Doc Ernie's Blog : Doc Ernie's Blog : Ernie Franz M.D. : Spinal Cord Injury, Disability, and Rehabilitation

13 July 2012 

More interesting survey details today.  Lots of ups and downs for terrain, side hill and more rugged balance challenges.  One Muslim older woman said if you urinate into a ground fissure or dried earthen crack while on your menses, then cover the fissure with earth, your uterus too will be sealed.  Another when asked about birth control methods stated that she and her husband sleep in separate beds and in different rooms, that this works for them.  However when asked to list the side effects of this method, she stated that it led to more quarreling and discontent in the home directed toward her from her husband.   We had a woman whose husband works in Nairobi, she has very high BP, which she says is due to a witch or night runner that attacks her house all night long when her husband is away.  Throwing rocks on the roof, hitting the walls, sticking fingers over the walls, between roof and walls, and running naked thru the brush when she opens the door to get a glimpse of him.  Her husband supports this story.  This, “the reason for her hypertension”.  They had 5 children, 4 have died, the one remaining lives and works elsewhere.

Another said pills work well for family planning, but when you do have a child after pills, they will be born with 10 heads.  And again a story of pills swallowed go directly (this time) to your tubes, where they remain and must surgically be removed.  Last Depo injections can “cause your heart to come out of its cage and move” to another area of your body, in this case the woman claimed her lower abdomen.  One day while coughing and pushing there, it “moved back to its cage”.

Sad case of the day was a young early 20’s woman with epilepsy, on no meds, with 3 children.  In April she seized and fell into the fire.  Her left knee still with open wounds and scarring and oozing, and difficult to walk or put any weight on it.  Her children very thin, the 8 year old girl was 16 kg and 120cm tall.  Giving a BMI in my head of 11; so sad, I shed a few tears right there for their situation.  The WHO says anything under 16 is extreme thinness.  Did not see a husband.  Nearly empty home still under construction.

Last, I had fun with Carlton, an 18month old kid.  His mom said I was the first Mzungu he has ever seen in his life.  We kicked a soccer ball (old plastic bags rolled into a ball) around for a bit.  He would take a running start to kick the ball, very funny to watch.  He is a talented kid!  Well I am tired, falling asleep now while trying to type.  One half day of surveying left. 

14 July 2012

At breakfast Dr. Omoto asked me to preach for 40 minutes Sunday!  Oh boy, a bit of panic – but how can I refuse?  So prepping for that as I can.  Last ½ day of surveying went fine, hitting over 355 households in total for the 4.5 days.   Dinner had the usual amazing layout of foods.  Again, the staff washed our clothes, ironed them, folded; shoes all scrubbed and washed to an amazing level of cleanliness.  My Keens done 3 times for extreme mud; but they take their job seriously and work on anything. 

15 July 2012

Preached on Psalm 133:1 and 2 Corinthians 4.  Community.  Tied in Dietrich Bonhoeffer’s words from the Service chapter of Life Together.  Spoke to our efforts to establish community in Khwisero and Miwani areas, with the challenges of sharing the gospel and scripture and praying for those in our communities.  By surveying their health and beliefs and lives, we have had a glimpse into the life of those who are suffering and who, like us, as jars of clay – fragile vessels, may find ourselves suffering at any moment.  However this drives us to God who gives us hope, if of nothing else, of eternal life when we are released from this life.  In the meantime we can be of service to those in our community who are broken and in despair.

Omoto’s church was nice, great singing and perhaps Pentecostal?  At the end of nearly every song they all moved into spoken prayers – since I cannot understand the language it sounds like fervent prayer offered in tongues, but could be a mix of Swahili, Luo and Luhya.  Gradually these prayers would fade and another song begun. 

Again a wonderful meal at Omoto’s.  Photos taken.  Goodbyes said.

Sylvester drove us back home to Nehemiah in just under 2 hours.  Looking forward to going home which will begin tomorrow,  16 July 2012!

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11 July 2012

Matt had a rough night, staying back today.  He was better by the afternoon, and even better tonight. 

Survey went well.  Lilian (one of the head nurses from Siaya District Hospital), a Community Health Worker (CHW) also named Helen, and myself tagging along.  In Khwisero, the town of Ebushybungo, with nice people and yet quite poor.  We are now at 127 households done in 2 days.  Welcomed nicely throughout.  Most with mud walls, floors and tin roofs.  None with electricity, a few with car batteries to operate radios.  Some elderly.  A few with hypertension.  Lots of missing teeth, some TNTC (too numerous to count) – or better yet to count those present – as in the case of the 86 yo man with 4 teeth present.  We did roughly 16 homes.  One woman worried if you cough hard you might dislodge your IUD and have it move to your heart. 

