Day 5 - Solving a mysterious infection among school children; getting to know Helen; the impact of the mining economy on the Fluorspar clinic; flying to Lewa

Jumbo!  My post today will be a combination of our day of outreach at Simit and our closing day at Fluorspar and arrival at Lewa.  

A magical moment again watching the cataract patients regain their eyesight.  Overall we’re quite happy with the results.  We did 27 surgeries over two days and all but two patients showed improved vision.  We’re hopeful that through proper follow-up treatment those two will improve.  At two weeks Jemimah will perform a vision test on the patients to assess their improvement.  Only then will we know whether the surgeries were a success.  Given our current results we are cautiously optimistic :) 

Let’s just say Simit never fails to deliver amazing experiences.  Some funny, and others heart wrenching.  You are emotionally and physically spent by the end of the day.  The ride there is 39 minutes (we timed it) up the mountain on unimaginably poor roads.  At one point our bus driver actually stopped as he was too afraid to go further.  We waited for another driver to arrive and we proceeded along with great trepidation.

We arrive to this scenic hilltop village.  We are surrounded by green lush hills with waterfalls and a river running through.  It is beautiful.

 Helen, the community health worker extraordinaire in Simit. Showing us her kitchen where she prepared the masala tea and mandazi

Helen, the community health worker extraordinaire in Simit. Showing us her kitchen where she prepared the masala tea and mandazi

Our first point of contact is Helen, the community health worker we’ve hired in Simit. Helen begins by offering us sweet masala tea and mandazi, a fried sweet dough.  It is delicious and warm and we are revived and ready to go after the treacherous ride.

Very typical at Simit, the outreach starts slow and then reaches complete chaos with a slow burn to the end with last minute walk-ins trickling in until nightfall.  You feel compelled to stay until you’ve seen everyone as it is their rare chance to be seen by our western docs. 

 Dr. Ed and Dr. Paul with the village chief whose house we are using to see patients. 

Dr. Ed and Dr. Paul with the village chief whose house we are using to see patients. 

Dr. Paul, our dermatologist begins by doing a skin condition clinic on school kids who have been brought in from the primary school.  Around 70% of the kids revealed fungal infections on their heads and were asked to stand in a line so that they would receive medication to treat it.  The incidence was so high that our clinical officer went to the school and asked if all of the kids could walk to the outreach in order to be checked. 

About an hour later another 120 kids showed up and they received both a vision screening and derm screening. 

Due to the high incidence of fungal we asked if they could locate the village barber.  About 20 minutes later he showed up. 

 The town barber speaking with doctors about how to prevent fungal infections 

The town barber speaking with doctors about how to prevent fungal infections 

Dr. Paul informed him of the fungal infections and then counseled him on proper hygiene and the importance of sterilizing his razor after each child.  We sent him off with a solution used to sterilize and hoped he would heed our advice.

If not diagnosed, fungal infections can lead to scarring and permanent hair loss and other serious infections.

Through the vision clinic we also identified a 14 year old who had developed a cataract due to trauma.  She has already been added to our list for when we come back in January.

One very difficult case was a woman who came in with an abscessed foot.  Unfortunately the clinic doesn’t have anesthetic to freeze the local area.  But the woman’s abscess was too advanced to not address it immediately.  Dr. Ed was forced to lance the woman’s foot with no freezing.  Despite the obvious enormous pain she was in as he performed the procedure, which required people to hold her down, she never once made a noise.  Plenty of tears rolled down her face but without a peep.  It was agonizing to watch, I can only imagine what she was enduring.   She was treated with antibiotic and will be monitored by Helen the community health worker.    

On a light note, we were very amused by an elderly gentleman who proved to be quite a good dancer.  The local “hotel” (a house with “Hotel” painted on it.  And as an aside, when I asked Helen who stays at the hotel, she just looked down and giggled.  I took that as a hint not to pursue any further), but anyways, the local hotel was playing music which came through the windows.  So the gentleman seized the moment and freely began to dance.  A picture of youthful disregard for what people might think. It made me happy to watch him. 

At one point I ask Helen, the CHW for Simit, where I might use the loo.  She walks me around the corner, points to an outhouse, I say thank you thinking that’s it.  But she suggests we take a walk to her house and have a general tour of the hood.  So we proceed to walk though lots of overgrown brush. Simit is very lush at the moment.  The maize crops look healthy and the community is hopeful for a good harvest.  We arrive at her house which is a round tin structure which when I look at it can only think how bloody hot inside it would be during the day.  

 Helen showing me her home and garden. She lives in one and the other 4 remain empty

Helen showing me her home and garden. She lives in one and the other 4 remain empty

There are 5 of these structures in her area but none of them are currently occupied.  She is alone.  In fact, all alone at the moment.  She has been a single mother for 10 years with two daughters age 11 and 24.  The 24 year old is at nursing school and the 10 year old is away at school too.  It costs her about $700 usd a year for school fees.  Her main form of employment at the moment is the work she does for us as a community health worker.  We pay her about $100 usd/month, the going rate.  She told me how appreciative she was for the job and that when we hired her she was able to pay off her children’s school fees. 

In addition to the CHW salary, she makes modest income from her garden that surrounds her home, planted in a haphazard sort of way.   There are greens, beetroots, pumpkin, squash, an avocado tree, a papaya tree, maize and bunch of sugar cane.  To give you an idea of the economy, she can sell a large papaya for 50 cents.  The small one for 20 cents.  One can see how thankful she was to have our job offer.

