Hookworm, Roundworm, Whipworm, Oh My!

So, it's official: "I'm in the shit" (copyright JNB-slash-rushmore). The project is in full swing, and day in and day out, my day is as follows: Wake up at 6:30, help with chores. Shove a tripple decker pb&j sandwich down my throat (I miss my lazy mornings of chai and chipathi!), and head off to school. By 7:45, I am coaxing young teenagers to hand over their poop. Literally. I am now at the Lwala Primary school - I had previously been at the small, new, Andingo primary school, where I thought there would be a riot if one of the little kids didn't get a sample kit - and I have started my collections with the oldest children (13-16 year olds). The allure of the Msungu has worn off a bit at Lwala since they have seen all the Msungus that come live with the ochieng's every summer - so really, I don't have much going for me. Instead, I usually get my friend Harrison (my 13 yr. friend and neighbor) to say in Dholuo "Remove your feces, bwana!" (bwana is the equivalent of man, buddy, or dude)... and everyone titters and giggles and quickly pulls their sample kits (created and designed by yours truly) out of their school uniform pockets and throws it in my handy dandy shopping bag and runs away. And that's how it goes just about every time.
Then it's off to the clinic (which is always very confusing to everyone who just greeted me as i walked to school) where I greet the 30-some-odd patients who are already inline waiting to be seen by Rose and put on my lab coat (which is so big, it's more like a lab dress) and get to work. I look at about 18 samples a day - and from 8:30 am-1:30 pm I stand hunched over our field microscope, squinting one eye closed, propping myself up on the table with my elbows, maybe holding my breath a lot. I don't break (which is baffling to the rest of the clinic staff who always - always - breaks for tea) because, let's be honest, poop waits for no one, I have to look at the samples while they are still fresh - yes, fresh.
Really, it's just like a smelly game of "Where's Waldo". There is a lot of fecal debris that resembles what you might think would be a worm or ova - but really is just a decoy. Tricky Parasites. By this time, however, I have trained my eye quite a bit so that I feel quite confident in my ability to find those suckers. And find them I do! As Antigo Montoya would say, "allow me esplain - no, there is too much - allow me sum up." These kids have got worms. I would say about 80-85% of the community has some sort of helmintic parasite - be it hookworm, ascaris lumbricoids, trichuris trichuria, or even strongyloids or even schistosomiasis (which is really hard to see)... and keep in mind, I am only doing a direct smear which is the least sensitive detection technique (but is also the cheapest and fastest) - so whatever I am finding is a decided underestimate.
Once i get through all my samples, I put together the sample kits for the next day, clean up (bleach is our friend), and stumble back down to the main house for lunch. Then it's off and running again to the school to weigh and measure a new batch of kiddos. Thankfully, Andrea (or Dr. Dre as we like to call her) has been around and has been a real savior. She helps me out with all of the weighing and measuring, sample kit preparing - and basically keeps me laughing and happy - it's a pretty great deal. She's also been a huge help at the clinic with her physical exam knowledge (which is far greater than mine) and her general craftiness. For example: thanks to Andrea and Ben (recent vandy graduate) we now have internet at the clinic (which is CRUCIAL for communications re: patient care, patient records, clinic needs etc). A computer had been donated to the clinic by a vandy undergrad - and needed to be defragmented etc and hooked up to the internet. Dre and Ben took on the job. But as soon as they opened the computer, they realized there was a password and they had no idea what it could be. Plan Foiled. They did not give up, however. Sleuths they be, they went to "password hints" and received the prompt that had been set up by the previous owner of the computer. it read: "what life is all about." In all seriousness, Dre turned to Ben and said, "Try 'love'." Needless to say, that computer is up and running, loving its new home in the solar powered clinic - where there is no running water, but I'll be damned, there is internet.
By the time we come back home, we basically sit and rest, do Jo's boot camp, help with dinner, possibly bathe (so over-rated... it's not like I'm dealing with dirty stuff all day), hang out, eat, eat, eat, and sleep. The days are quite exhausting, but also pretty great.
There is a lot of excitement about the upcoming de-worming. When I receieve consent forms returned by the children, I often find detailed questions written on the back from the parents (as such, I will be teaching a class about worms, how you get 'em, how your get rid of 'em etc). I also met a parent on the road the other day who had a number of questions for me. After answering them he thanked me profusely for what I was doing. I, in turn, proceeded to thank him, for allowing me to do what I was doing. We continued to exchange thanks (thank you... no thank you...) until we had to go our separate ways on the road. The funny thing is, this is really something all of Kenya supports - in fact, I think the government will even pay for de wormings. When I child goes to the hospital - they are automatically de-wormed. Problem is, in a place like Lwala, you don't get much attention from the government, and you don't make many trips to the big hospitals. So, instead, they get some crazy Msungu who decided to come in and look at poop for a summer. go figure.
What else? The spring has been protected! Thanks to the hardwork of some of the undergrads, Dr. Young, the Ochieng's and some very strong men and women laborers, a good chunk of the lwala community will now have fresh, uncontaminated, running spring water. That was really a big accomplishment.
The undergrads leave on Monday and morning and then Dre and I head out the following week - it's pretty crazy to imagine how fast the summer has gone. Fred has started his project and i think will really be some valuable information - he is basically conducting a study that will look at the clinic's accuracy in diagnosing malaria. Consider the following story. A 70 yr. old woman came in the other day presenting with bursts of fever, back ache, stomach ache, and mestrual spotting/missing her period. She was inititally to be treated for malaria. right. Hold the phone, but ma'am, you do not look like a 70 yr old woman. Right again. Turns out, she had a few friends lie for her and say she was 70 so that she could be seen at the clinic for free (children under 5, people over 70, HIV/AIDS, and TB patients are all seen for free- the rest pay 50 shillings - less than one american dollar). She is in point of fact, 50 years old. And she has menopause. Not malaria. I think the news came a quite a pleasing surprise, in fact. And our friend was sent home with advil, not chloroquin.
ok, so kudos to you if you've made it this far in the blog... I am very impressed. I guess I'll quit now because there is much to do in kisii today, so I think I'll head out. I miss you all like you could never understand. It has been a fantastic and challenging summer - and I am so happy that I am doing what I am doing. At the same time, I will be a very happy Msungu to be able to see you all again and explain the summer in person.
much love,
jobaby
ps: i just received confirmation that my IRB was approved... booyakasha.
pps: the fame of the msungus still has not worn off as we head past schools and homesteads on our 5.5 mile jaunt into town. They all come careening out, sprinting to the road to shake our hands. They scream Msungu, and we respond as if that were our first name. Now, however, I have started to level the playing field... and I scream back, hey! Jeretang! which means "hey black person!" (yes, this was culturally approved by Fred and Grace) - and it always gets a good laugh from the onlooking mothers and children near by.