Lexi on a roll tonight with her language and stories.  She had one wedding proposal today, as noted, to be his first wife!  How kind, and such an honor.  At dinner she had Omoto and his staff in stitches sometimes with her mix of Luhya or Luo or Swahili.  Later a huge bug flew into dinner, after it passed over all of us, Lexi calmly swatted it from the air, and picked it up barehanded from the ground to show us the very large dung beetle.  Matt, scared of all insects, was impressed as Lexi strode out the room to toss it back outside.  Omoto quite impressed too, he could hardly believe a Mzungu would take on a dung beetle in such a manner. 

Times like these, and you think no problem, I could come back and jump into the efforts here.  Then other times like this past Monday thinking, What am I doing here! What was I thinking?!  It will be nice to be home!  So some major ups and downs – but today was very very good.  Ended with prayer and singing – after an amazing meal of rice, green grams, avocado, greens, ugali.  The avocado the best I have ever tasted, by far!!  Texture and flavor – WOW.  And the price in Kenya is typically 5 to 15 shillings at most (that is roughly 7 to 22 cents).   

12 July 2012

Survey day.  Matt much better!  He slept solid.  All is well mostly, the imminent feeling of impending malaria fading a bit.  Somehow during the night I spilled some urine out of the urinal onto myself, my shirt and bedding.  Argh!  Thinking I would shower off in the morning, but no power and just as I am wondering what to do, the gentle knock on the door of “warm water at your door.”   Amazing.  Finishing up my morning routine, 40 minutes went by before I would access the warm water.  No wash cloth, decided to strip and pour some over me with a 3 liter water pitcher.  Mistake.  The water was intensely hot!  Still, now 10 hours later my skin is burning, but no sign of burns.  It hurts though.  On top of that the cracked toilet seat (yes, even at Dr. Omoto's guest quarters) managed to inflict a 2-3 inch long superficial laceration to my thigh this morning; no pain as I have little to no sensation there, but still not good to get up from the seat and find a bloody surface.  Oh well, the ups and downs continue.

Surveying went smoothly, though I bonked for some of it – needing food and/or water.  Made it till 4 pm.  Some interesting cases though.   One lady 170/120 for BP.  Stopped her Nifedipine 3 months ago due to the cost of 250 KSH ($3 USD) every 2 weeks.  No money to afford it.  She has been having chest pain and palpitations recently.   The next home we visited had an 18 year old with a history of seizures.  No sooner had we entered than she went into a classic grand mal seizure.  Her mother restraining her through the tonic-clonic phase then released her to be postictal.  About 15 minutes of slowly becoming more arousable, and she was soon up.  The mom said they had tried phenobarbital and what I later discovered was Dilantin, both without success.  So they gave up.  Not even sure she ever hit therapeutic doses of each.  She is quite talented with crochet, having knit many items quite precisely – a table runner, pillow covers and decorative items.  She apparently seizes 6-10 times per day.  I wrote out a list of other possible medications to try (Tegretol, Neurontin, Lamictal, Depakote) and we encouraged them to pursue care again.  Next we had a 22 year old with what first looked like a dense cataract (in the dark of her home), but outside it was actually a corneal scar near the central visual axis that she had for 5 years.  Perhaps scaring from infection, an ulcer or trauma?  It was only about 4 mm in diameter and solid white. 

