Today, Sunday, we had mass at 8:30am. It is a huge church that seems to hold about 200 hundred people. Malawian Catholic mass is longer than that of in America and last about 2-3 hours rather than the short 45min to an hour mass that we typically find in America. While that may seem long, it is made short by the beautiful voices of the Malawians – the priest would say few things then there would be about 10 minutes worth of singing. It is almost like going to a concert.
I was also reminded of how time is different here. There are no appointment that one has to get too, no pre-arranged plans; one just has to know that it is going to happen in the morning or after lunch. Today, after the mass and lunch I knew that Mr. Stima, the hospital clinical officer, was going to meet me after lunch and we are going out to visit some of the villages for Home Based Care (HBC). During these visits the clinical officers donate their time to visit patients who are unable to make it to the hospital or afford to pay the consultation fee at Ludzi Health Clinic – remember it cost about MWK300 (~$1.87) for consultation, which if the average Malawian lives on less than a dollar a day is quite expensive.
The Home Based Care visits are actually quite fun, we get to use motor cycles to go to the villages that are only accessible by walking, cycling, or by motor bikes. When I found out that I would be riding motorcycles the first thing that I thought was about the story that my mother and Grandma always told me about to scare me from riding motor bikes – when Uncle Clint was younger (in his teens) and was visiting a friend who had a motor bike. Grandma Chris, knowing about the motor bike, specifically told him not to ride because he would get in accident. Well sure enough, Uncle Clint rode the motor bike AND got in an accident. Fortunately for me, I didn’t get into a motor bike accident so mom and grandma you don’t have to worry:-)
This trip to Home Base Care was a great experience and allowed me to see the country side. I went with Mr. Stima (the hospital clinical officer) and Mr. Kaziputa, who is in charge of administrative duties for Home Base Care at the hospital. We took two motor bikes and went to visit the Village Headman to request permission to visit his villages (yes it is plural as he is in charge of multiple villages) and their respective Home Based Care patients that we know about. Shortly after leaving the village headman’s house one of our motor bikes broke down and we had to stop at the local mechanic to get it fixed.
Following that, I was astonished to find out how big of an area we had to cover in order to get to our first patient as it took about 25 minutes after our break down to get to our final destination – it was a good thing we were using motor bikes. Our first patient was Mrs. M and she was on HIV/AIDS anti-retroviral (ARV) treatment. According to my clinical officer, three months ago she was bed ridden, very weak, suffering from TB, and was struggling to provide care for six children – two of whom were hers and the rest were her deceased sister’s children. Mrs. M’s mother was helping as best as she could. Additionally, Mrs. M's husband had two other wives and had not been tested for HIV/AIDS and rarely was able to provide for financial support their two children. But she was put on the free HIV/AIDS ARV treatment provided by the Malawian government and the difference was astounding – she had been able to fight off the TB infection, had a healthy weight and expressed no visible HIV/AIDS symptoms. However, now that Mrs M, with the ARV treatment, had been able to bring her HIV/AIDS infection to manageable levels she was now struggling to find enough food to feed her and the rest of her family. The Mr. Stima was pleased to see her in improved health and had now decided to continue to provide her with counseling and emotional support. He had arranged to visit her again the next time.
Then again we hoped on our bikes and headed out to our next patient which was a 20 min ride away. Our next patient was Mr. D an older man who was in his late 60’s and has been suffering from chronic abdominal pain for three years. He eyes looked sunken, he was always weak, generally malnourished, and could not walk far – significant when men are expected to work their fields and grown crops. Additionally, he said that whenever he ate foods high in fibers he got real bad stomach cramps and about the only thing he was willing to eat was nsima (basically maize flour and water). His stool was yellow “like bamboo.” Additionally, he was having dysuria (painful urination).
Now the trick was to try to figure out based on his symptoms what it could be…….Yellow stool can mean many things but two things came up in my mind: giardia (sp?) or a reflection of his maize diet. Giardia is a bacterium that when it gets in your digestive tract and causes the patient to have sulfuric gas (burps and farts) and yellow diarrhea. However, Mr. D explained to us that he was not having diarrhea and Mr. Stima reminded me that giardia does not cause dysuria (painful urination). So that ruled out giardia…….
After much discussion with Mr. Stima, we had decided that the most likely suspects of Mr. D abdominal pain were either Bilharzia or worms. Bilharzia is a water born parasite that lives in the snails in the local waters here. It spend most of its life in water snails until a human passes by and it moves from the snail, burrows into the human skin, hits the blood stream, and finally settles in the kidney. Upon arrival in the kidney, the parasite then begins to reproduce eggs. The eggs then burn their way through to your bladder to be excreted out in the urine, which explains way patients infected with bilharzia have painful urination (dysuria). To diagnose for bilharzias, one can take a urine sample and look for eggs under a microscope. There are many types of worms that can infect the GI system and all of them can cause abdominal pain. The only way to tell if one is infected with worms is to take a stool sample and look at it under a microscope.
Next we told Mr. D what we thought could be causing his abdominal pain and told him the only way we could treat him was to have him come to the clinic to give a urine and stool sample. However there was a problem because Mr. D could not afford the hospital consultation, lab fee, and drug treatment which was about MWK750 ($5.00)…….think about it. All he need were some simple test and drugs but couldn’t even afford to pay $5!!!! He lived with this abdominal pain for three years!!!!!
Realizing this, I decided that I would be willing to pay all of his fees and told him to come to the hospital the next day for treatment.
We then hoped on our bikes and headed out to visit our last patient – Mrs. A. She was unfortunately afflicted with what was presumed to be a malignant tumor (presumed Birkitt's Lymphoma) on the left side of her face. Initially you couldn’t notice the tumor because she was able to hide the tumor by using a head scarf tied around her face, much like many Muslim women do in the area. However when she took off the scarf the tumor took up much of her face (see attached picture). It was extremely painful and she had gone to Lilongwe for surgery to remove the tumor, but the surgeons decided against it because the tumor was complicated. I am sure she was living with excruciating pain as there some open sores on the bottom of her cheek that looked infected. There was nothing we could other than to tell her to come to the clinic to treat the open sores and some free pain killers (morphine).
By that time it was getting dark and we had to make it back home. It was great day and I was able to see much of the country side and had a great opportunity to help as villagers as best as we could.
No comments:
Post a Comment