A Heart of Flesh I-By Edward Maroncha

6 PM. Hilda is preparing dinner for her children. Ugali is cooking slowly over the open fire, and she is cutting the sukuma wiki to go along with it. Her children are in the main house, ostensibly doing their homework, but Harriet suspects that what they are really doing is watching television. Teachers say that under this new curriculum she should be helping them with their homework. But she needs to cook for them, and besides, she is illiterate. Hilda’s is thinking about this when her first born suddenly enters the kitchen, followed by the second born.

“Mom,” the first born says. “Mark is dying.”

Hilda puts the sukuma wiki down and rushes to the house, where she finds her four year old son on the floor with froth on his mouth.


Hilda lives in a three roomed wooden house that her late husband had built before he died two years ago. He left her with three children: Sharon who was then six years old; Mike, who was four, and Mark, who was two.

One of the three rooms in their house is used as a sitting room, and the other two are bedrooms. When Adiel was still alive, one of the bedrooms was the master bedroom that they used to share with baby Mark, with Mike and Sharon taking the other. After Adiel’s death, Hilda brought Sharon to her bedroom so that the boys could share the other room. The kitchen is separate from the main house. It is a mud-walled and grass-thatched structure next to the wooden house.

Life has not been easy ever since Adiel died. They have never been rich, but at least when Adiel was alive he used to provide for the household. Now everything is on Hilda’s shoulders. Adiel was a very hardworking motorcycle rider, and he used to provide whatever they needed. He was a good man. He did not drink, and as far as Hilda could tell, he did not keep other women. What that means is that all his income would be used in taking care of the family.

Hilda used to stay at home to take care of the house, the small farm and the children. They have half an acre of land which they inherited from Adiel’s father. Since their children were born two years apart, it means that she almost always had a child to take care of. When Adiel died, Mark was the baby.

Her days were pretty predictable. She would wake up in the morning to prepare breakfast for Adiel and the school going children. Adiel always took the children to school on his motorcycle before going to hustle for pillion passengers. When they left, Hilda would feed Mark porridge. After feeding Mark she would wash utensils and then she would feed the chicken and the goat. They have one goat which gives them just enough milk for their tea.  After that she would start washing clothes.

She would then start preparing lunch. Adiel always came home for lunch, but the children would eat in school. Adiel had enrolled them in a small private academy that offered tea and two slices of bread at ten o’clock, lunch and chocolate at four o’clock. After taking lunch with her husband, Hilda would go to the farm either to till, weed or do whatever else needed to be done. Half an acre is not a large piece of land, and she discovered she would take care of it adequately if she devoted her afternoons to it. She planted mainly maize and vegetables. In the evening she would shower and then start preparing supper for the clan.

Things have since changed. She is now the sole breadwinner of the family. These days she packs lunch for the children to carry to school because she no longer can be available at home during the day. She pulled them out of the academy because she could no longer afford it, and enrolled them in a public day school that does not offer meals. With the exception of Sundays, she goes out to people’s farms and homes every day to till and weed, to pluck tea or coffee or even to clean houses and clothes.

She doesn’t discriminate work because she really needs money. She has to provide food, pay for electricity and do all the other things that Adiel was doing when he was alive. All the three children are in school. Although Hilda transferred them from the academy to a public school where tuition is free, there are still levies that have to be paid. Right now the school is constructing new classrooms and parents have to contribute two thousand shillings every month, a total of six thousand a term. The head teacher had actually wanted the money to be paid per pupil, but parents protested and it was agreed that the levy would be paid per parent.


Mark, Hilda’s last born is a sickly child. He is very susceptible to common diseases like flu, stomach upsets and malaria. Whenever the other children catch a flu, for instance, they are able to shake it off even without medical intervention. But Mark usually gets fevers running up to forty degrees, and there was a time he could barely open his eyes. Hilda is often forced to take him to private clinics because these days the services at health centre in the neighborhood are terrible. When it was built, the health centre was a life saver in the impoverished village. But in the last three years it has become worse than hell.

In addition to support staff, the health centre has two doctors, a pharmacist, three clinical officers, eight nurses and a lab attendant. One of the doctors is the administrator of the hospital and doesn’t do clinical work, although his predecessor did. Being a government facility, the health center’s services are free. But unless you are able to find a clinical officer called Rosemary and either of the two good nurses, you might as well not go there. Even Rosemary and the two nurses cannot help much because there are almost always no drugs at the centre, but at least the three are kind and attentive. Rosemary does proper diagnosis so that all you have to do is buy medicine at a private pharmacy. Everybody else at the centre is a joke.

