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Kenya: Medical Free Clinic & Deworming

July 24th, 2010

The next couple of days in the clinic went much the same as the first, except the number of patients increased with every day. Word was spreading around the region that there were mzungu doctors at the Port Victoria hospital, and they were giving away free medications. People showed up who appeared healthy but claimed to be sick; some mothers brought all their children, saying vaguely that they thought they might all have malaria. You couldn’t blame them for wanting to stock up; if they weren’t sick now, they would be at some point, without this kind of access to medications or nutritional supplements. The doctors inevitably prescribed something — vitamins, Advil, folic acid — just to make sure people were walking out of the pharmacy with something useful. So many of them wanted to see the lone mzungu doctor Casey, who’s still in med school, that some patients came back and waited in line again, after they’d already seen a Kenyan doctor, just so they could have an appointment with him.

One thing the doctors prescribed a good deal was Oral Rehydration Therapy, to anyone with diarrhea and to all sick babies and children. It’s just a simple mixture of salt and sugar — the salt to replace lost sodium, the sugar to ensure its absorption in the intestines. But it saves lives all over the developing world, where diarrhea (and associated dehydration) is the second biggest cause of death among children under 5.

The pharmacy had packets of oral rehydration salts, the kind found in all travel med kits, that they doled out until they ran out. Dani had written and illustrated a bunch of leaflets in English and Swahili, with instructions on how to mix oral rehydration solution. We dragged a table outside to where people were clustered around the pharmacy window waiting for their prescriptions. There, with the help of a translator, she did ORT demonstrations and passed out the leaflets. When people received prescriptions for ORT after the packets were gone, Danielle would meet with them in the Nutrition/ORT office for a one-on-one testimonial, and to give them sugar and salt. I’d bet anything that several Kenyan kids will, over the years, owe their lives to Dani.

I went to two more schools to dispense deworming pills, hiking for 3 hours down dirt roads and smaller dirt paths, through mud-hut villages, before we arrived at the remote schools. The uniforms were more worn, the buildings more run-down, the teachers more likely to carry thin reed sticks with which they would swat errant kids into place. They had the same reaction to seeing mzungu as the children in the first school. This time I remembered to dispense pills with my sunglasses off. I’d learned in other countries that people who’ve never met Caucasians before are especially interested in seeing blue and green eye color. It is disconcerting to have person after person after person staring at your eyes, but I did make eye contact with every child, and I was glad for that. The clinic organizers had recommended that we volunteers deworm ourselves before leaving this area where parasites were so prevalent. So at one school I demonstrated taking the pill for a couple hundred children, brandishing the big tablet with a flourish before washing it down with water.

When we got back from the hike that afternoon, after giving away thousands of deworming pills, I arrived to find more people than ever gathered outside the pharmacy. With a growing stream of patients and one harried pharmacist being assisted by just one volunteer (Megan, who wasn’t a pharmacy tech), we had a serious bottleneck. One of the other volunteers, Laura, and I squeezed into the small pharmacy room to help. The pharmacist would read the prescription from the growing stack in front of him, scribble the drug and dosage onto a small Ziploc bag, and one of us would locate the medication and count out the pills. We stayed in that office until after the sun went down. The building electricity never came on and the hospital groundskeeper had to wedge in there holding a flashlight so we could see to count. We worked like this until all the day’s prescriptions were filled. We took prescriptions written by non-clinic doctors, too, if we had the right meds. We dispensed drugs and supplies for a huge variety of injuries and illnesses (especially malaria); we saw people of all ages, including a baby named Barrack Obama. I admit I threw more vitamins, Advils, Tylenols and Pepcids into the bags than were prescribed. I knew they wouldn’t go to waste.

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Kenya: Medical Free Clinic, Day 1

July 18th, 2010

The morning of the first day of the clinic, and we hadn’t even set it up. We arrived around 7 a.m. — we were supposed to open at 8 — and already at least 100 people had lined up outside the hospital waiting for us.

