placenta still present two days later, a period of time that I was sure the medical journal’s editors did not even contemplate.
The third manner of infection was through breastfeeding, which accounted for about one-third of all mother-to-child transmissions. Such as it was, this was Chipo’s one break—by abandoning her immediately, her birth mother had eliminated that possibility.
The most troubling indicator by far was her medical chart since birth. It read like a textbook study of the most virulent form of the disease.
Her weight had plummeted by more than 33 percent in her first few weeks. Her breathing was irregular and weak. She was racked with diarrhea. She had had pneumonia at least once; perhaps it was what had sent her to the hospital before. I read the report “Identifying Infants at Risk for HIV Infection” with a growing sense of dread. “Infants born to HIV-infected women should be identified promptly so that prophylaxis can be initiated before these infants are at risk for PCP (pneumocystis carinii pneumonia for children).” Well, she already had pneumonia—but did that mean she was HIV-positive?
It got worse the longer I read, until a paragraph at the end of a list of bulleted items seemed to leap off the page: “Growth failure and neuro-developmental deterioration may be specific manifestations of HIV infection in children.” Chipo’s weight chart, headed steadily downward, was only too fresh in my mind—as was her nonresponsiveness.
In infants, HIV progresses in two distinct forms. The first and most common, at least in Western countries, is that it behaves much like it does in adults; after infection, the virus can wait for several years before it causes full-blown AIDS. Children so infected would not be particularly ill when young and would likely survive until their teenage years.
The second type, comprising about 20 percent of pediatric AIDS cases studied in the West, is severe and quickly lethal: “Severe immunodeficiency develops quickly within the first year or two, manifested by multiple opportunistic infections and frequently major cognitive dysfunctions as the virus invades the brain. These infants never thrive, and their prognosis is grim. Nearly all die in early childhood.”
I sat in my office in silence. Chipo was asleep in her infant’s seat next to me. I watched her for several moments and felt far more helpless and scared to the marrow of my bones than I ever had been before. The odds she had so far survived and was now facing sank in on me then, far more clearly than they had that day in the orphanage. I made a three-line grid across a yellow legal pad. Above the top of grid on the left-hand side, I wrote “Just a little sick.” Above the middle column, I wrote “HIV+ (slow).” In the third, I wrote “HIV+ (severe).”
I tapped the paper with my pen. In which grid would a reasonable analysis of the information at hand lead one to place a check mark? I considered that for a moment. I didn’t like the answer. So I closed the door to the office, picked up the phone, and called an old friend in Detroit.
Kathryn Moseley is a pediatrician and board-certified neonatologist, a doctor who specializes in the care of critically ill infants, and her practice focused on black children. She was educated at Harvard and the University of Michigan. Her car’s vanity license plate once read TWO-KGS, the weight at which infants could be discharged from intensive care. She was also a good friend. She picked up on the third ring at her office at Henry Ford Hospital in Detroit.
She burst out in a cheer when I told her Vita and I had a baby girl at home, but grew serious when I told her that she was a special-needs child. Chipo now weighed a little more than four and a half pounds—
“A newborn!” Kathy interrupted.
“She’s closer to four months,” I said.
“Oh,” she said. “That’s not good.”
“No. And she’s got pneumonia.”
“Oh.”
“And she’s been hospitalized twice—well, three times now, for the pneumonia, for vomiting uncontrollably, for dehydration and diarrhea. She started out weighing six pounds and eight or nine ounces. She was at four pounds and three ounces when we took her to the hospital.”
“She lost two and a half pounds in less than ten weeks?”
“Um, yes. Correct. Her stomach was bloated. It looked like marasmus to me, but I’m not a doctor, and it wasn’t necessarily diagnosed that way. Also, she can’t sleep more than an hour at a time.”
“What does your doctor there tell you?”
“That she’s really pretty sick.”
“Can you bring her to see me? Or somebody in London, something like that?”
“Not a chance. She doesn’t have any paperwork.”
There was a pause.
“I don’t think I have to tell you that this is not very good,” she said. “How is her color? Her responsiveness?”
“Her color
has improved since we brought her home. She doesn’t look anemic, if that’s what you mean. But she doesn’t smile or giggle. She’ll follow you around the room with her eyes. She’ll hold your finger. She cries every fifteen minutes.”
“Good,” Kathy said. “She’s telling you she doesn’t feel well, which sounds like just the reaction she should have. Bad is when they get too weak to cry.”
I asked her about HIV tests and the implications for treatment.
“Well, if you were in the United States or Europe, of course I’d say yes, get one immediately,” she said. “But you’re not, so there’s no sense talking about it. Get one when you can, but there’s no need to rush down there today. The tests for infants are relatively new, and the older types of tests, which is what I bet they have over there, test false, either positive or negative, a fair amount of the time. But at a basic level, she is or she isn’t infected. Neither one affects what you should be doing for her on a day-to-day basis at this point.”
“Which is?”
“Feeding that baby!” she nearly shouted. I had to laugh in spite of myself. It was almost verbatim the mandate that a doctor had written on her medical chart two months ago, what Dr. Paz had ordered, and what Vita had been doing religiously. “The better nourished she is, the faster her immune system will develop. That doesn’t change her HIV status; it helps protect her against it. She’ll sleep more. She’s waking up every hour or so, I would imagine, because she’s so hungry. Every time she opens her mouth, put something in it.”
I was at the store an hour later, raiding the shelves of almost every little glass bottle of Gerber they had. I bought three canisters of Nan, the infant formula, and boxes of infant cereal. We had been feeding Chipo at a heady clip and giving her formula constantly. But now the great feeding campaign began. I was up with her at six, mixing the cereal with hot water, a teaspoon of peanut butter stirred into it for the extra protein, and off we went. Patricia Wicks, Vita’s best friend since childhood, flew in from Dallas with a suitcase of the latest American baby food and vitamins. Chipo would sit in her high chair and eat and chew and chew and eat until she passed out on a cereal high, slumped over her bowl.