It wasn’t always this way. Under the previous governor the facility was working: there were drugs at the pharmacy and the staff members were kind. But when the current governor was elected, all the good staff members were transferred and new one brought. Rosemary and the two nurses are the only ones who were there from the time the centre was opened. The current doctors are almost never there. There is a clinic where patients of the centre are often referred, and some people say it belongs to one of the doctors. Hilda has never been there so she cannot be sure. Some even say that the current Medical Officer in charge of the health centre is the current governor’s husband.

Whatever the case, the truth is that other than Rosemary and two nurses called Gideon and Anne, all the staff at the health are rude and hostile, and behave as though patients are a major inconvenience. The doctors are often said to pinch medicine from the health centre, which would explain the perpetual shortage of drugs there.

With her son unconscious and frothing, however, Hilda knows that she has no option but to take him to the health centre. She is crossing fingers that she will find Rosemary there. Perhaps if he is stabilized, she can take him to a private hospital even though she has no money. She can always borrow money from friends. All she needs is for her son to be okay. She quickly calls one of her late husband’s brothers to rush her there in his motorcycle.


Rosemary heaves her body into her car and sighs. She is bone tired. She has just attended the last of the outpatients and now wants to go home before anyone else comes. But she takes a moment to breathe before she starts the car for the drive home. She has a date tonight with her fiancé Horace, but she wants to rush home and take a quick nap before she meets him for dinner at 8.00 PM.  They are set to get married next month, but Rosemary is feeling drained. It is now 6.30 PM, yet her shift was supposed to end at 5.00 PM. She has been at work since 5.00 AM. But Grace, the CO who is supposed to be on night shift, has not yet shown up. And Joseph, the CO who was supposed to be on the day shift with her, did not come the whole day. There is supposed to be a doctor on call at night and another during the day, but they have no time for the health centre. Besides, the administrator declared that unlike his predecessor, he has no interest in doing clinical work.

This has been Rosemary’s life for the last three years, and it is draining her. It is as though she is carrying the health centre on her shoulders. It really frustrates her, but there is nothing she can do about it. The man in charge of this place is the governor’s husband so if she complains she will get fired. As it is, she is already in his bad books because she refused to work at his private clinic like the other clinical officers and nurses of the health centre. Even the other doctor, Silvia, works at the clinic.

Rosemary was approached by Dr. Benjamin Makali, the health center’s boss, shortly after he took over the running of the facility three years ago. She was offered half the salary the county government pays her, without the allowances, but she was assured that she would always get the county government salary on time. But she would have to prioritize Makali’s clinic over the public health centre. Rosemary refused. Having grown up in a poor household, she knows how important free but quality health care is to poor people.

But Rosemary is disillusioned. With a workforce that is almost always absent, and with drugs that disappear before they land on the shelves, the health centre is a shadow of its former self. What is worse is that Makali requires the COs to refer patients to his clinic, where they are charged an arm and a leg to get the services they should have gotten for free at the health centre.

Rosemary starts the car and is about to drive out when a nurse called Anne comes running. She is one of the only two nurses at the health centre who share her passion for the health center’s patients.

“Rose, we have an emergency. Mark, Hilda’s son, has been brought. He is unconscious and frothing in the mouth.”

“Has Grace arrived?”

“No. I have tried calling her but she is not picking my calls. I have tried calling Dr. Sylvia, but she is not answering either.”

“Okay. Let’s go.”

Rosemary jumps out of the car. As she runs towards main building of the health centre, she calls her fiancé and cancels the date.

“I cannot do this anymore, Rose,” Horace tells her.

“What are you talking about?”

“It is obvious that your work comes first, and I respect that. But I cannot marry an absentee wife. I am calling off the relationship and the wedding.”

“Babe, can we talk about this later? I have a patient who is on the verge of death.”

“There is nothing to talk about. I have made up my mind. It is over between us. Goodbye Rose.”

He hangs up before she can respond. She would probably have called him back, but she has gotten to the casualty area where Mark is. She shoves the phone in her pocket, grabs a lab coat and gloves and gets to work. Saving lives comes before her personal frustrations.

(Continued Here)

Image by Fernado Zhiminaicela from Pixabay:


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