I have been with Susan for three weeks and have gotten a feel for how things work around here and the kinds of patients that come through the clinic. On Wednesday patients come in for vaccinations. Susan stores her vaccines at another facility because of lack of electricity and the cost of fuel to run a generator for the refrigerator. That has its costs as well since she has to pay transportation costs to go and retrieve the vaccines. Vaccines are provided free from the government and Susan charges a nominal fee for administering vaccines.
Last week it was announced that there was to be an area wide measles campaign for children less than five. We had about 200 little ones come through the door with various family members over 2 ½ days. It was an exhausting couple of days. We ran out of vaccine one day and many of the woman had walked far to get here. They were not very happy to have to return and have another a day away from farming etc.. We decided to draw straws for the last 4 vaccinations among about 30 women. There were very eager mothers to draw the right straw!
Open wide for a few drops of Vitamin A…before the injection
In the end I terrorized little ones, some because I gave them an injection and others because they have never seen a white person PLUS I gave them an injection. Susan and I did trade off making the kids cry.
I did have the pleasure of meeting up with a cheerful four year old girl named Janet a few days later at a home of a friend. She announced to me that I had INJECTED her and showed me where I had committed the crime and the smudge mark we had made on her little finger indicating she had the vaccine. She seemed to forgive me.
Janet showing me “the” arm
In the meantime my midwife friends would be happy to hear that I can actually find fetal heart beats and am batting about 50% in figuring out if the fetus head is engaged. I struggle with arms and legs and sometimes I think the head is the butt, but I am learning. The mothers seem tolerant of my role in their care and Susan tells me I am getting better at it. Note to my family practice friends, ante-natal care is a nice change from the sick patient. If you are in a rural area, it is a good skill to have, as long as you have a good referral network.
Warning for the squeamish, you might want to skip to the next paragraph or two.
I have now watched a couple of birth control “rod” implants in women’s arms. I am scheduled to do the next one that comes through the door. For those not familiar, a small incision is made in the underside of the upper arm and two flexible hormone rods about an inch long are inserted just under the skin to provide slow release of contraceptive hormones. No sutures required. The rods allow for five years of birth control or until taken out. It is one of the Millennium Goals for Kenya to emphasize long-term birth control options to improve the health of the woman and children. Spacing and fewer births are important for that goal. Both public and private clinics will be required to meet the goal.
Also, for all of us who are familiar with the PAP smears, the way that cervical cancer is detected here is definitely less costly and immediate. A sterilized cotton swab is soaked in household white vinegar, although I am told all brands are not alike. The swab is applied to the cervix. If the tissue reacts by turning white (VIA +), then you have a suspect case. Then another swab soaked in Lugol’s Iodine is applied the same way, and any tissue turning yellow is again suspect (VILI +). I had read about this method being used in India as well. Susan says she has found a few cases that were referred for treatment. Only one patient she referred died as the cancer was too advanced.
Otherwise we are seeing out share of respiratory infections, worms and amoebas, cuts, and rashes. There is no such thing as a text book case of any rash here! I recommend to my colleagues never leave home without an atlas of dermatological conditions and treatments. Furthermore, I was shown today a Nairobi fly that looks more like a long skinny beetle with longer antennae. If you are bitten you get shingle-like rashes. Having had shingles, it is one African experience I shall avoid.
Susan’s neighbor brought me Arabicum flowers and beet roots from her garden to welcome me to the neighborhood. The flowers are sold for export for about 10 shillings a stem (85 shillings to the US $). Consider that when next you buy flowers.