Doc Ernie's Blog

Kenya June/July Update #5

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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Ernie Franz, MD | Bainbridge Island, WA 98110