Thursday, March 22, 2012

Hearts warmed, hearts broken

Thursday, March 1, 2012
Day Four

the thorns of the Acacia tree

After the overnight storms moved away, the day dawned cloudy, breezy, and cool. We hung things out, mopped up the puddles in our tents, and opened the flaps in hopes that they would dry during the day. Breakfast was served at 7 am--eggs and toast, sausage (think "hot dog"), fresh fruit, juice, and good strong coffee.

After breakfast we were introduced to our English speaking host, Elias, several of the local elders and officials,

as well as the young Masai (or Maasai) warrior who guarded the camp against nocturnal prowlers, hyenas among others.

Masai warriors are young men between the ages of around seventeen (when they are circumcised without any anesthesia) and thirty-five, when they become elders. While they are in training they live separately where they participate in initiation rites and learn to fight and hunt. Historically, the warriors fought to protect the village when tribal warfare was rampant. Now that peace reigns, at least around Lobosoit, they are charged with protecting the cattle herds against attacks by lions and other predators, and with guarding crops against herds of elephants that tramp through indiscriminately. As if the circumcision wasn't enough to prove their courage and strength, they were traditionally required to kill a lion with a spear before they earned the title "warrior". This, of course, is no longer permitted.  Warriors are identified by the head dress they wear and the long braids they sport. You can learn more about them at .

Once the introductions and welcomes were finished, we headed out to the clinic. I'd seen pictures of it before--a small, spare concrete building--but it wasn't until I saw it for the first time myself, with a long line Masai villagers already waiting for us, that I knew what we were up against.

the "waiting room"
my examination room
Right next door, the construction team got to work on the school building with a few simple tools and alot of muscle power!
The school before...
and after!

The clinic is staffed by three national nurses and a national doctor. Despite the inadequacies of the physical layout, the absence of any professional support system, and a shortage of medication, Dr. Boniface arrived every day with a broad smile and willingness to help and to be helped. It took several hours to organize and set up the clinic, meet our translators, and begin registering patients. The medical record consisted of the chief complaint, a brief (1-2 lines) history, the diagnosis (or as close as we come to one), and the treatment plan. Follow-up, for the most part, was impossible. Nevertheless, we saw over 50 patients before we had to close the doors and get back to camp. 

Our medical team
With all due respect for HIPAA (which thankfully doesn't exist in Lobosoit), this is some of what we saw on just the first day:

                    --Almost every man, woman, and child complained of chronic conjuctivitis and cough, the result of daily exposure to wood smoke and dust.
                    --Almost every patient complained of headache, neck and shoulder pain, and low back and leg pain. I have to admit that I was under the impression that African women were somehow uniquely suited to carrying heavy loads, that they were strong and resilient from years of physical labor, so that carrying five-gallon jugs of water on their heads, cultivating gardens by hand with a baby strapped to their backs, and sleeping on the hard floor with just a simple mat came naturally to them. I learned otherwise. Chronic, unrelenting pain is as much a problem for them as it would be for us under similar circumstances.
                    --I saw a child with a stiff, swollen, painful knee following an attack by a bull some three months earlier.
                    --There were many women with STD's, urinary tract infections, menstrual problems, and infertility.
                    --I saw a woman with anemia and rectal bleeding by history whose problems had been attributed to an hormonal imbalance for reasons I will never comprehend.
                    --And I learned to diagnose a belly full of worms by feeling them in there!

For me, making an accurate diagnosis was "iffy" at best. The language barrier made it difficult to obtain an accurate history. We lacked adequate facilities to examine patients (there was no place for them to lie down to be examined). We lacked even the simplest lab tests, and despite everything we brought with us, we still lacked the medication we needed to treat many conditions. This was a problem because unless the patient could be treated in the clinic...there simply was no treatment for them at all. Most of the villagers could neither find transportation to the hospital in Arusha nor afford the cost of care there. Therefore, people with the most serious illnesses or injuries still had no access to definitive care. And even when we offered patients a small amount of medication for their chronic pain and coughs, it was only enough to last a week or two.

It was so hard having to turn patients away when there was nothing we could do for them...they came so full of hope.  From time to time I had to ask myself what we were doing there...other than breaking our own hearts.

At three o'clock we had to close the clinic doors and send people away so we could finish up and make it back to camp before dark. There were no indignant outcries for immediate attention, no grumbling or head wagging. The people simply picked up their belongings and headed back home across the fields. They would be back in the morning.

When we got back to camp, we were just in time for a photo-op with the wildebeest they killed that day.

This little fellow appeared on our plates that night and in various other forms for several days. What we didn't eat (some 500 pounds of meat) was donated to the village. Let me just say that chewing wildbeest is alot like chewing rope...or what I imagine chewing rope to be like. I gave up on it after the first bite...otherwise I'd still be chewing on it today!

To our delight, the staff had a roaring fire going when we got back to camp and they actually heated water for us so we could enjoy a brief but warm shower. It's amazing how little water you can make do with when the supply is limited!

After supper we gathered around the fire again until it started to rain. The rain continued gently all night long but I slept soundly with a just few brief awakenings, still warm and dry. It was a better night in anticipation of another busy day.
"Doctors prescribe medicine of which they know little,
to cure diseases of which they know less,
in human beings of which they know nothing."
In my next post, I'll tell you about an amazing man and how the team stepped up to assure him the medical care he needed.
Be still--

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