Back in Kigutu

I have arrived here at the clinic. It is, for me, a coming home again; a coming home to a place that will always be special to me; a place that is now a constant in my life. I was nearly brought to tears tonight as I sat there at the communal dinner, with all of my friends and colleagues around me, eating our usual dinner of rice and beans, with Melino's African music playing, and the beautiful African star-lit sky around us, breathing that soft African air. All of us there for a common purpose, and I share in that purpose. I am, as I keep saying, the lucky one, that I can do this; that I can be but a small part of this selfless endeavor. I cannot imagine not doing it. I know my time here is limited, and I would not, nor could not have it any other way. But I love it here, for it brings a certain meaning and joy to my life that I could not have elsewhere.

 There have been significant changes in the clinic since last year; “changes” meaning modernization of the clinic. There are now three separate wards: one for men, one for women and children, and a third one for malnutrition (some of the sick, non-malnourished children are housed in this latter ward). Previously, there were only two wards: the first was for men and women together; the second for the malnourished children. The sick, but not malnourished children, were divided between the two wards.

There are new tile floors in each ward, as opposed to the dusty and dirty, old concrete floors. There is more space between the beds, although the wards would still seem impossibly crowded by American hospital standards. The overall effect is that the clinic seems cleaner and more sanitary.

This is my third year at the clinic, and I know that the cliché of “expect the unexpected” is a truism here in Kigutu. But my first working day back at the clinic was far more than unexpected. It was my medical version of what Alice must have experienced when she walked through that famous looking glass into her wonderland.

The day started out innocently enough, as the team of doctors and nurses started our hospital rounds with the usual suspects: the diabetics with their diabetes out of control. We can regulate the diabetics’ blood sugars in the hospital with the use of insulin. The problem comes when those diabetics go home. They vast majority of them cannot afford the cost of the insulin. We can give them a short supply, but once that supply is exhausted, they are left where they started: blood sugar again out of control. Moreover, most of our population can neither read nor write, nor do they know numbers either. That makes it impossible for them to administer the appropriate dose of insulin.

We, therefore, try to transition these diabetic patients to an oral glycemic agent, like Metformin, before we send them home. The process of effecting that transition takes days, if not weeks. That is why we have at least three or four diabetics in the hospital at any given time.

We eventually finished rounding on the diabetic patients. It was then that my “looking glass” day began. The next patient was a sixteen year old boy, with a history of epilepsy. He had been on the ward three months. His story goes as follows: he had a seizure at home, during which, as a result of the seizure, he fell into a fire. However, no one would rescue him from the fire while he was having the seizure. The reason? Because it is a commonly accepted belief here that, if one touches someone who is having a seizure, one will then develop epilepsy; that epilepsy is passed on exactly in this way; that it is contagious by contact with a patient in the midst of a seizure. But, wait, there is more to the story: if the person having the convulsion passes gas (aka, farts) during the convulsion, one will then develop epilepsy as a result of inhaling that gas. That is why people stand far back when someone is having a seizure.

This Burundian folk belief was confirmed by another, and completely independent source. One of my clinic patients today was a sixteen month old boy who has a previously untreated seizure disorder. The child has had multiple seizures, and I questioned the mother as to what she does when her son has a seizure. She said that she never touches him during the seizure, but, instead, stands several feet away.

There is more to the story of the 16 year old boy with the seizure. His seizure, as all seizures eventually do, stopped. It was only then that he was pulled out of the fire. It goes without saying that he suffered severe burns. The only good news is that the burns were confined to the lower half of his body. He was then taken to the traditional healer (mupfumu) for the treatment of his burns, rather than being brought to the hospital. Herbal remedies were applied to the burns for two weeks. The burns became increasingly infected, to the point that his entire legs were one coalescent abscess. It was at that belated point that his family carried him into the clinic. He could not walk by then. Appropriate and aggressive treatment was begun immediately with high doses of antibiotics and frequent dressing changes.

It is to the credit of the doctors and the nurses here that the results are as good as they are. The fact that it is three months since he was first admitted to the clinic gives you an idea how severely infected the burns were when he was first admitted. The boy would have died if his family had waited any longer to bring him to the clinic.

Perhaps you can get some idea of the extent of his burns when you see this picture taken of him, three months after admission to the hospital.

 The story of the epileptic boy and his burns is indicative of the strength of cultural beliefs here. It is unfortunate that these beliefs are often so damaging and dangerous.

I saw again today the power of these beliefs. A six month old child was brought into the clinic this afternoon. He was close to death. He had high fever, and, more importantly, had been suffering from what must have been severe diarrhea for a week. He was as dehydrated as any child I have ever seen. He was a limp rag, barely aware of his surroundings. He made no eye contact, and did not move as I examined him. One of the reasons for his profound dehydration was that his mother had given him an “enema with traditional herbal medication.” Her thinking was that the enema would, in her words, “relax his stomach;” not exactly the right approach when your six month old has profuse, watery diarrhea. 

Here is a picture of the child prior to his fluid resuscitation. 

I will, however, reassure you that the child will almost certainly recover. Maneno, one of our most expert nurses and a magician at getting I.V.’s into tiny veins, got an I.V. into this particular child. The child is now receiving the large amounts of I.V. fluid needed to correct his dehydration. You will be even more reassured to know that I just saw the child. It is now approximately three hours post-admission, and the child is significantly improved. He is moving again, and is far more reactive and responsive. I have every reason he will ultimately be fine. Hopefully, the next time he gets diarrhea, the mother will not give him an enema with traditional herbal medications.  

I break off here my tale of my first workday at the clinic. I do so because there is so much more to tell about that first day, so much that will require further blog postings. I will get to those future postings, but first I want all of you who read this blog to once again get a flavor of “my home away from home.” I leave you with two pictures, the first, taken from the hill overlooking the clinic, of sunset over Lake Tanganyika.

And, finally, to get the human element at the clinic, a picture of a family of three children enjoying the little toys that I brought from home.