The Project Has begun!

Well, since I last wrote, it has been a big couple of days. We have all been quite busy - running around, traveling between the clinic, kisii, kisumu, and back. The vandy undergrads have been quite busy teaching classes at Lwala Primary School, starting up the spring protection (they are protecting a local spring where about 200 people go to get water multiple times a day), workng with the women's group and helping with the clinic. Andrea has been at the clinic every morning, and then helps me (bless her heart) in the afternoons. I have started my project (more to follow) and Dr. Bill has been doing it all, overseeing everything and taking house calls as well. And ya wa tho, we have seen a lot.
The first was the man who had been to the clinic when we first arrived, insisting that the Msungus (kate and I) amputate his foot. He had some pretty severe pitting edema in both feet/ankles (which we suspect might be from Diabetes - tough to imagine managing such a disease in such a setting as Lwala)... and had gotten "pricked by a small stick" which currently stands as a complete circumferential avascular necrosis ulcer that wraps around his entire enkle, spanning about 4-5 inches. It was by far the most gruesome wound I had ever seen. Andrea and I gloved up and helped DR. Young clean out the wound and redress the bandage. I think our patient was so appreciative of Dr. Young's attentiveness, despite his pain and limp, he walked on out of that clinic with a huge smile. he now returns everyday for proper wound redressings and debridement - and we plan to take him to kisii on monday to go the hospital for consultation on what can be done (which may have to be amputation).
Our presence in the village/at the clinic is quite tricky. Dr. Young can both make the decision and the pay the bill to take someone to kisii, but what happens after we leave. The clinic doesn't have an ambulence - and recently, we have just been using Omundi for emergency travel. For example:
The other night while I was helping to make chipati in the kitchen, a man stopped by to speak with fred. Not knowing what he wanted, we invited him in, made small talk, etc for about 15 minutes - until we finally realized that he was here because he had been bitten by a snake... wulalalalalalalao. So polite and cordial, smiling, even, while he felt the poison climbing up his leg. We consulted a favorite book (where there is no doctor) - b/c doctor young - as great as he is - doesn't deal with many snake bites in the OBGYN dept's of NH. We knew he needed to get to kisii for antivenom (about 1.25 hour drive) - but it was dark, and late at night - every kenyan agreed that it wasn't a good idea. So we had to wait. So we did, and by the next day, his entire leg was swollen - we brought him to the hospital - and found a great physician who was quite helpful... and our man was admitted over night and seems to be doing well... had we waited any longer, however, he probably would not have made it, says the kenyan Doc.
And then just yesterday, a small child came to the clinic with his mother. The motehr says the boy is 4, but he looks about 2. Why were they there? This small, sweet little child, had rectal prolapse (for those not in the medical field - slash - those who have not taken first year anatomy, this when the rectal canal litterally collapses outside of the body... basically an inside out rectum .. now on the outside. It can be do to congenital defects or often, malnutrition.) He had had it since february. Rose tried to replace the rectum, but it was not feasible. So off to Kisii they went, courtesy of Omundi's Ambulence - and luckily, with the help of some valium, the rectum was replaced - and we hoped, soon to be fixed.
It has been an intense couple of days.
Also augmented by the fact that I started my project. On thursday morning, I arrived at the Andingo school (a small, recently built school of 100 children) - to pick up the poop. The teachers weren't there yet, so what else is there to do with 100 children who don't speak english? why you sing of course. That's right, The Princess Pat has made it to yet another african country - and is now sung daily - sometimes twice daily - and usually upon request. In fact, now when i arrive, a small child rings a very large bell - and all the children come running from their homes, the cornfields, the class rooms, and we sing. It's quite the image. For the past 2 days, I have had 100% compliance in poop deliveries whch is really quite incredible - when you think abuot how long it normally takes to even get a urine sample for a research study back in the states... I look at abuot 20-30 samples per morning - and it is very long, smelly, and tiring. We use field microscopes - which only have one eye piece and use a mirror and sunlight for light (the ligth microscope has not been used because the solar power has been out due to lack of adequate sun).. we don't have chairs yet, either - so we stand over the scope, cover one eye, hold our breath - and watch the worms swim by. Litterally. Most of the time, we see a lot of Ascaris lumbricoides (round worm) eggs - and a lot of things that look like they could be something - but probably are not - and my untrained eyes are just fooling me. We've seen one case of whipworm, 2 of hook worm, and a handfull of larvae that actually swim and curl across the screen (difficult to identify, but is almost certainly either strongyloides or hookworm).
