My Luo name is Akinyi. It means baby girl born in the morning.
Our days under the tent are numbered. The cloth tape that has secured the plastic diaphragm to my stethoscope is becoming frayed at the edges.
I lost the rubber ring that seals it together in India four weeks ago.
Dave convinced me to spend another morning rounding on patients. I am not quite sure how he managed to do so- seventeen months and counting on the wards seems more than enough.
Nonetheless, we rounded with 2 other doctors this time, making the experience much more rewarding. But the cases we saw were not any less tragic.
As we walked from bed to bed, thumbing through the paper charts that vaguely resembled the blue exam books we used in college, a woman in the corner began make grunting noises and banging her right arm against the mattress repetitively. She was clearly having a seizure. The doctors we were with didn’t bat an eye.
Her forlorn husband used her paper chart to fan her and swat the flies away from her face.
She was still seizing by the time we got to her bed. I asked about rectal diazepam or any IV benzodiazepine to use as needed.
They didn’t have any in stock. She was receiving IV phenobarb daily.
“She now has stage 3 bedsores. I am afraid that is what will eventually put her down.”
She at various points in the last 2 weeks had been treated for crypto and toxo and now they were considering giving her anti-TB treatment and steroids. And in the end what may kill her is becoming septic from her bedsores.
One of the medical officers suggested “home care,” or hospice. In the end they knew that the husband would not agree.
Some things are not any different at all.
We spent a total of 4 hours seeing 30-40 female patients on 20 beds, often in pairs as many women shared the twin size mattresses. I learned that when antimalarials failed to break a fever or if the smear was negative, the next course of action was to check titers for Brucella, in addition to Typhoid, though the titers for the latter are often not very specific. Blood cultures are the gold standard to diagnose both, but those are not readily available of course.
Pneumonias are treated with “x-pen and gent” or crystalline penicillin and gentamicin. Diarrheal illnesses are treated with chloramphenicol and metronidazole. With the exception of metronidazole and penicillin, none of these drugs are ones we use in the states given their side effects and sometimes irreversible toxicities.
The patients with psychiatric illnesses are not separated from those with medical illnesses. Schizophrenia is not uncommon.
One young 14 year-old girl was admitted for chronic abdominal pain that she seemed to develop right around exam time; Julie, one of the doctors, kindly asked her questions about abuse at home and at school, both of which she denied. In the end they decided she was clinically depressed.
One of the last patients we saw suffered from TB lymphadenitis and chronic anemia, with a hemoglobin of 7.5. (Normal values are above 12.) She was also diagnosed with “somatoform disorder” because she had a habit of “complaining about everything” and asking for blood transfusions daily.
If only those doctors knew how good they had it.
At the end of rounds we quickly wrote up several discharge summaries and then proceeded to draw blood from several patients; the nurses and lab technicians were having some dispute over lab draws so the medical officers had to take it into their own hands.
The women in my life have a habit of burying the name of a God or a Saint in their sigh. It sounds like an exasperated plea, but in reality it is just an acknowledgement of The Way Things Are. An acceptance of sorts.
And so I find myself frequently sighing “Ai, Ramarama,” just as I have heard my mother do so nearly every day for the last 30 years.
*
Acres of sugarcane surround our home in Rongo. The house itself clearly was once beautiful, but years of neglect have worn it down. Brown water stains grow ominously on our plastered walls, windows with a few panels of cracked glass are constantly left ajar letting a number of winged creatures gravitate towards the lights in our living room, in spite of our vain attempts at shutting them closed with waxy dental floss. On our front lawn sheep and chickens and sometimes cows lazily graze and peck on wet grass and rarely seek shelter, even when sheets of rain pour heavily down.
There are a few empty plastic bottles and aluminum chip bags scattered around, sullying the otherwise breathtaking pastures.
We lose power almost nightly. Sometimes the blackouts last the entire night, well into the next morning and so we walk around our house with our headlamps until it is time to crawl under our mosquito nets. On several occasions we were told that the blackouts were not limited to our district- it seemed that the whole country had been affected, as there are a handful of power supplies that provide electricity for the entire nation.
Only once have we run out of running water, when the tank across the lawn was likely empty. So we washed our hands in the rain.
We read voraciously and browse the internet longingly. The last few nights we decided to complete a few of the Chronicle’s online crosswords. It is the only game that Dave and I have ever played where we were not competing….probably because neither one of us is very good at them. It is a good thing that the New York Times crosswords cost money, sparing us some embarrassment over our general ineptitude.
Time has passed by.
To think that we had arrived here less than four weeks ago. It was dark, we had spent hours on many a backroad from Kisumu to Rongo, a vain attempt to shorten the drive.
We had no idea where we were.
I feel so sad to leave. It is a chronic problem with me.
*
We spent the last weekend in Kisumu. I woke up at 4am on Sunday morning because my allergies there were terrible. I was hoping the Benadryl would kick in soon, but in the meanwhile, I checked out the Big Game scoreboard online. Dave woke up not long after to watch the last ten minutes.
Outside, the roosters crowed heralding dawn and the guard dogs howled in response, signaling the end of the night and their shift.
The morning’s cantata opened with the pure singular intonation of the local imam, calling all to prayer.
I soon heard several cars honking on the otherwise quiet streets of Milimani. I walked out onto the balcony of the flat and saw several fancy cars filled with Aunties and Uncles, one of which was decorated in marigolds and chrysanthamums. It was not the kind of Indian wedding party I was accustomed to. I tried hard to spot the bride and groom, but the cars were packed full, matatu style.
Later in the day, we had lunch at a local ex-pat hangout where we noticed several Indian men walk in, their foreheads anointed with fresh red kumkum. They had clearly just come from temple. They sat down, lit cigarettes and ordered cold Tusker, a Kenyan lager, on this day of rest.
Dave and I ourselves toasted our Cal victory with a Tusker malt and a Savannah cider from Stellenbosch, South Africa. (The socially responsible South Africans made it a point of labeling the cider with a warning: “Alcoholism is dangerous to your health.”)
Go Bears.
*
And now time to wax poetically, as if I haven’t done so enough. We leave Nairobi on Thanksgiving.
There are a few things in my life that cause me enormous happiness and gratitude.
Running by large bodies of water. There is nothing like feeling the soft land fall swiftly beneath your feet as you breeze past the Bay or the Hudson, and the promise of the Bridge looming large ahead of you…and then safely behind you. It is the only run I allow that is not a loop. There and back.
Driving across the Bridge. Take your pick- The Bay, Golden Gate, Tappan Zee, GW. I really don’t know what it is. Part of it may be the sheer expanse, the feeling of being suspended over water, the gentle bob of the cables and the constant movement.
But the other part of it may be the excitement of experiencing something new.
And the promise of returning home.
Asante sana and Erok Amano to all of you in my life. You continue to inspire me every day and I am grateful.
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