We’d been told more than once that “in Africa there is no hurry” and today this was maddeningly true … keys had to arrive, meetings had to be held, organizers had to walk through the clinic building and figure out what rooms should be used for what purpose. The rest of us sat outside on benches, in a small shaded area with benches in front of the clinic building, and busied ourselves preparing intake forms and other administrative stuff. I wrote signs in both Swahili and English for the various clinic functions: Admissions, Clinic, Pharmacy, Nutrition/ORT (Oral Rehydration Therapy). Massive suitcases containing donated medications, syringes and first-aid supplies sat unopened. More and more people kept arriving, and it was past 10 by now and the patients were growing less patient by the minute. Finally we got word that we could move into the clinic building.

We began dragging the suitcases indoors. Before we could get them all inside, though, some of the patients waiting in line saw us making the move and a few of them hustled up to the benches we were vacating. This triggered a mad stampede of people running en masse, to claim these valuable spots closest to the door. Some of our staff were afraid they’d be trampled, and really it was a legitimate fear. Lots of needy people, plus foreigners showing up with free health care and drugs, can easily become a recipe for disaster. Lesson number one for this fledgling medical camp: crowd control, right off the bat.

Inside, I stood with a couple other volunteers in the pharmacy room and we unpacked the medications. The shelves filled up with antibiotics, antimalarials, antihistamines, antifungals, dewormers, acetaminophen, ibuprofen, paracetamol, vitamins and lots more. The three Kenyan doctors we’d recruited, plus Casey and the handful of local nurses we’d hired, had begun seeing patients. People started trickling in, handing us their prescriptions even before we’d gotten everything unpacked. Ready or not, we were open for business.

At one point I looked out the pharmacy door and saw Casey in the hall with the old man we’d seen yesterday in the village, the one with the mass on his leg. They were sitting on a bench with a cardiologist named Kenneth, who had flown in from Nairobi to donate his time. It was good to know that at least the man would see a doctor and get that giant lump removed and biopsied, a chance he probably wouldn’t have had without our clinic. Turns out that Casey’s mud-hut diagnosis was spot on; I hoped the guy had just the bone infection, and not cancer. He’d have to wait several days for his biopsy results to come back from Nairobi. At least he’d have an answer. That had to be better than nothing.

As soon as we’d emptied the last suitcase, I beat it out of there to let the local pharmacist and one volunteer get started on the incoming flow of prescriptions. It was about 2 p.m., and after a quick and unsatisfying ham sandwich, was time for me to help with the outreach part of the clinic: going to schools for deworming.

I walked with Rennatus, Serena, Laura, and Ferdinand to a nearby public school. We had a big bottle of deworming pills with us, enough for the thousand or so kids from first through eighth grade. Each child had to take a tablet to kill internal parasites, and most of these kids surely harbored at least one of the main types of parasites so common in the area: schistosomes, helminths, pinworms, hookworms, tapeworms, whipworms and more.

The school was a series of frankly dirty cement rooms in the middle of well-trimmed and lush grounds, a battered Kenyan flag flapping on a pole. We went first to the office of the headmaster to introduce ourselves. Rennatus had sent word of our mission through a teacher, but the headmaster hadn’t gotten the message, or maybe he had forgotten. Either way, he seemed glad to see us, and agreed to set up a couple of tables outside for us with pitchers of water and communal cups; yes, communal cups. Not the most hygienic of situations by a long shot, but 1000 disposable Dixie cups were rather out of the question here.

The teachers let their students out of the classrooms grade by grade, and they ran over to our tables, yelling and shouting, a manic sea of faded and well-worn blue uniforms. Most of them had spotted us out the window, and they reacted to us in much the same way the kids in the village had. It took all the teachers’ efforts to get them lined up in some semblance of order so they wouldn’t mob us.

