An Open Heart (5 page)

At ten a.m., surprisingly prompt for the Kenyan culture, a well-dressed man driving a Toyota Land Cruiser pulled into the lane outside Jace’s little house. Jace looked through the bars over his kitchen sink to read the emblem on the driver’s-side door: Ministry of Health.

Jace opened the door as the man approached. He was young, dressed in a dark blue suit with a white shirt and black tie. He held out his hand. “I’m Samuel, John Okombo’s driver.”

Jace shook the man’s hand firmly, alternating with a grip of his fingers and sliding into a grip of his thumb, a traditional Kenyan handshake. “I’m Jace Rawlings.”

Samuel nodded. “I am to take you to see the minister.” He handed Jace a business card.

Jace wore a blue blazer, a dress shirt, a red patterned tie, and khakis. From the looks of the driver, he might have underdressed.

“Please sit in the back. It is safer.”

Jace nodded and obeyed. He was glad not to have to drive himself. He didn’t want to repeat his last performance behind the wheel. As they pulled away, he studied the little card. “Hon. John Erastus Okombo, MP, Ministry of Health.” A Luo name, Jace thought. The Luos, the third-largest tribe, were often at odds with the Kikuyu, and often had last names beginning with O. Kikuyu was the name of the largest tribe in Kenya, and their last names often began in K, M, or N.

The trip to the edge of the capital city of Nairobi took just under an hour. Often traveling in excess of 120 kph, Samuel wove in and around the traffic with rally-car enthusiasm. Jace remembered how he used to amuse himself as a boy on road trips by counting donkey carts, bicyclists clinging to the rear of unsuspecting trucks, or anything else remarkably African. Often he and Janice would count the number of men urinating at the roadside. She always joked after she saw another one. “Okay, now my day is complete.” On this trip to Nairobi, Jace smiled as he counted five.

As they entered the city, the driver turned right on James Gichuru Road to connect with Ngong Road, a major Nairobi artery.

“Going the back way?” Jace questioned.

“We have a stop to make first.”

The driver offered no explanation, so Jace just watched from the window and stayed quiet. At every stop, street vendors selling everything from roasted corn to pirated DVDs of in-theater movies hawked their wares. He had once purchased a Rolex knockoff for his father for Christmas from a vendor on the street. The guy was wearing twenty watches, walking up and down the street, pausing at every stopped driver to display his collection. It cost Jace seven hundred shillings, about ten US dollars. Jace just shook his head. Some things never changed.

The driver turned right off Ngong, heading for Kibera.

Jace wrinkled his nose. Kibera was Nairobi’s largest and one of Africa’s most famous slums, home to over a million people. A typical dwelling in Kibera was made of sticks and mud and had corrugated metal roofing, without electricity or running water. Located on a slope near the heart of Nairobi, Kibera was a politician’s nightmare. Open sewage, disease, prostitution, and HIV had all found a home.

The driver pulled up in front of a small shop displaying hundreds of pairs of used shoes on the ground. He motioned to a young boy, spoke in rapid Kiswahili, and handed the child fifty shillings. Samuel looked at Jace. “He’ll watch the vehicle. Come,” he said. “Minister Okombo wants you to meet someone.”

Jace followed Samuel down a muddy street, careful to step over a black serpentine stream smelling of a mix of human sweat, sewage, and burning charcoal.

Samuel squinted into the midday sun. “Watch for flying toilets.”

Jace knew the term. The lack of running water, the paucity of Porta-Johns, and the danger of going out to the few long drops at night had given rise to the common practice of defecation into black plastic bags. The bags were then thrown in a stinking heap, sometimes in a trash pile, sometimes on a roof, but, every time, somewhere as far away as the donor could pitch it. Thus, the “flying toilet.”

Jace nodded soberly. “Thanks. I’ll keep an eye out.” He stepped past two youths who knelt at the roadside, each with a glue bottle shoved up his nose.

The driver kept walking, ignoring the shopkeepers offering to show their products. “Stay close, Daktari.”

In a few minutes, they arrived at their destination, and Samuel knocked on a wooden door. “Hodi,” he called. Jace recognized the typical Kiswahili request: “May I come in?”

From inside, a weak voice, answered “Karibu.” Welcome.

