Saturday, November 6, 2010

Leaving Karero...

It was a busy week in Karero full of projects and patients.  We showed up to a beautiful site!  The clinic looked wonderful.  The community has taken such good care of it, creating walking and car paths and keeping it clean.  The rains came so we stayed a few more days than expected, which was really a blessing.  Mike and I put in windows using clear plastic instead of glass.  Mike brilliantly figured out a way to make the windows open and close to accommodate for the fluctuations in the weather.  Oh my wise husband!  The Maasai have given him a new Maasai name, Eloshordro (El – oh – shor –dro, you have to roll the “r”s with your tongue).  It means something like “the one who gives of his heart without asking.”  Typical Mike fashion, he works diligently and quietly and, before you know it, things are done!  He is an inspirational fellow that one.  The windows work really well to protect against the heat, wind, dust, and various animal noises.  We also tiled the bathing room floor as the concrete was quickly eroding from all the water.  And, we built a door for one of the rooms.  It was quite a site watching two westerners construct a door with old, run-down wood and some rusty nails.  We had some help from the locals and it turned out really well. 

It was a busy week with some complicated patients.  We went to the nearby boma to visit a woman who had had stillbirth at 8 months.  This was her second miscarriage. She was very dizzy, lightheaded, and weak.   Lab tests are limited in Karero without electricity and we have no way of getting hematocrit or hemoglobin, but I expected both tests would have been extremely low. She was so anemic that her tongue was white. We walked to her boma, brought her to the clinic where we were able to do an exam, give her some IV fluid, medication (vitamins, antibiotics, and analgesics) and to observe her for several hours while she rested.  It started pouring while she was at the clinic so she was stuck with us for several hours! She stabilized with foods, fluids, and rest.  I instructed to get to the clinic in Namanga for lab tests.  I checked on her the next day in her home where we shared tea.   It turns out she is the wife of the man whose head I sewed up the first night we arrived!  She was doing a bit better. As expected, she did not tolerate the vitamins I gave her... imagine prenatals on an empty stomach, yuck!  She was told to keep trying and to take with food.  I expect a slow steady recovery.  Her husband and all the other women in her boma were extremely supportive. I was told that after a woman gives birth or miscarries, she often resides in her manyatta (the house within the boma) for a whole month while the other women take care of her and the other children.  It is a beautiful lesson in community. Her husband was very grateful, and offered to slaughter a goat for us next week!  I told him it was unnecessary, but that he had to take care of his wife.  He agreed:) 

We had a very complicated patient the last night we were there.  A mama brought her two-year-old baby in at about 9pm complaining she had been having “convulsions” through the day.  She said she had about four convulsions without any other symptoms.  She had similar symptoms about 1 month ago when she was diagnosed and treated for malaria.  I assessed her and she was burning up with a fever of 39.1C, otherwise unremarkable.  She had a normal affect for a sick child, alert and responsive without any seizure activity.  Her blood slide was negative for malaria.  I diagnosed her with febrile seizures and covered her for infection with both septra and AL for malaria.  Her fever was reduced with paracetamol.  She was given clean water and instructed to push fluids and return in the morning for reassessment.  When she returned, she was afebrile, but very lethargic. Mama said she had had a few convulsions in the morning.  I was concerned that this was much more than just febrile seizures. Her typhoid test was negative.  There was no history of trauma and no family history, so far as we could tell, of seizure activity (but this is hard to determine!).  She had a small seizure in the clinic that lasted for about 1 minute, despite the anti-seizure medication that was given.  It was helpful, although very difficult, to observe the type and duration of seizure.  The child was postictal.  Our concern, obviously, was that this child would continue to seize and suffer irreparable damage.  She needed to get to the district hospital asap where they could observe her and perform more tests.  Tyson was expected to come to Karero to pick us up and he arrived just as I was calling him to tell him we needed to take this baby to the hospital.  I was really worried he would not make it due to the rains and the roads, but thankfully he arrived just in time.  Again, it was really incredible to watch the community come together.   The baby’s father was not around, but several men in the community came to discuss how they could get this mama and baby to the hospital.  Most people will not go to the hospital when referred because they cannot afford transportation.  The district hospital is in Kajiedo which is about 2 ½ hours from Karero.  They have to get a motorbike or car to come to Karero and drive them to the main road in Mal tisa, which is about 400 Ksh.  Then, they have to get a matatu (the local bus system which is terrifying – imagine 20 people in a small minivan with people hanging out the doors and on the roof travelling along bumpy roads!).  The matatu to Kajiedo costs about 200 ksh.  We all worked together to find a solution.   The plan was to drive them to the main road where they would then get a ride to the hospital.  Ester, the mama, baby, one of the men from the community, and another older mama came with us to Mal tisa.  I was a bit concerned about them making to to the hospital, so we ended up just driving all the way to the district hospital where the child was admitted immediately.  I was so thankful for the Kenyan doctor that we met right away.  We discussed the situation and we were immediately on the same page.  She was started on IV diazepam (valium), given IV fluids with dextrose, treated with quinine for malaria and was going to have more blood work and an EEG, if possible.  The hospital took the baby with the mama and they will take care of her, keeping her at least through Monday.  The baby had several small seizures en route to the hospital and was post ictal and sleeping the rest of the time in my arms.  The mama was having a very hard time observing all of this, as expected, as it is incredibly difficult to help a little one through a seizure.  Thankfully, the seizures were short and her airway was not compromised.  We all worked together to care for her and she made it safely.  My hope is that the seizures are secondary to a curable illness or electrolyte imbalance, but I am also concerned about epilepsy…especially if there has been a history of seizures in the past (again, hard to determine).   It will be very difficult if the result is in fact a chronic illness that requires frequent observation and continuous medication.   I hope and pray for the recovery of this baby.  It was a true experience of the challenges facing much of the rural population in Kenya.  It was also a tribute to how important it is to have a clinic in Karero where there are hardly any other resources.  I am not sure what the outcome would have been for this little one had they had no place to go, or had they walked four hours through the bush to the other nearest clinic.  Thank you to all of you who have helped create and sustain the clinic…you helped save a baby’s life.

We will not be returning to Karero during the remainder of our time here.  We will really miss living and working with the community.  I must mention that the use of alcohol in Karero has drastically reduced, if not disappeared.  Those women really made a difference when they protested last month!  All the stores have stopped selling alcohol.  We got to spend a lot of quality time with the ladies at the clinic as well as several members of the community.  We hope we can return there again to continue to work with the community….perhaps next year to build some housing for the ladies at the clinic???  Although, the Maasai women have informed me that I should have at least two babies by now so maybe that will have to come first!  We cannot express our gratitude towards Ester, Faith, and Joyce, as well as towards the entire community for welcoming and taking care of us while we were in Karero.  We cannot begin to articulate all that we have and continue to learn.  This last trip to Karero allowed us to go deeper into the community, and I believe it is a testament to time…time spent sharing, sitting, drinking chai, and lots of time spent laughing as we were trying to communicate in different languages.   It has been the exchange of stories that, I believe, will generate the most change. Perhaps we have all gained a little more global perspective, become a little more patient with that which we initially don’t understand, and gained a little more stillness with that which feels so uncomfortable.  This is my hope.

Now, back to Kimana!  We have only about 1 month left of our journey.   I have almost completely lost track of time, so it seems bazaar to make note of that timeframe. The money has arrived for more renovations and the building of the girls’ dormitory at Oloile!  We are going to be busy organizing, building, and teaching.  Thank you again to all of you for making this journey possible.  Peace to you all!

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