A Dedication

This will be, unlike most of my others, a short blog posting. The fact that it is short should not detract from the message and the emotion it conveys. I write this as a dedication to a woman whom I only came to know about nine days ago. She is a woman that you already know. Her name is Colusha Nyogusenga, and she is 34 years old. You met her in my recent blog post about the mupfumu and medical care in Burundi. She is the one who, against her wishes, was taken to the mupfumu for treatment of her massively enlarged abdomen. He performed multiple scarifications and prescribed a soup of herbs. It was when those mupfumu methods did not work that she came to the clinic. She came, like so many others, to be cured. We have no such magic powers for her, because she has advanced and incurable cirrhosis of the liver. Her prognosis is non-existent. She will die as a result of her disease: a disease for which she is not to blame. She did nothing to cause this. She is certainly not an alcoholic. If she were a patient in the United States, she would be on a transplant list for a new liver. She is otherwise healthy. It goes without saying that such a thing is impossible here.

We have done, over these past nine days, what we can to make Colusha more comfortable. We have treated her with our most potent antibiotics to eliminate the infection that is almost certainly brewing in her abdomen. More importantly, Melino has three times drained her abdomen of fluid. Each time that he has done so, he has removed at least five liters of turbid fluid. But these procedures are only a temporizing measure, for the fluid accumulates as quickly as it is removed.

Yet through it all, Colusha gives me a radiant smile whenever and wherever I see her, which I do on many occasions. I see her on morning rounds, and I often see her outside sitting on the steps. She likes the feeling of the sun shining on her face, for it warms her disease-ravaged body. She is weak by now, so I often have to help her back to her bed, when she gets too tired to sit. She always clasps my hands in a warm embrace when she sees me. She generally talks to me, at least a few words. She speaks to me in Kurundi, so I understand virtually nothing of what she says. Yet I respond with the few words I do know. My words probably mean nothing to her. We do not communicate in words, but I think we communicate on a different and perhaps deeper level. I believe that she knows that we are doing what we can for her, and that we do care for her. I do not think she understands that she has no hope of recovery, but I think she implicitly understands the severity of her condition.

I have often talked of the "espirit" that one sees and feels here. Perhaps I have talked of it too often. That does not stop me from talking about it again, for this is a different form of the Burundian and African "espirit." It is that form of the "espirit" that Colusha personifies. She is a human being who, except for a swollen abdomen, is skeletal in appearance. This is a woman who has virtually nothing left to her absurdly shortened life; a woman who physically is suffering the effects of a debilitating disease. Yet she still looks to the sun for warmth and comfort. She still looks directly into the camera and gives us a beautiful smile that lights up her emaciated face. It is a smile that speaks of nobility of spirit, of grace and dignity under the most trying of conditions. This is a woman who is dying, and yet she is still capable of transmitting the warmth and generosity of her soon-to-be extinguished being. This is the "espirit" that moved me when I took and ultimately saw these pictures. That is why I dedicate this blog post to her. I can think of no one who deserves it more.

Colusha will probably go home tomorrow, for her time here has come to an end. We can realistically do no more. She only awaits some form of transport to take her home. She is too weak to walk, and her home is too far. I will, as with so many of the patients here, never forget her. That lovely, shining smile, in the face of her abysmal fate, will stay with me. Her smile is, in a sense, the metaphorical smile of Burundi, a country that, like Colusha, has been beset with its own abysmal fate. The metaphorical smile of Burundi bespeaks of the grace and dignity that is this country.