Traditions.  Learning lots of these, and myths too, or perhaps "urban myths, or legends".  Many Kenyan women, who are close to getting married, have their lower front 6 teeth broken out?!  This as a sign of a marital commitment.  No numbing, just trauma to break them out as proof “she is tough enough to be an adult woman”.  Fortunately this practice may be declining as we saw this more commonly in women over 40, but not usually in the yonger.  Birth planning, and complications of contraception were always interesting parts of the survey.  IUD’s can apparently travel to the heart, where they are a cause of persistent coughing as one tries to bring it up.  Depo is preferred by many women, as their husband cannot detect that they have had a shot and then not be upset.  Apparently many who use pills have to argue with their husbands who can see they are trying to not have children.  Another said she did not like taking pills because they will go to the uterus when swallowed and cause it to be blocked, once enough pills are taken, and you will need surgery to remove the blockage.  One other felt a part of a condom would be left inside the vagina, and this too will block later attempts to get pregnant.  One man commented he does not like the IUD because during sexual intercourse he feels it and it hurts him.    Another woman, whose husband’s testicles never descended, had been unable to get pregnant, so she had a child by another man.  But in the meantime her husband learned the cause of his impotence, and he knows the child is not his.  He was furious.  Beyond this we have two unusual practices.  Wife-inheritance and polygamy – both common.  If a husband dies, his wife is inherited by his brother next in-line, if he wants her.  If he does not, the option goes to the net male in line.  If she is not chosen, then she is considered “shamed”, and is to stay out of public view as much as possible (not going to market, or even to be seen outdoors in the garden is bad luck to other men who might cast eyes upon her). And beyond that, polygamy is common, especially if the woman cannot bear a husband a son.  We saw several cases of the man and his wives all living in the same compound, just not under the same roof.  One of them commented for birth control he “just senses when one wife is ripe for conception”, so he “runs” to the other wife’s home during those times.  I cannot believe the women put up with this!  Soon, though not soon enough, perhaps they will stand up for their rights and things will begin to change.  When both polygamy and wife inheritance are gone it will impact HIV/AIDS transmission; but even beyond that, women need to be more respected, given a voice and an ability to generate their own livelihood/income.

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9 July 2012

Siaya, and needing to vent a little bit.  All is mostly well, at least thankfully I am doing okay. 

Admittedly some fear since Matt developed malaria while taking Doxycycline.  He is sure he has been faithful about it, perhaps one dose  taken 10 hours late.  Anyway about 40 hours ago he developed teeth chattering chills, sweats and fever, with nausea and extreme weakness.  Wiped out, awful feeling.  No appetite.  Decided to start him on the Coartem that I had bought on my last trip here.   So far all is well, he is doing much better.  A fast response to the meds.

Though I am fearful of what is to perhaps come for the rest of us.  All others also on Doxycycline 100 mg once per day.  So a bit disappointed to see it may not be the 99% effective drug I thought it was.  That and now 48 hours ago I got at least 15 bites while watching Sherlock Holmes with the gang in the coach house.  Feeling like the more bites I get, the more at risk I am – which is quite true.

NOTE: I did later happen upon a meta-analysis which stated Doxy is 92-96% effective; still is that per person or per single bite?

The lectures today to the “medical students” went well, though honestly the students were actually the equivalent of graduate level nursing students.  So needed to flex a bit to talk at a slightly lower level, nonetheless all seemed to be well received.  One more day of lectures, then onto Mundeko and Khwisero to work with the survey in that area.  The 3 girls will start there tomorrow, after they spent the day observing at Siaya District Hospital.

My hotel room is pretty funky.   Not quite as pictured on the internet!  Two light bulbs, one of which is out often – that is, when we have power to notice it is out.  Power out today for a while after a thunderstorm.  No internet.  No mirror anywhere, so hard to shave or groom.  Sink does not work at all.   Unable to wash except in the shower.  The previously used sink “soaps” are actually broken chunks of the deodorizing blocks of crystals they toss into the base of urinals.  Toilet leaks onto the floor.  Shower basin does not drain at all, unless the water gets high enough (as the drain is the well established high point of the shower floor itself), even so leaving 1-2 inches of water in the basin.   My mosquito net seems effective thank goodness, though barely reaches to the edge of the mattress.  My pillow stuffed with bubble wrap for firm support!  Toilet seat badly cracked with chunks of plastic missing, it threatens to completely come apart every time I sit down.  Just a few of the challenges for me!!  Lord grant me patience, a sense humor and continued health measured with gratitude for what I have.

Tired and off to bed, hoping that no chills and fever await.  My headache through the day was helped for a brief time by a Tusker beer, but quickly returned and again in the night with Tylenol 1.0 gram just taking a tiny edge off.  I think this is a caffeine withdrawal headache – no coffee or caffeine since Sunday morning, it is now 36 hours later.  Wow, it is bad – I am really surprised and annoyed at how bad it is.  Were I home, besides getting shots of espresso, I would be in bed.   But this is Siaya, and there are lectures to give shortly.

  10 July 2012

For breakfast at the Mwisho went for freeze dried Nescafe (my Dad’s old standby!).  Two packets in a ½ cup of hot water and I began to feel some life infusing back into my veins.  Two more, and even a bit more life and the incessant headache began to fade!  This was the medicine I needed.  So again once more, 2 more packets before lecturing and I was running on nearly four cylinders.  Shortly thereafter the headache gone – and still gone, Hallelujah! 

