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country before; namely, the Philippines, and I’ve seen the less-than-sanitary conditions, the lack of supplies, the outdated equipment, patients piled together in too-small, dingy rooms.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.
