Friday Clinic

I woke up with the idyllic rooster call and sunshine peeped through the window of my mud hut. It was Friday and just one more clinic day stood between me and a relaxing weekend. I stepped outside, took a deep breath of fresh Kenyan air and I saw Paulette sitting near my hut, enjoying her breakfast.

“Don’t look to your right,” she says.

“Okay, I won’t…. why?”  My curiosity got the best of me.

“They’re slaughtering a cow right outside your hut.”

Aside from my rough start to the morning, I was excited to experience another day of clinic outside of Bungoma, Kenya. Dr. Keith Scott announced to us that some of us needed to leave for clinic early. I volunteered and piled into a vehicle with the other early birds and we took off for clinic which was located one hour away.

Our final destination was a small mud-building with a tin roof. We found out that it was the village’s church. A lady and a gaggle of small children meandered out of the church to see what was going on. As we poured out of the vehicle, some of the little kids acted a bit terrified of us. I even heard some of them crying. I guess they don’t see wzungu, whites, very often.

We checked out the building and realized it was just too small for our clinic and there was no shade outside so we couldn’t work outdoors, either.  Some of the locals told us of a better location just a little way down the dirt road. I grabbed my belongings and Marcy helped me pass candy out to the children as we headed to our next location.

A man led us to a green yard with a nice house and a canopy of trees. We were told that this house belonged to the pastor of the church.  We began setting up our clinic stations and the pharmacy.  I found a nice shady patch, grabbed a translator and was ready to get clinic started.

My first patient was a 3 year old boy. I recognized him as one of the children from the small church. He had a patch of impetigo on his upper lip.  His little nose was running onto the impetigo and he had flies crawling on his face. I grabbed wet wipes, Hibiclens and triple antibiotic ointment and got to work. The little boy stood there, quietly, while I scrubbed his face. I even cleaned the parts of his face that weren’t affected since I didn’t want flies to walk over the impetigo. When I was done, I gave him some candy and toys and sent him on his way.

My next few patients were a smattering of the usual: osteoarthritis, GERD, untreated hypertension. A mom brought in a 5 year old girl for tinea capitis (tinea = ring worm, capitis = of the head). The little girl’s younger brother was so scared of me that he buried his face in his mom’s chest and wouldn’t even look at me. I tried to offer him some candy so that he might not be afraid, but he was hanging on to his mom for dear life.

The LSU medical team began wrapping up clinic a bit earlier than usual since many people were leaving for the United States the next day and needed to pack. Right when I was about to start getting my things together, a mother walks up with her four young children. My translator, Ellah, who is also a Kenyan physician, gave me a pleading look that said, “Please don’t leave me!”, so I asked Mary Katherine and Mama Joyce if it was okay for me to stay behind. They said it was fine, and thus began the most overwhelming afternoon of my life.

Once all of the LSU wzungu left the clinic, the only medically trained people left were Ellah and Edward (Kenyan physicians), Karen (Kenyan nurse) and myself. Ellah eventually found another interpreter for me so that she could start her own clinic station and we could get through the patients more efficiently.

I still had to examine and manage the mom and her four children that arrived at my station. The first child I examined was an 8-year-old boy who had a history of complex partial seizures ever since he had meningitis when he was 2 years old. We cannot treat chronic seizure disorders from our clinics since we cannot follow-up with our patients, so I explained to the mother that she needed to take her son to a hospital or clinic so that he could be treated and followed for his disorder. As good measure, I decided to listen to the boy’s heart. I was startled when I heard a systolic murmur. It was loud and clear. Panic ran through me: I could hear Dr. Kiel’s voice in my head, asking me what might be causing this boy’s heart murmur. Unfortunately, my mind was blank. I also didn’t have any American doctors to consult anymore since they had long since left clinic. I started to get more history on the boy including his activity levels and any history of syncope. I felt horrible that there was nothing I could do for him at clinic (even if the American doctors were still there), and I knew that if we were in the US, we’d get an echocardiogram on this patient to find the cause of the murmur. Unfortunately, we were not in the US and this family had very little money. So I told the mom that she needed to have a doctor listen to his heart when they take him to get his seizure disorder worked up.

Next, I listened to the boy’s younger sister. The mom said the little girl had a history of asthma-like symptoms. As I was listening to her lungs, the little girl laughed a lot. I was glad that a child was not terrified of me for once.  Her lungs sounded great, which made me happy since I didn’t want to add any more problems to this mother’s load.

The next sibling, was a baby over a year old. Her lungs sounded terrible. I could hear wheezes and mucus all over her lung fields. The baby didn’t look toxic, which was a good sign. I discussed the case with Ellah and she suggested we give the baby amoxicillin and a shot of rocephin to cover most causes of pneumonia in a patient her age. I ran to the pharmacy and Karen helped me mix up the amoxil. I started looking around the table for the rocephin, but I could not find any sterile water or glucose to mix with the rocephin in order for us to administer it intramuscularly. That meant the baby would only get amoxicillin. We had also run out of albuterol and all other inhaled medications meaning we couldn’t offer the baby any immediate breathing relief.  The best we could do was crush up some salbutamol and mix it in water to give the baby. It wasn’t anything I’d do in the US, but I was desperate to make her feel better and keep her out of the hospital.

At this point, many other patients had arrived and registered to be seen by a doctor. I think they may have been telling this woman things in Swahili because she told me that she wanted to withdraw the fourth child from being seen. I made sure she got a refund for that child. The mom grabbed her children and left quickly after I educated her on warning signs that the baby might be experiencing a respiratory emergency. Even if the baby did need to go to the hospital, I am not sure the mom would be able to find transportation there.

The rest of the afternoon was a bit of a blur. I knew I had to see many patients and I had to see them quickly. I also had to depend on my brain, my books and my stethoscope (my otoscope and ophthalmoscope ran out of batteries earlier).  I also did not have my attending doctors to consult when I was not sure of what to do. Luckily, most of my patients were pretty much complaining of musculoskeletal problems, GERD, headaches and other very common ailments that I could manage.

One older woman had a very deformed ankle that she came to clinic for.  She told me (okay, she told the interpreter who then told me) that she had broken a bone in her leg last year and was in the hospital for 3 months while it set. It was obvious that the bone was not set correctly as it was now grossly deformed. The woman was in so much pain and could no longer work due to her leg. I asked Ellah what this woman’s options were in Kenya. Ellah said that all we could do was treat her pain. If we were in the US, this lady would be having orthopedic surgery. It made me so frustrated that there was not more we could do for this woman.

The three of us somehow managed to see all of the patients. Ellah congratulated me on my hard work and I told her that I was worried I did not do a great job. She told me that we were not only treating the patients physically, but also psychologically since we listen to their problems and we show them that we care about what they need.

I thanked Ellah for her kind words and felt a little bit better about my afternoon. Mama Joyce thanked me repeatedly and told me that I was very brave for staying at clinic without the rest of the LSU team.  I finally felt like I actually may have made a larger contribution than I initially realized and felt good about the work I did. I heard thunder in the distance and was glad clinic was over so we wouldn’t have to be in the rain. A single rain drop fell on the side of my face. I wiped it off with my hand.

It was a bird dropping. 

- Allison Cormier

February 8, 2013