Observed the Physiotherapy department and took several photos.  They have so little equipment, very battered and falling apart at the seams (literally, the medicine balls were splitting apart at the stitched seams).  They could use Pilate’s balls, my Body-Blade, any hand exercises, weights, almost anything.  They are hoping for a massager, a TENS unit and more.  To fix their exercise bicycle they need a new seat, clamp assembly and quick release lever for seatpost adjustment.

Still the ER has no monitor, no EKG machine, no defibrillator.  And this, a 220 bed hospital.  In fact, no defibrillator for the entire hospital, ER, OR nor anywhere!

The beautiful African Clinical Officer (CO) who was evaluating children did not examine them, or barely so.  Hannah described her as “modeling gorgeous”, and Matt as “the most beautiful African he has seen anywhere, anytime”.  She was mostly taking a brief history and reviewing some lab tests for malaria.  Sometimes would look at the conjunctiva as she reached across the desk, but no stethoscope and generally “hands off”.  Otherwise asking the mother a few questions and even with the Electronic Medical Record (EMR), minimal documentation.  That, and she, was working for free!  Finished with school, she cannot get a job apparently that pays, so just volunteers and sees 150-200 patients per day.  My favorite new chief complaint by mothers for their children?  HOB = “Hotness of Body”.   Reserving “fever” for documented temperature elevation.

Lectures today went so much better!  Mostly because I was not too hot, and the headache was gone!!  The students seemed quite attentive, and had worked on their learning objectives as well regarding some DKA treatment.  My last lecture was on the trauma I experienced and a changed life.  For some reason I struggled through it emotionally in several spots; which really surprised me.  When finished they were really gracious and kind with comments.  I heard a few sniffles too.  The elder stateswoman nurse for them pronounced a wonderful blessing over me, and said we can see you are a Christian, that God has spared you for His purpose and work, and we pray a blessing upon you and your efforts.  The kind words washed over me and were amazing, all making it worth any effort I had put forth.  Then she asked one of the other Sisters to pray for me, they all stood and insisted I sit down and the prayer in Luo or Luhya was emphatically prayed.  Several were very sweet.

After observing the aforementioned striking CO Helen, we went to Dr. Omoto’s home where they have been without power for 24 hours.  Shortly thereafter hit with a prolonged thunderstorm, we discussed the day over Chai tea with Matt feeling worse by the minute.  Finally in darkness the girls returned.  More Chai and then a great dinner of cabbage, chicken, rice, chipati, and broth.  Matt off to bed with no dinner accompanied by shaking chills, and yet only one dose away from completing his malaria meds.  Walked back the 300 yards from Omoto’s to our room with thick red clay stuck to my Keens, so much that walking became very difficult.  Only then to find Matt soon having prolonged vomiting and diarrhea and thankfully he could use my headlamp to aim both!  So in the dark, he was wretching, bundled up with shaking chills and V&D.  Ugh!  Hopefully he will make a quick turnaround tomorrow.

So highs and lows both.  Such is life.  Glad I could share my life and information with the graduate nursing students; yet feeling bad for Matt and praying for a quick recovery.  Tonight not feeling so anxious about impending malaria, but will see what the new day brings tomorrow, hopefully power for a start!

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 Sorry that this update has taken so long to post.  Excuses, excuses...... too busy, no power, or power and no internet, traveling, or recovering from travel, or (now home) too preoccupied with catching up on life.  Enough of that - here goes.

The preliminary survey in the Miwani area covered a total of 3 days, and in total we saw 157 households.  We were kindly received and all went well.  Many surprises, and some concerns for certain.  We will all know more once the numbers are analyzed.  Though I participated in day one of the survey, the other areas our teams covered were too far a distance for me to cover on foot (some were close to 10 miles roundtrip).  For the most part everyone walked, yet there were a few instances of hitching a ride in a passing truck or hiring piki-piki's (motorcycles - despite prior agreement not to do so from those I am responsible to "supervise").  Thankfully - all went well.

Saturday July 7 saw the 4 Mzungu's hike to Nandi rock and into Nandi itself.  They were gone all day and tired that eve, but not too much so to still watch Sherlock Holmes.  With my impaired sensation I managed to get 15 mosquito bites during the movie, not feeling them attacking my exposed flesh.  Still I figured I was "covered" by my Doxycycline, or so I thought....   more on that thought soon.

Sunday July 8 and we will as a team be headed to Siaya and Siaya District Hospital.  Two days of teaching at the hospital, and observing their Emergency Department before we head off to survey the Khwisero area with Community Health Workers.  Overall I have been feeling very good, many days thinking I could do this long term and without difficulty - other than my usual accommodations. 

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