The door opened after someone struggled for a few moments with two locks. Inside was a darkened one-room “apartment.” Jace paused to let his eyes adjust. A table, two plastic chairs, a bed, and a small desk crowded out any walking space.

The woman wore too much makeup. Red lips and an immediate smile. In broken English, she said, “You brought me customer.”

The driver held up his hand. “Hapana!” No!

The woman frowned and stepped back, sizing Jace up. Her face looked Kikuyu, but she wore tight jeans and a blouse whose missing buttons exposed too much. “We could be friends.”

Jace looked at his hands, suddenly wanting one of those gel sanitizer bottles. He looked around the room, contemplating African sexual viruses, and retreated toward the center of the small hut.

Samuel talked in rapid Kiswahili to a woman and a girl of about sixteen. After a moment, the woman nodded. The girl stood and stepped toward Jace. “Dr. Rawlings, this is Beatrice. The minister of health desires your opinion of her condition.”

Jace was on the spot. He hadn’t even brought his stethoscope. “What’s the problem?”

The woman spoke in English. “She is always tired. Always coughing.” She held up two small clear bags containing white tablets.

Jace inspected the bags. On the outside of one, someone had written, “digitalis.” On the other, “furosemide.” Medicine for heart failure.

Jace ran through a list of questions, probing the girl’s history. Before he’d heard the end of the story, he’d made a preliminary diagnosis. “Here,” he said to the girl, “sit here.”

Beatrice sat on the edge of a small bed. Jace took his hand and laid it on her sternum. She had a remarkable murmur. For this one, he did not need a stethoscope. He placed his ear against her back and asked her to breathe and then examined the veins in her neck.

“She’s in heart failure,” he said. “How far can she walk?”

The mother answered. “Only across the street. Then she’s gasping for breath again.”

“Who is caring for her?”

“We take her to Tumaini clinic, here in Kibera. A doctor comes once a month.”

He looked at Samuel and then at the mother. “She needs some tests. Possibly surgery. For now, I want you to increase this medicine. Instead of one pill twice a day, take two pills twice a day. It will help get rid of the fluid in her lungs.”

“Thank you.”

Samuel spoke quietly to the woman. “Minister Okombo will arrange for her treatment. Perhaps Dr. Rawlings can see her again in Kijabe.”

They walked out along the same path, again ignoring the offers from the shopkeepers.

Jace was almost certain the young woman’s aortic valve had been severely damaged from an untreated strep infection. The girl had gotten sick six months ago, had a sore throat, but didn’t see a doctor. After a few weeks, the sore throat went away, but she became weak and short-winded, unable to complete even menial tasks without gasping for breath. Without a valve replacement soon, the girl faced worsening heart failure and eventual death.

Once back in the Toyota, Jace shook his head. “That’s a tragedy back there. She needs heart surgery, and sooner rather than later.” He paused, wondering. “Why did the minister want me to meet this woman?”

Samuel nodded, his forehead wrinkling and his eyebrows lifting in concern. “Can you help?”

“Maybe. If we can get our equipment through customs. If I can find the right staff for an ICU. If I can convince the administration at Kijabe Hospital that it is worth the risk. An open-heart program is very expensive.”

“In Kenya, we are used to facing obstacles.”

Jace nodded.

His talk with the hospital chaplain the day before had convinced him that his dream might be difficult to implement. Jace knew only too well that money would be the issue, and the trade-offs would be heartbreaking. Save one child with valvular heart disease or treat five hundred cases of HIV?

He thought of Timmy O’Reilly. Money had always been the issue at the mission hospital. Spend the least money to serve the most patients. Do what you can. Some patients are going to die. Give up the sickest to save the most.

Is that how it was always going to be in Africa?

The driver shifted into reverse. “We need to go. The minister will be expecting us soon.”

5

The contrast between the Kibera slums and the opulent Ministry of Health offices highlighted a common problem in Kenya: the fat get fatter as the poor beg at the gates of the rich.

The Honorable John Okombo held out his hand as Jace and Samuel approached. “Karibu, karibu,” he said. Welcome.

First impressions came quickly. Okombo was an impressive man, to be sure. Sharp features, a gray suit, and generous lips that hinted at a smile. But what struck Jace was the sheer size of the man. He was Shaqesque, towering above them. Jace’s hand disappeared in Okombo’s, and his voice caught in his throat. “An honor to meet you.”