All we had to do was stand there with surgical gloves on (for sanitary purposes, though that seemed rather moot, what with 1000 of them sharing six cups) and dole out the pills, child by child. Three seventh-grade girls appointed themselves my water helpers, taking turns filling the communal cups and giving them to each kid who received a pill. I greeted every kid in line with some basic Swahili phrases I’d memorized: hello, how are you?, what’s your name? and, after they swallowed the rather large and bitter pill: good job!

The whole situation seemed surreal to me. Not just the rockstar treatment that came our way, but the fact that none of their parents knew we’d be here today, medicating their children. We’d been told the deworming pills had no ill effects; that this type of treatment was necessary and potentially lifesaving in this area; that infected kids would pass the dead parasites over the next couple days; that nothing adverse would happen to kids with no parasites.

But I still felt as though we were committing a fundamental wrong. In the U.S., and many other cultures, it would not be okay at all for strangers to show up and dispense pills to an entire student body without parental consent, no matter how well-intentioned. The headmaster and teachers acted like it was just fine, though, and I had to remind myself that I was working within their culture and not the other way around. I tried to see the situation through the children’s eyes: lining up in the schoolyard so the mzungu lady in rubber gloves can hand you a pill to swallow. That had to be surreal for them, too.

By the time we got back to the clinic, crowd control was under way, in the form of a lottery system and a larger-than-life local volunteer named Mishat with an affable personality and booming James Earl Jones voice. Everyone had received a numbered ticket, and Mishat passed through the crowd, identifying those who needed to be seen right away and arranging for their number to be called next. It took another hour for the day’s patients to move through the system, and we headed home at around 6 p.m. Dark was falling and the rest of the staff looked as tired and worn out as I felt. As we walked down the main dirt road of Port Victoria, I saw a bright and colorful spot bouncing in the air: the kids from yesterday, still playing with the beach ball we’d brought. Next year, I thought: 1000 beach balls. At least.

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Kenya: Port Victoria and Outskirts

July 16th, 2010

Our group woke ready to head to the local hospital, set up in a clinic building on premises, and start unloading all our suitcases full of donated medications before tomorrow, the first day of the clinic. But we didn’t have permission to take over the building yet; that would have to wait. We headed over anyway with a local volunteer, Ferdinand, a cousin of Rennatus.

Seven of us walked about a mile into the center of Port Victoria, discovering right away that the locals here don’t see mzungu too often. Children screeched and waved, and adults eyed us curiously or greeted us with “Karibu!” (welcome). Some of the kids ran over to us and jostled each other to shake our hands and practice their English: “How-are-you-I’m-fine” in robotic, excited voices, laughing hysterically when we answered. I had two of Dani’s beach balls with me. On a couple of occasions I pulled one out of my bag and spent a few minutes blowing it up in front of the puzzled audience, who’d confer with each other about what this mzungu lady could possibly be doing. Then I’d toss the ball over to them, and happy shrieking would take over. The kids got so much enjoyment out of the beach balls that I was mad at ourselves for failing to bring more.

We took a little tour of the local hospital. I’ve been in public hospitals in a developing country before; namely, the Philippines, and I’ve seen the less-than-sanitary conditions, the lack of supplies, the outdated equipment, patients piled together in too-small, dingy rooms. But it never fails to shock and upset me. The children’s ward, in particular, hit me right in the gut: here’s one crying baby girl in a cot with both her tiny legs in traction, high in the air; a child with horrible burns, lying under a little tent made from a worn-out blanket, another small sickly cough permeating the room. No specialty wards anywhere, not much staff in sight, and I’d bet no very strong painkillers either.

Ferdinand asked if we’d like to visit the village where he grew up, and it was a relief to say yes and get out of that hospital. We walked back through the center of town, past the kids we’d met earlier, still playing with their beach ball. Port Victoria’s town center is really just an intersection with a gas station, market stalls, various shops selling clothing or fabric, packaged groceries, animal feed, farm supplies; shacks identifying themselves as hotels, a couple of bars, and lots of individuals selling their wares (shoes, cooking utensils, street food) from blankets on the ground or from big baskets they carried around. Dirt swirled up constantly from the unpaved roads. Cows and chickens and goats roamed around. A mountain, whose name I don’t know, rose in the distance at one end of the main road.

