Jeep Doctors

A couple weekends ago, Britt (the Swedish dentist I love to work with) had another Swedish visitor here- Remi- who is also from Sweden. Remi works for Rotary Doctors which is a mobile clinic in Homa Bay, Kenya. Doctors from Sweden come every six weeks and go to different villages Monday through Friday and are referred to as the "Jeep Doctors."

Chelsea, Sarah, and I arrived on Tuesday and were pleasantly surprised by the adorable guest house where the doctors stay. The other doctor currently there is Lea- she's from Finland and retired.We got settled and Remi took us out for a tour of the town. Homa Bay translated literally means "fever bay" because of the vast prevalence of malaria and I am not at ALL surprised. There were mosquitoes EVERYWHERE. That first night we were sitting around reading (there wasn't a TV- *gasp!*) and I could literally reach out and just grab them out of the air. Despite my efforts, I got about 8 bug bites while we were there while the others walked away with none. Don't worry, mom, I'm taking my prophylaxes daily. Anyway, the risk of malaria is compensated by a breathtaking view. I can't wait to post photos because I know my words won't do it justice.

The next day we got to work. Each doctor has their own route they go on each week and they take with them a driver/pharmacist, a nurse, and an HIV counselor. That leaves one spot in each vehicle and as there were three of us we drew cards to see who would go. I just so happened to get to go to the clinics both days, but we also drew cards to decide who would sleep where-there were two twin beds for the three of us- and I also just so happened to get to double up both nights.  Gotta make a sacrifice sometime!

So Wednesday, after a quick breakfast on the adorable porch I took off with Remi, Usuf, Janet, and Phyllis for my first Jeep Doctor clinic. I was excited to find that they do a lot like what we did with The Luke Commission in Swaziland, but on a much smaller scale. We set up in a school building that was made of mud with two windows and no electricity. It was dark and really hot. The patients line up and come one by one to see the doctor as Phyllis interprets. It costs 50 KSH per visit (less than a dollar). 10% goes back to the community and the rest is used to purchase supplies for the clinic. The money from clinics barely helps, but it's important for there to be some kind of charge to insure that they are serious about taking care of themselves. Depending on their sickness, they are sent to Janet to be tested for malaria or HIV, then come back and are prescribed medicines which are dispensed by Usuf through the back of the vehicle. It was a busy day and we saw 48 patients- more than 1/4 of which had malaria.

I have to say it was an absolute pleasure to work with Remi. He cares deeply for each of the patients that come through the clinic and has a heart of gold. It was a welcomed change from the coldness of the hospital where each patient is addressed as a specimen during ward rounds.I could feel the hurt he felt when child after child came in completely malnourished and how joyful it made him when patients he had seen in past weeks came back improved. This is what medicine should be- a compassionate fight for the patient.

Speaking of fighting for the patient, about halfway through the day we were told there was an emergency case and quickly ushered them in. The young girl (probably 2 or 3) looked like she was struggling to stay alive. She had a fever of over 40 C, and awful cough, and was having trouble breathing.She looked exhausted, I could see her heart beat through her chest and every time her eyes closed or her breathing faltered I thought for certain that she had died. Remi immediately gave her a fever suppressant and set up mother and baby under the shade outside to force feed liquids and wait til we could take them to the hospital. I was given the task of checking her temperature every so often and breathed a sigh every time it went down.

By the time we finished with the rest of the patients she had been unable to swallow the liquids and was now coughing up blood. She had called the child's father to come take her to the hospital (Rotary Doctors provides money for travel expenses) but he was still a long walk away. The mother couldn't take the girl to the hospital (about 5-6 km away) because they had a one month old at home who hadn't been breast fed since they came to the clinic that morning. There was a dilemma of taking one child to the hospital and leaving the baby to die, or not getting to the hospital soon enough and ensuring the death of the other. Remi was distraught begging the mother to go now, and although we saw her walking towards the hospital as we drove off, there's no way of telling what happened to that poor family. We went home with heavy hearts and prepared to do it all again the next day.

On Thursday I went with Lea to another clinic.Although we only had 12 patients, it was another heart-wrenching day. Soon after arriving, I was approached by a woman who believed I was the doctor. She told me about her sister's child who was "white like me." Confused, I asked if the father was white and she said no so I knew that the young girl must be albino. Lea advised her to go get the child and we could see what the problem was. When she arrived a few hours later, we were surprised that the mother would not come in the examination room and the aunt quickly handed six month old Eunice over to me (the mothers usually hold onto their children-fighting for them and fearing for their lives). She was perfect. Confused, Lea told the aunt that she looked quite healthy and what was the problem? She simply said, "Well, what are we supposed to do with her?" I was floored. I wanted to shout at her that what she should do with her is lover her, and make sure she grows up knowing that she is just as good as the black children, and pray that she might not have to endure the kind of ridicule that destroys so many children at an early age.

Lea was a lot more patient than me and explained how they needed to make clothes for the girl that would completely cover her skin and a large hat to protect her from the sun. Then I carried her to the examination table and did a few tests because she had a kind of twitch in her eyes. Unfortunately, her eyes didn't respond to light. She also didn't respond when I snapped or clapped my hands by her ears on either side. There's nothing we can do about developmental issues and told them to visit an ophthalmologist in a couple years. I almost couldn't bear handing her back over to this family, knowing that she would grow up without the kind of love that each child deserves. I even found myself wondering how much I had in my bank account and if it was possible to raise an adopted child in medical school. I was genuinely distraught by the thought and it didn't help when Lea later told me about the mass slaughtering of albinos in African history. It still makes me shudder. In fact, after you read this you should google it.

That day we also saw a young boy who had surgery on his legs and still couldn't walk. I taught him therapeutic exercises and we referred him to the hospital- his wounds are infected and we're worried it has reached the bone causing osteomyelitis.

There was also a young woman with a terribly malnourished baby. Her husband left right after the birth and she was living with her father and step mother. However, her step mother wasn't happy about caring for a daughter that was not hers so they stopped supporting them. She was going to start a coal business so she could once again feed herself and her child. Lea offered her 2,000 KSH (a little more than $20 dollars- huge to people in villages like this) to help with the business. However, a few minutes later she took a pregnancy test and found that she is again carrying a child. Lea's English isn't very good so she tends to state things quite bluntly and after we got the news of the pregnancy she turned to me and Grace (the nurse) and said, "That baby in her arms is going to die." It's shocking when you hear it so bluntly, but it's the truth and we can't ignore it any longer.

We left Homa Bay physically and emotionally exhausted. I think if I ever came to Kenya when I graduate med school it would be through that kind of program. I'm shocked and amazed by the absolute poverty and poor health of such a vast amount of people and re-inspired to make sure I'm one day capable of offering a helping hand.