“Sit.” Okombo gestured to a leather couch.

Jace looked around, taking in the oil landscapes, tropical palms in huge decorative planters, and a Persian rug. He sat next to a bronze sculpture of an elephant that served as the base of a table lamp.

“Governor Franks told me to expect you.”

Jace studied the huge man for a moment. Nothing like starting by dropping the name of a famous friend. “You know the governor?”

The MP chuckled. “I’ve done business with Stuart. Kenya and Virginia have much to offer each other.” He smiled to reveal even rows of gleaming white teeth like two opposing teams lining up across a gap.

Jace nodded, thankful that Minister Okombo continued.

“He owes you a great debt, Dr. Rawlings.”

Jace looked up at a Kikuyu woman wearing a short skirt. When she leaned forward in front of him, she displayed more flesh than an American teenager at a Britney Spears concert. She set a tray on the coffee table and began pouring tea into china cups. “Chai, Daktari?”

“Thank you.” He reached for a cup. “It was an honor to serve Governor Franks.”

“An honor?” Okombo leaned forward. “You have a strange way of showing your loyalty.”

Jace straightened. What was this? Another powerful Kenyan flexing his muscle? A test? “Don’t believe everything you hear.” He hesitated. “Or read in the papers. Our media is more concerned about opinion than truth. Vice, not virtue, is what sells papers.”

“Opinion is all I have, Dr. Rawlings.”

Jace stayed quiet, hoping the man would reveal his agenda.

“Scandal seems to follow you.”

“A misunderstanding. Nothing else.” Jace set down his cup. “Why should this be of concern to you?”

Okombo shrugged, feigning nonchalance. “I need to know everything about my associates, don’t I? You’ve come to practice medicine in my country. Things are different in Africa. This knowledge will help secure your loyalty.”

“I am committed to principle. Morality. Surgical excellence.”

“Interesting,” he said, slurping his sweet chai with vigor. He looked at the steaming liquid. “The British taught us to like what was under our noses all along.” He smiled. “The best tea in the world is grown right here in Kenya.” He laughed. “Have you ever seen a Brit drink a cup of tea? They were always critical of the width of the African nose,” he said. “But they have such pointed beaks that it is difficult for them to get their nose into a tea cup.” He imitated a clumsy attempt to sip tea, bumping his nose onto the opposite rim of the china.

Jace shifted, his pants sliding across the rich leather cushion.

“You’ve seen the girl in Kibera?”

“Yes.”

“Share your opinion with me.”

“Aortic stenosis, heart failure. Likely a valve destroyed by an untreated strep throat. Without surgery, she will drown as her lungs fill with fluid.”

“Swimming without jumping in the pool.”

“So to speak.”

“I want you to fix her.” He paused. “We have thousands more just like this one.”

“I am far from having a program up and running.”

“Perhaps you could do it at Kenyatta.”

The Kenyan National Hospital. The place had a horrible reputation. Jace wanted a place to practice far away from government bureaucracy and inefficiency. “I would like to open a program in Kijabe.” Jace paused. “You have a few other heart surgeons. Why don’t you lean on them?”

“The few Kenyans who have left our country for training and returned have gotten a taste for the lifestyle of the West. They want to operate in Kenya, but prefer private practice, where they can charge Western prices, over practice at our government hospital. I am hoping that you will be different. The few surgeons we have prefer their private cases at Nairobi Hospital, while the cases stack up at Kenyatta. At least half the patients die just waiting in a queue for surgery.”

“If my interest was money, I would have stayed in Virginia.”

Okombo poured himself another cup of chai. “If I know that you will serve the poor and charge only a small fee, I can smooth the way for your equipment to get through customs.” He paused. “You know it was me who approved of your intentions to begin such a program for the poor.”

“You have my sincere appreciation.”

“The heart surgeons who practice at Nairobi Hospital will be upset if you begin doing private cases.” He shook his head. “I’m not interested in facilitating a turf war.”

Jace took a deep breath. “Offering open-heart surgery for a few private patients in Kijabe could finance medical help for the poor there. My interest in private patients would only be to help defray the high cost of the program, not to pad my wallet.”

“How altruistic. But I’ll warn you. If Kenyans know that a famous American heart surgeon is available in their country, they will find a way to knock on your door.”