It only took a couple of minutes to get through the town center and head down the dusty road toward Ferdinand’s village. Kids along the way clutched each other and screeched at the sight of us, sometimes following our group down the road. We walked through floodplains with large swampy pools here and there; one reason for the pervasive malaria in this region. When we came to a narrow river, we had to wait for a large canoe that served as the ferry. A bridge wouldn’t have been hard to build, but the frequent flooding and less-than-optimal building materials available here would crumble it in no time. These big canoes were the way to go, on most trips carrying several bicycles jammed together into the bow. We paid our ten shillings apiece and got to the other side where it was more of the same: a dirt road with marshy fields stretched out on either side, most of the transport in the form of bicycles or boda-boda (motorcycle taxis). This was an road where no motor vehicle could pass; the lack of bridges ensured that.

Ferdinand’s village consisted of nearly identical huts made from branches, dried mud and cow dung, with thatched palm-frond roofs. Most were round, others rectangular, all very small. In these villages, water comes from central wells or cisterns, carried back home in big plastic jugs; light comes from the sun, the moon, lanterns, candles, fire and flashlights. The kids here were especially excited by our arrival, even more so than the ones in town. The last time they saw mzungu was when Casey had been here two years ago on a similar trip, and they remembered him. We found ourselves mobbed by kids and young adults, at least 50 of them, all of whom wanted their photo taken and screamed with delight when they saw their images on our digital camera screens.

We followed Ferdinand along narrow pathways that wound through the close-set homes, past goats and chickens and flapping lines of laundry. The kids accompanied us in a big pack, the bolder ones grabbing our hands in ones and twos. When we ducked into the house of Ferdinand’s older brother, they stayed outside, gathering at the window to peer in.

We mzungus were surprised to see there was plenty of room inside the hut for several visitors to sit comfortably. We probably shouldn’t have been; with extended family and community at the heart of village life, naturally they would make space for big gatherings. The walls inside are draped with plastic, fabric or some kind of oilcloth to keep the dust at bay; the partitioned rooms small but serviceable with beds, tables, armoires, couches, chairs and stools. The decór runs to that curious third-world habit of displaying children’s toys (mainly plush animals) and pictures of babies or animals one would find in an elementary school classroom. Inflatable balls advertising Fanta soft drinks hung gaily from the ceiling of this particular home — smaller versions of the beach balls we’d brought from England.

Ferdinand’s brother was telling us about an elderly man in the village who had a problem with his leg. Casey was the sole medically trained one of us in the bunch; he made it clear he wasn’t a doctor yet, but would be glad to take a look. We left the first house and walked over to the home of the old man. The kids sprang up to join us, the ones who’d initially grabbed our hands quick to locate their chosen mzungu and clutch our fingers again. When we reached the second hut, again they assembled themselves on the ground and waited.

Casey’s patient was in his late 60s, thin and frail; he would have been mistaken for an octogenarian or older in Western culture where life just isn’t this taxing. When he rolled up his pant leg it was hard not to visibly react. Right beneath his left knee protruded a lump bigger than a golf ball, but more pointy, with a cracked tip that revealed pink flesh underneath. He waved flies away from it as he explained that this had started growing a couple of months ago. Casey examined the mass and then palpated down the rest of his leg to his foot, asked him to move his toes and ankle, and asked some questions though Ferdinand the translator.

“I’m not a doctor,” Casey repeated for the zillionth time, “but what I think this is, is chronic osteomyolytis, a bone infection. Can he make it to the clinic tomorrow? We’ll have a doctor look at it.” The man’s son agreed to bring his father into town tomorrow. The patient, his son, and two wives — yes, two wives, not uncommon in these parts — thanked Casey profusely. The kids outside jumped up when we left and gathered around us again.

