Nothing about this feels normal. I was up late last night listening to the bush babies cackling in the trees and the night-time guard dogs barking at them, but I couldn't bring myself to close my window because it was so uncomfortably HOT. I'm tired, both mentally and physically.
When we arrived at the clinic at 08:00, just a short walk from where we are living this week, there was already a huge line of people waiting to see us. It was a rough start to the day, and we had to adjust the workflow process several times throughout the day. There are some very sick patients here. So far I have seen malaria, brucellosis, amebaosis, typhoid, upper respiratory infections, conjunctivitis, musculoskeletal sprains and straines and fractures, HIV related infections, tuberculosis, and really bad hypertension. Asthma is also very common, as families cook over wood burning fires to prepare food. We also see a lot of eye irritation because of this as well. Everyone who came to see us also got a multi-vitamin and deworming medications. We had a little 86-year old woman as a patient today who is almost totally blind and who broke a rib when she was knocked down by a cow a week ago, and an 80-year old man who was walking to our clinic this morning and tripped over a rock while crossing a river and broke his clavicle. We met 5 and 7 year old orphans who have recently lost their parents to HIV and now reside with their grandmother. I have met battered and abused women, too. I feel like we are running a MASH unit in a war zone. I was not mentally prepared for this. We had a 10-month old with probable cerebral malaria come to us. She was extremely lethargic and started having seizures. Without care at a hospital she would most likely not make it. All we could do was start an IV and give her oral Tylenol, IV fluids and Rocephin and try to get her an urgent ride to Nairobi, to a hospital. She did NOT look good. It took us almost an hour, but we finally found someone able to drive her to Nairobi with her mother, who was also quite ill but not on the verge of death. What have I gotten myself into???
Another challenge has been getting translators. We have several of the benefactors, the young adults from MCF here, translating for us and I have loved meeting them and working with them. Although they do a great job, there are several different dialects being spoken in Kenya. Kenya is a country primarily assembled into tribes. The tribe is still lead by a tribal leader, though the modern role of a tribal leader isn't very specific. Historically, the tribal leader was the figurehead for the law enforcement and the civil affairs within the tribe. I can't get a definiteve answer as to what they do in 2011, but from what I gather the tribes are still very important to people and marriages between persons from different tribes is not encouraged. It is still very much a part of a person's culture and identity, including preserving the dialect: some of the older generations speak only their tribal dialect and have not learned english or swahili. Kamba is one of the more popular tribal languages in the area. It's all very interesting. Another challenge with giving care instructions or prescription information has been the lack of written language. Although most of the younger generation has been taught to read and write, not all of our patients are literate and none of us write in swahili. Our benefactor assistants have taught us how to write instructions so that they have meaningful information (for example, a BID medication given twice a day would be written out as 1 X 2, which to them means "take one pill two times in a day"). Even with that problem handled, dispensing multiple drugs at a time with different directions and uses makes me nervous. Some of the pateints with multiple issues need 3 or 4 or even 5 medications and these don't all get taken at the same time. Some are once a day, others are twice or three or even four times a day. I want them to be able to take the medicaions safely and effectively, but have not come up with a sure-fire way to do that yet. So I explain what they are taking, why they are taking it, when they are supposed to take it, and any side effects they might encounter. Then I ask them to repeat part of it back to me. This is time consuming, especially when it all has to be translated on the spot into swahili with the help of a translator. I have come up with a system of marking syringes with cloth tape for liquids and syrups given to children. Explaining asthma inhalers is still a challenge. Without giving myself multiple doses throughout the day as a demonstration, there isn't really a good way to show them exactly how. Most of them have never seen a metered dose inhaler before, but it is a pretty effective way to deliver aerosolized medication. My hope is that they still remember all of this when they get home. Culturally, I don't think they feel comfortable asking a lot of questions.
We saw about 200 patients today. We didn't close up shop until nearly 7:00pm. I am dirty and tired. Dinner never tasted so good. I'm going to wrap it up here and go to bed early and hope that I fall asleep easier tonight
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