Easter Weekend

It’s been a quiet week here on Lake Victoria. There haven’t been any more cases of cholera in the clinic but plenty of other interesting things. Malaria is still the #1 reason for seeking care and nearly everyone is tested for it. Prenatal protocols call for treating for malaria twice during pregnancy which can be tough to accomplish since women don’t seek care until late in second or third trimester.

A ten year old boy came in this week and had been bitten by a dog about 6 weeks ago. His family took him to a traditional healer but he developed rabies. By the time he was seen in our clinic there was nothing to be done. He died almost upon arrival.

Many dogs and cats have rabies here and post exposure immune globulin should be given right away and followed up with 4 more doses. The rabies vaccines and immune globulin are very expensive both in the States and here in Kenya. Our vaccine cost Kaiser $150 each and we received 3 doses. Here the immune globulin costs the clinic about 1300 Ksh per dose and costs the patient 1000 Ksh which is cost prohibitive for our patients.

**Addendum- We've had some questions about the rabies protocol so here's some clarification. The clinic gives the first dose of immune globulin whether or not the patient can pay for it. That gives the family time to come up with money for the remaining doses. If possible, the animal is tied up and watched for signs of rabies for 10 days. If none develop, then you're done- no further treatment is required. If the animal shows signs of rabies, the remaining 4 doses are administered. Unfortunately, there isn't an animal control type agency in the district so no reports are filed. but the staff said they see 1-2 cases per month.

The most unique injury we’ve seen came in on Friday night. The Kenyan staff has a 4 day holiday so we’re alone here with one driver/guard and one nurse who takes call. The guard came to get us late Friday to see a patient with a gunshot wound to the chest. Apparently he’d been shot accidentally by some men who were trying to kill a hippo. Not a history you hear very often in the US. Paul and I worked to get vital signs and do a simple exam, jockeying for position with the 18 family members or friends crowding around the cot. The nurse got an IV started, I dressed the wound and we sent him off to the hospital. I’m not sure if he made it. We may never know.

You may wonder why they were trying to kill the hippo. Hippos spend their days in the water but come ashore at night to feed. They’re voracious eaters and we’ve been told that the farmers hate them because they can eat their entire crop as one day’s meal. So, sad as it is, they’re often shot when spotted on land.

Saturday morning we set out for a long walk in the countryside. Just 50 feet from our front gate was a toddler with the big belly full of worms (see photo). We’ll try to get him in to be treated when the clinic reopens on Tuesday. We saw several other children on our walk with the same problem. It’s so common that the clinic protocol is to treat children every 6 months, even if they’re not symptomatic. All pregnant women are also treated once during pregnancy, regardless of whether they have symptoms.

The majority of the people in Kenya are either Seventh Day Adventist or Catholic. Saturday is the Sabbath for SDA and we passed lots of people walking to church in their finest clothes. Women wear beautiful dresses or skirts and men wear dress shirts and suit coats. It was very hot this morning but the men pedaling their bikes dressed in suit jackets didn’t seem to mind. We’re the only ones who suffer in the heat.

It’s the start of rainy season and every day starts out overcast. By 10 AM it’s sunny and hot. In the afternoon a breeze kicks up off the lake and after sundown it starts to rain. There’s so much rain at night that it literally keeps us from sleeping. The heavy rains have been leaking through our house’s tin roof and soaking the bottom of the bed. I have been waking up with damp and cold feet. The maintenance guys plan to fix it but in the meantime Paul readjusted the mosquito netting and moved the bed about 2 feet. That kept us dry last night.

The rains have an effect on the clinic too. People didn’t come in for a few days because they were planting their fields after the first rain so we were slow the latter part of the week. It’s interesting to have our lives so intertwined with nature. We wake up at dawn, eat what’s available at the market and have a busy or slow work day depending on factors in nature etc.

AND NOW A WORD ABOUT CRITTERS

There are 2 eucalyptus trees outside our house that are home to dozens of hanging nests. They’re made by the male weaver birds who hang upside down to make the “L” shaped nests. If the female bird finds the nest is not up to her standards she loosens the ties and sends it falling to the ground. Every week we find several of these rejected nests on the ground.

There are also 2 Lake Eagles who live in our area. They make a racket squawking in the morning but also keep us entertained by coming to eat the fish they catch in a tree near the cook house.

Every night we crawl under our mosquito netting to read by flashlight or headlamp. Tiny gnats are able to squeeze through the netting and fly around our lights and heads until we finally give up and go to sleep. We sweep up a dust pan full of the same tiny gnats from our floor every day and wipe them off our table before every meal. They’re a nuisance but otherwise not of consequence.

Since the rains started we hear a loud chorus of frogs at night along with the usual insect sounds. While walking yesterday we came across a giant millipede similar to the one Sophie, Chloe, Isa and Phil pooled their allowance to buy a couple years ago. The kids here find lots of things to do outside. One boy was sailing a homemade boat on a big puddle. He made it out of a discarded flipflop, a bit of plastic and some wood scraps and it worked really well. I'll try to post a photo of him.

We also spotted out first Monitor Lizard but barely managed to get one picture before he saw me and took off running. Boy can they run!