Walking alongside Casey I asked if the guy could be helped. “I don’t know,” he said honestly. “With an infection like that, after it’s been there for a while it becomes squamous cell cancer, and I bet that’s what’s happened already. If it has, then the leg will have to be amputated, and he still wouldn’t live long. But even if it’s just the infection, he needs to be on IV antibiotics for at least a month. I don’t know if that’s even gonna be possible here.” We looked around at the mud huts, the lack of running water or electricity; the long hike into town, bisected by a river. In short, the guy was probably screwed. That would be the diagnosis: Sorry, you’re screwed.

Even as the kids gathered around us at the roadside, dancing and jumping up and down and yelling their goodbyes, I felt a little trepidation. Was this type of thing going to be a typical case tomorrow? How many more “Sorry, you’re screwed” diagnoses would the doctors be making? The need around here might be too much for what we had to offer.

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A Little Theft, A Whole Lotta Bumpy Road

July 10th, 2010

After our grueling jungle trek, Dani and Serena and I decided we deserved a day at the Hotel Serena for poolside piñas, and we’d begin the journey to Kenya refreshed and rejuvenated that night. Our sense of relaxation came to an abrupt end not long after we left the hotel, when Dani had her backpack stolen from the bed of the pickup truck in which we’d been riding. Dani wisely had all her valuables in the daypack she kept on her, so there was nothing of worth to the street kids who had run alongside the truck and lifted her bag. Size zero female clothing, miniature high heels and Caucasian-complexion makeup didn’t interest them, so with the help of a friendly local businessman, Dani miraculously got her bag back the next morning. Just about everything was intact (albeit smelly and dirty). We chalked it up to a valuable travel lesson we needed; we’d been too complacent, had ignored the gut instincts that told us putting our bags in back wasn’t a good idea.

And now we had to double-time it to Kenya, busing it from Gisenyi to Kigali to Kampala to Kisumu. More than 24 hours and two border crossings later we arrived at the guesthouse in Kisumu where our friend Casey, and other volunteers with the medical project he’d organized, had gathered.

Casey, a med student at Tulane, was there with fellow project planners and volunteers from the U.S. They’d been organizing this free clinic for about a year, and had brought thousands of dollars’ worth of donated medications and supplies to set up in a local hospital in rural Port Victoria, on the Ugandan border. It was the home town of one of the organizers, Rennatus, a public health officer now living in Atlanta. Of the three of us latecomers, Dani was the only one with health skills to lend to the project (she’s a nutritionist). But as we’d learned in previous volunteer stints abroad, anyone willing to help can and will be put to work.

We took much-needed showers and met up with the other volunteers at a small lakeside restaurant for dinner (grilled tilapia eaten, per custom, without utensils) and Tusker beers. Then it was on to the Hotel Imperial bar to watch Ghana vs. Uruguay in the World Cup. Ghana, the only African team left in the tournament, had the rabid support of everyone in town and so we all cheered for them too: me and Serena and Dani and Casey, and the others: Megan, Stephanie, Laura (all Americans) and Rennatus, Mike, and Merugi (Kenyan-Americans). Ghana lost in a heartbreak ending just as both Casey and Laura started feeling the first rumblings of travel illness (blamed on some street-vendor samosas eaten that morning). The day was definitely over.

By 3 o’clock the next afternoon, when we met at the bus station for our trip west to Port Victoria, the worst of Casey and Laura’s puking was over, though they still felt pretty lousy. I felt bad for them, first on a jostling and hot 2-hour bus ride, then crammed into a matatu (mini-bus) for another two hours. It was definitely a Developing Country Travel Experience, with 22 passengers packed into 10 designated seats, more people clinging to the outside of the vehicle, and all the associated smells and sights and sounds that come with it. My iPod kept me sane as I pressed against the window and thanked the travel gods that at least this road was (by Kenyan standards) relatively smooth. A million stars and a big meal greeted us when we arrived in Port Victoria, and then we distributed ourselves into the three resident houses where we’d be spending the next five days.

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