She proceeds to go to the sugarcane and well…basically...manhandle one  of the stalks.  This tiny woman rips it down, breaks it in half, peels it back and hands it to me.  She said, “try it”.  And so, not to be rude, I took a big bite of it, sucked all the sweet juice out of it and then kept chewing…..and chewing….until she finally said that I needed to spit the chewy part out.  Not to swallow it.  Relieved, as I had no idea how I was going to get this down, I spit it out (in the most elegant way possible) and told her how delicious it way.  It was so good in fact I continued to eat it while she kept talking.

 Helen taking down the stalk of sugarcane

Helen taking down the stalk of sugarcane

 Helen walking back to the outreach with the 3 sugarcane stalks

Helen walking back to the outreach with the 3 sugarcane stalks

As she continued to talk (and me eat) she ripped down 2 more stalks, told me to hold her 2 writing pens and then took the 3 stalks and carried them on her shoulders through the overgrown bush back to the outreach.  I quickly and obediently followed behind struggling through the same bush (with her 2 pens) that she was navigating with agility and ease (with 3 sugarcane stalks), she sometimes glancing back at me giggling at my complete awkwardness in dealing with the brush hitting my face and the muddy ground.  Helen is an incredible woman with an enormous inner strength and level of intelligence that has enabled her to systematically identify people in her community who are at risk of chronic disease.  She has self initiative and a very big heart.

 Helen showing Vanessa and me her self made chronic disease posters that she uses when travelling in her community identifying people at risk for chronic diseas 

Helen showing Vanessa and me her self made chronic disease posters that she uses when travelling in her community identifying people at risk for chronic diseas 

Vanessa had the opportunity to walk with Helen and visit some homes in her community.  Together they are testing out a Community Health Worker kit that Helen requested and Vanessa has developed.  The kit will allow Helen to better educate and inform her people on chronic disease and strategies for prevention.  I’ve asked Vanessa to write up her own entry on her experience so that you can hear first hand an afternoon that I’m sure was a memorable one.

Finally, the end of the outreach.  After seeing a couple hundred plus patients, we pack up and head back to Fluorspar.  The staff back at the main house have prepared tea and a selection of beer and wine.  We are so appreciative.

The next morning we have our wrap-up meeting with the clinic staff.  Our main concern at the moment is the future of the clinic.  Unfortunately the mining industry is in a downturn and the competitive climate has changed with new entrants offering Fluorspar at lower prices.  The mine has been forced to close down and the clinic’s future is uncertain.  The staff has begun to quit leaving only 4 now.  They are working hard to compensate for the shortage of staff and it is taking a bit of a toll on morale.  We suggest some strategies in stretching the people resources, one being perhaps they may need to only be an outpatient clinic at this point.  They are reticent to scale back as they know the community relies on them to be available 24/7.  But I think they are at the tipping point and this is something they need to consider.

 Jemimah and Dr. Sidiqa saying a sad goodbye. They've worked together very closely over the last 2 years as Jemimah was being trained by Sidiqa to be the "optometrist" at the clinic. 

Jemimah and Dr. Sidiqa saying a sad goodbye. They've worked together very closely over the last 2 years as Jemimah was being trained by Sidiqa to be the "optometrist" at the clinic. 

We say our goodbyes, lots of hugs and photos, and promise to see them in January.  I think deep down we all know it’s not a sure bet.  But we feel compelled to keep the faith that the mine will recover as it always has and everything will return as normal.  The next few months will reveal a lot and we’ll be sure to keep you posted on the progress.

 With the clinic staff. Saying goodbye

With the clinic staff. Saying goodbye

Next stop…..Lewa.  We board our charter flight at 11:30 a.m. and arrive at Lewa airstrip at 12:15 p.m.  Imagine arriving in the middle of an African safari with giraffes, elephants, zebras…in the distance.  Surreal. 

 Vanessa moments after seeing her first elephant in the wild

Vanessa moments after seeing her first elephant in the wild

We are greeted by the clinic manager of Lewa clinic, Ezekiel.  We dropped our things at Ngiri House, our lodging for the week.  We have a beautiful lunch overlooking vast terrain with all sorts of animals off in the distance as well as up close.  It is totally normal to have monkeys, impala, warthogs walk by.  We were then told that the clinic staff were in a meeting that went long and they asked if we wouldn’t mind going on a game drive before heading to the clinic.  We were like, uh, no problem?!  So off we went in our jeep and saw elephants, giraffes, rhinos, impalas, zebras, monkeys, baboons, buffalo,…and the list goes on.  Really incredible.

Finally it was time to go to the clinic.  Ezekiel and his staff had an incredible presentation and introduction and were full of suggestions on how the week together would work best.  We made some adjustments to the schedule, had a tour of the facility for the newcomers and were on our way back home. 

Tomorrow we begin at 8:30 a.m. at the clinic.  The morning will include 4 presentations from our docs in the morning followed by clinics of chronic disease and pediatrics in the afternoon.  Dr. Paul will be doing a lumps and bumps clinic as well. 

We are super excited at the potential of this week.  The clinic staff is full of positive energy and seem to be eager to learn and take advantage of this opportunity. 

There are countless more stories to tell but you’ll just have to talk to us in person to hear the rest.  We all would love to share for those who are willing to listen.

 Until tomorrow…..lala salama!

 Stacy