The trash piled up in our field pharmacy.  There were no trash cans, no trash bags, nothing in the church for us to put garbage in.

I had been stuffing garbage into my pockets, and piling up empty bottles and boxes behind our table.  As we sorted prescriptions for each patient, stray pills fell onto the table and floor, or into our bins, and there was a growing mess of random pills.

In Kenya, the pills are not labeled with codes, as they are in America, and every pill is the same size and color—round and white.  Unless you took a pill directly out of a marked container, it was difficult to know what type of medicine it was.  The pills looked the same for malaria, or typhus, or ulcers, or pneumonia, or any of a range of other diseases the patients standing in line at our table came to be treated for.

I carefully collected the stray pills into containers and set them to the side and guarded them, to make sure none of our patients were given the wrong medicine.

Someone finally brought a roll of plastic garbage bags, and I filled them with our pharmacy trash.  Rukia, a nurse and translator at the Ushindi Baptist Church, came over and started gathering up the garbage.  I grabbed the remaining trash bags and followed her into the large courtyard of the church.

She dropped the trash into a big pile in the red dirt and said, “Let’s hurry.”

She sprinted across the courtyard.  She wore a brightly colored dress, and she was a stout woman, and seeing her run in that colorful dress was sort of funny.  We entered a long low building with a tin roof.  The small room was soot-blackened and smoky, and there were several large cast-iron pots in the center of the room, next to a fire pit.

She said this was the kitchen, where the meals for the church and boarding school were cooked.  It looked like something out of a pioneer story, nothing but a fire pit and kettles and tin pots, and a single wooden shelf on the wall with a few cooking implements and small bowls.  They cooked meals here for 600 people.

She reached with tongs into the fire and dropped a glowing ember onto a wood chip.

“What are we doing?” I said.

“Come on, we have to hurry,” she said, and sprinted out the door and back across the courtyard, holding the wood chip in front of her and sheltering it with her other hand.

By the time we got back to the trash pile, thirty or forty children were digging through the bags, ripping them apart, pulling out the contents, the empty pill bottles, the packaging, and my boxes of stray pills.

As we approached, Rukia scattered the children with perfectly timed swings of her free hand, her feet sweeping and kicking at the children, her other hand carefully holding the wood chip with the ember.  She was exceedingly good at scattering the children.  She did not land a blow, and I sensed that this was a practiced dance with the children, and they knew how to stay just out of her radius.

The children formed a crowd around us, ten feet back, and watched as Rukia dropped the ember into the center of the trash pile.  She got on her knees and blew the ember until it smoked, and then waved at it with the side of a cardboard box.  A small fire started, and she began to gather the paper and other trash the children had ransacked, and threw it into the flames.  The plastic bags and pill bottles began to smoke, and there was the stinking smell of burning plastic, and then the fire caught and the flames rose and began to consume the pile.

“I’m sorry we had to run,” Rukia said.  “We had to get this trash set on fire fast, or the children would have gotten everything”.

“Why were they getting into this trash?” I said.

“Oh, they would love to have this stuff,” she said.  “They would make toys out of it.  Look at all these pills.  They would eat every one of them.  They would eat them like candy.”

I looked back to the children in a crowd around us.  They watched Rukia push the garbage into the fire with a stick, the boxes and zip lock bags, the packing material, the medicine bottles, the pills.

“There are many things we can save and give to the children, but not this material,” Rukia said.  “They could get very sick if they got into this.”

The trash pile burned down to ash, and the children drifted away to other pursuits.

Rukia said, “Do you do this in the United States, burn your trash?”

“In the United States, they give us huge trash cans,” I said, and held my arms in a circle, “this big around, and this tall, and we put our trash in it, and roll it to the street.  A big truck comes to empty it, and take the trash away.”

“They give you a container, this big, to put trash in?  Who gives you this?” she said.

“The trash company.”

“I would love to have such a container, but not to put garbage in,” she said.  “Oh my Lord, how do you keep the children from digging in the trash?”

How could I explain that in America, most children would not dig through the trash, not even to pull out a perfectly good toy?  I wondered if there was a single child in the entire country who would tear into a pile of trash for food.

“In the United States,” I said, “you can leave the trash out all night.  Nobody will bother it.”