An African sunrise drinking sweet chai (tea) looking out over the dusty drought-stricken landscape. To the left a passing giraffe and herd of zebra, to the right a bright yellow land rover with big letters saying “MOBILE CLINIC, Reproductive health, HIV/AIDS Mobile VCT” loaded to the brim with tents, medicines, testing kits, gloves, and lots of condoms. As you drink your tea and have your breakfast some wandering herdsmen come by, one with complaint of what turns out to be a fulminant prostatitis (previous week diagnosed as malaria), vertebral collapse due to spinal tuberculosis or malaria.
As you finish up with the first patients of the day the car is started up, sputtering against the nippy morning air, and the four manned team hops on their yellow chariot to putter along dusty pot-holed dirt roads to the destination of the day, passing by herds of elephant and buffalo and scaring away warthogs as we hobble past. After an hour or so as the destination is approached (this may be a school building, a shack or an acacia tree providing slight shade from the merciless blistering sun), the driver hoots his horn to inform the people living in surrounding villages that the clinic has arrived. As the car is unloaded and the tables set up people from different tribes (mostly Samburu and Turkana – often still wearing traditional dress and beads) pop out from their manyatta’s (homesteads) and from behind bushes with babies, young children, grandmothers and sisters all needing what the clinic has to offer. And that is how a usual day starts for me these days with the mobile clinic.
These past weeks have been the most amazing experiences. I have seen so much, learnt so much, done so much, and my eyes have been opened to so many things. I would not want to be doing anything else at the moment. Let me start with some things that I have learned.
- When the car is stopped by a passing car and they ask for biscuits-they in fact do not want cookies-they are asking for a box of condoms. We hand these out for free to anyone who wants them.
- Do not take your stethoscope when you need to go behind a bush or to a long drop toilet. It is bound to fall off.
No, but in all seriousness it has been a great experience. We’ve been to a lot of different places already. We often set out from base for a four-five day camping trip to reach different far and remote places. Then we come back for one night to restock our vehicle, and then head out the next day for another trip to a different area.
We usually start the day with immunizations (BCG, Polio, Pentavalent, Measles) and there may be up to thirty babies needing vaccines. While doing this we usually test the mother’s HIV status and inform them about family planning methods as well as HIV. People out here have babies from as young as fourteen (completely normal for here) until the age where they are no longer fertile. It’s therefore no surprise to see a mother who just gave birth to child number nine, or a nineteen year old giving birth to child number three. Of course all these kids need to be fed. And all the boys later want lots of cattle and a lot of grazing land, all of which the family and the country cannot supply for the ever-growing population. So we educate them about Family Planning. The men are often against Family Planning, so the women come secretly for a three month or three/five year contraceptive implant, because they fear being beaten by their husbands. Husbands here ‘buy’ the right to beat their wives when they pay their dowry. So I’ve become expert in backseat Implanon implants. This basically means that I hop into the back of the car with a woman to proceed to stick a very large needle in her arm, to put a chip in her arm so that she will not get pregnant for three or five years.
After the immunization and Family Planning we see the sick people. Mostly its diarrhea, dysentery, typhoid, coughs, colds, STDs and pneumonia’s. There are also really septic wounds and panga (huge knife) cuts. This all happens in Kiswahili by the way so my comprehension is improving steadily but I still need help with translations (a locum nurse assists me with this) One of the most difficult things (funny enough) is actually recording all the complaints in this big book that we have because a) there’s not a lot of space on our tables, and b) I have to write down the names which is problematic for various reasons: the L’s here are pronounced as R’s and everyone has very long complicated names that are pronounced super fast. One of my favorites turned out (in my writing) as Nteregwe Lekawaraborot pronounced in naught-point-two seconds flat. I was very happy when the next person was called Grace!
We also see to pregnant women and a lot of HIV-positive patients. The day before yesterday I was seeing to a young girl (16) and her baby. Both were sick. In the middle of my questions, I get passed a small note by the head nurse saying, “The mother is ‘positive’, check the child” - both were positive, so sad … and she also had a three year old at home.
So most of my days pass like that busy busy busy and hot hot hot! One of my most exciting and busy days was when we went to a post-tribal-battle zone. Three days before two tribes had fought over grazing land and cattle and at least thirty seven people had been killed (a lot of women and children and cattle). A mass grave had been dug for the many deceased people but there were apparently still several bodies lying out in the plains that had not yet been buried and the place was littered with decaying cows. It was pretty intense to go there. Their mud-huts had been destroyed so people had to sleep outside in the cold and the wind at night. There wasn’t any clean water around either so we treated a lot of typhoid/amoebiasis and dehydration.
Like I said it has been a fantastic experience so far!! I have seen a lot more that I can write about at the moment and I can only imagine more is on the way. I have one more four to five days clinic before I head out on the camel-clinics – this entails a month of walking through the bush I can’t wait!