Well it’s Sunday again and I’m tired! It’s been a big week that feels like at least a month. A lot has happened this week, and on the other hand a lot of nothing.
We’ve had three older, severely malnourished kids come in this week, and as those of you who are medical know, patients always come in threes. Seven-to-nine-year olds come in weighing only 12 kg, their long bodies accentuated by the emaciated appearance of saggy skin on bone, every rib, joint, bone clearly defined, a mere shadow of a child.
In a culture that doesn’t understand and has a fear of giving blood - they believe they cannot live well, will be missing something if it’s taken away - a transfusion here is rare.
Our doc matched for blood type again and gave over a pint or two, truly giving over blood, sweat and tears for the patient. The boy's lifeless body rallied after receiving blood but as a further transfusion is needed, and there is no compatible donor, trust me to be bloody AB +, things are grim. As it is he is constantly moaning and crying out. The cerebral malaria has taken its toll on his body and mind and even if he lived what life would he have in the harsh realities of this culture. The adults are all off tending cattle or cultivating maize, the children left alone in the village, the older ones left to tend to the little ones. Often, as was the case this week, a child’s illness is not noticed until it is too late.
At 6.30 am on Tuesday we went to Jikow with our fixed 75hp motor on the little aluminum boat. The boat was really low in the water and had no power. After 20 minutes I questioned the driver, Duk, and we proceeded to move all the boxes of equipment, drugs, etc. into the middle of the boat. This didn’t help so he pulled up to the bank and told us to get out. With one eye on the lookout for crocodiles and snakes the other watched him test the boat without our excess weight. I said to the health officer, “mmm I think someone's trying to tell us we shouldn’t go to Jikow today” The boat was no better so we returned home, unloaded the boat into the car and headed for Nib Nib, the village closest to Jikow.
We can’t drive to Jikow anymore as it’s too boggy and also the cultivation is growing right through to the bank. I called the Health Extension Workers (HEW) and told them we would meet them in Nib Nib, and so they together with around 100 patients (some who had walked three hours to get there) walked the further 10km to reach us. When we arrived at the bridge they were working on it and we had to wait 20 minutes for them to move the truck and flatten the newly dumped dirt. Again I said to my colleague “Someone really doesn’t want us going to Jikow today”
It had rained heavily the day before and the track was really bad. We stopped many times looking on foot for solid ground for the car to travel on. Both the car and all of us were covered in the rich black mud. We came across a 4x4 with armed soldiers in the back, bogged to the doors, and as we went past them our car slid sideways mounting the muddy step in the middle of the track and guess what? We too were bogged, the wheels free spinning, as the chassis was sitting high and dry on the middle embankment 20 meters away from them!
OK, so we were stuck on a track somewhere between Ninenyang and Nib Nib. The only car at the compound had road tyres, the luscious grass, dense and approximately 10-12 foot high surrounded us, and it was too dangerous to walk through to find sticks or wood to help gain some traction. And it was HOT! Absolutely, stinking, bloody HOT! Not to mention the track we were on was covered with stagnant, green, slimy, malaria-infested, mosquito pools, created by previous vehicles - mostly our own - attempting to get to Nib Nib. The boys stripped off to shorts or jocks and commenced digging, the three-month-old severely malnourished patient and her mum sitting patiently in the back.
After two hours of digging and many failed attempts, our driver, arguably the best in Ethiopia, got us out. By then the HEWs had walked to find us, reporting there were over 100 patients waiting for us and one critical "so please hurry!" We were all covered in mud and sweating like a hot, meat pie in a plastic bag, not to mention exhausted as it was now 12.30 pm and the day had started pre-dawn at 5am. The boys went and washed as best they could in the stagnant water puddles, guzzled the whole four litres of water in one sitting, before climbing into the back to again set out for Nib Nib.
When we arrived we first washed at the borehole, then met with the community leader before going to the clinic. The people were sitting under trees waiting, a long, long day for some. As the boys began to unpack and set up, I attended to the critical patient who had been carried several kilometers on a stretcher fashioned out of sticks and a blanket. He was around 50, which is old considering average life span here is 47, totally emaciated with a huge swollen abdomen. We carried him over behind the car for a little privacy, as much as you can get when working in a clearing under trees, assessed him and believed he had a bowel obstruction. We put a line in, gave him some fluids and made him as comfortable as possible, and then set to work on the restless awaiting crowd.
Consultations were slow going with an already exhausted team. At 3pm I said we had to go to attempt to get home before dark so we again triaged and saw the last of the most needy patients - leprosy, TB, snake bite and wounds. We had to leave around 40 patients unseen and considering some had walked many miles before again walking the further 10km to Nib Nib plus waiting all day, it was pretty horrible. There was wailing and tugging and pulling as people begged to be seen. Yes I was told I’d need to get used to, but it still sucks and I feel really bad for them, but I know in my heart we all did our best and couldn’t do any more. We did not leave anyone critical behind, and the team worked well above and beyond their duty. I am really proud of them.
A good thing that happened on the way home, apart from actually making it home. A large genet or possibly a cheetah wandered out onto the track, stopped and looked at us before running off. That lifted the spirits of the team as they know I’m always on the lookout for any wildlife and we all got a good look at this beautiful cat.
That night however, the genet in the compound killed another one of my chooks, my favorite one who would follow me around, lay eggs in my tukul and provided a good amount of conversation and entertainment. That was sad and left only one.
On Wednesday I bought another from the Adura clinic so the remaining one wouldn’t be lonely. I went to lock them up and one was in so I went around the compound to find the other one to no avail. When I returned to the pen after five minutes all that was left was feathers! I didn’t hear a squawk or cluck and was within 20 meters the whole time. So that’s the end of my chooks. No more!