We are only using a direct smear/wet mount technique which is not very sensitive - and means that I am probably missing a lot of cases. Out of the 50 kids I have looked at, I can say that probably 70% of them have some sort of intestinal parasite infection - and bare in mind, that's an underestimate.
I keep referring to "we" because i have had company in my little lab. A woman named Yunice who has been asking to vollunteer as a lab tech since we arrived. Apparently she has 3 years of schooling as a lab tech, and 4 years of experience. She wants to work very very badly, and is obviously willing to do a lot in order to do so (she looks at poop with me from 8 am till 2 pm)
The problem is, I am the one who ends up teaching her - and that is just wrong in so many ways. I am really not experienced enough to do so. I would love to have her train and get better, but I am not the person to be doing that training. It's sort of stressful, because i think she takes my word as solid gold when really what I am saying is "i think this is hookworm"... it's yet another case of the best intentions with quite inadequate training. It's very sad - and very frustrating.
A little hope (and more despair) was shed on the situation when I spoke to a real poopologist from Wash U who is based in Nairobi... Ilal Kanye, Dr. Jud! This guy knew everything - and is very eager to help - and has even offered to send me an experienced lab tech from nairobi to work with me for the next two weeks. It's no guarentee, but it is a hope. Talking to Dr. Jud was great - but also a little discouraging in that I realized how insensitive my direct smear technique is (I was doing only the direct smear to save on time and because that's what all the kenyan hospitals do - but apparently, that is quite inadequate). You'll really know the level of helminth infection if you do up to three different techniques on each sample - but unfortunately, I don't have the time or the money or the facilities to do all that. Wulalalalalalalo.
So hopefully, I'll be talking to Dr. Jud again today before he leaves town for a bit and we'll see what the reality is of the next three weeks - good lawd - three weeks and so many poops samples! The good news is, I am detecting worms/ova/parasites - at some level - period. So we know the de-worming will be useful and effective. The frustrating news is that I could (apparently) be doing it a lot better. The good news is I am showing hundreds of children and their schools and their parents that their health is a priority to us and the clinic.
So that's about where i stand. It's hard to write it all down - and we really are quite busy these days. We get up at 6:30 to help with chores (mopping, sweeping, dishes, breakfast making), then I head to the school, sing a song or two, collect samples, analyze them on our little field scopes till about 2 pm, scarf down lunch, head to the other school to weigh and measure kiddos there (though the teachers there were so excited they wanted to be weighed as well... and... sigh... they broke my scale!) then come home, get water from the water pump, help cook dinner (see this. Jobaby with a knife the size of her face peeling little bitty potatoes by candlelight, while passer bys grab her head and twist it around to check out her braids... the novelty has yet to wear off). and then we eat like kings (kate, everyone now knows to get the Blue Band butter out for me... and the salt too. But it's cool, apparently blueband is now rich in Vit A! No wonder these kenyans have such good night vision) - and i fall asleep sitting up ... then we pass out under a canopy of mosquito nets. it's pretty great.
so on that note, I must go... we have the whole crew in town (including dada, harison, and Anyango - who never come to kisii - and saw a mirror for the first time while they were here) - so a giant size plate of chips (french fries) is calling my name.
Abiro Nenu,
and much much love,
Jobaby