Open Wide and Say "AAhhhhh"
Today a group of us head to Chiga Community near Kisumu to meet with about 30 widows. Our team has been organized by Elizabeth of Heaventrax Ministries and consists of the Canadian medical students, Karen and Parem, and nursing students, Jackie and Angela. Plus me and Elizabeth and her husband, Rev. George, and our two drivers. Elizabeth's community-based organization (CBO), Heaventrax, works with grandmothers who care for their orphaned grandchildren. Oftentimes, these women are unable to feed and clothe the children and cannot afford school fees. Our mission today, which we've each willingly accepted, is to begin medical files on all the widows, young and old. This will include taking down their medical histories, hearing about their current ailments and performing complete physicals.
Elizabeth has arranged with Aga Khan Hospital to borrow the necessary equipment, so we stop by and pick up the blood pressure machine, weight scales and scopes for checking out ears, eyes, noses and throats. We purchase a thermometer and tongue depressors at the hospital pharmacy. Here's our system: I'll begin by taking and recording their blood pressure, temperature, heart and breathing rates. We'll also measure their height and weight. I'll also ask them questions about their occupation, income, possessions, number of pregnancies and deliveries and basic hygiene practices. Karen will continue the medical history interview by asking about past illnesses and surgeries and current maladies. Once the chart is complete, the ladies will visit Parem to have a complete physical, including eye chart exam, hearing test and pelvic exam.
The larger group will congregate under trees as Jackie and Angela educate them about diet and health, particularly diet and nutrition related to HIV/AIDS since all the younger widows in our group are HIV positive.
When we pull up in two cars, the ladies are waiting and give us the traditional Luo welcome. They stand, clap and sing as we climb out of the cars. We're in a compound of five houses. Two houses have been set up for the exams; one belonging to an older widow and the other belonging to a younger widow. We decide to begin with the older women since they've been waiting and are getting tired. They range in age from 60 to 85. The old widows cannot enter the bedroom of the younger widows, it would be too much like them lying on the bed their sons slept in. Because of this cultural consideration, we set up in the older widow's house to begin examining the women.
The houses are very neat and have been cleaned. Linens are draped over the backs of seats and couches. The walls and floors are made of mud and cow dung, considered a semi-permanent dwelling, and are smooth. Some houses have layers of cement spread over the floors and walls, making them permanent dwellings. But all the houses in this compound are of mud and dung. It takes a couple practices for me to get into the swing of taking blood pressure with the borrowed machine. I took a healthcare course 25 years ago at a vocational school and soon find the process returning!
Each of us needs a translator because none of us speak Luo and few of the old Mamas speak Kiswahili or English. Even Elizabeth, who teaches Kiswahili and is married to a Luo, doesn't know the language well enough to capture everything the ladies say.
The most challenging aspect for me is getting the ladies to put the thermometer under their tongue. They are all so obedient and earnest, but many don't want to shut their mouths. One woman keeps her head tilted back the entire time, as though the thermometer might slip. We should have learned the very basic Luo words for "sit," "stand," "close," "open," etc. We want to know how many times they have been pregnant and also how many of those pregnancies went full term. We really want to capture whether they experienced miscarriages or abortions. That topic seems a bit private to discuss with such old Mamas, though. When I do ask (through the 15-year-old interpreter) how many pregnancies and how many deliveries each woman has had, it is always the same number. I attempt to explain that it's possible to be pregnant but not to have a baby as a result. This concept just doesn't get through to the interpreter or the old Mamas. That part of our record-keeping may be skewed.
These women gave birth 13 times, 10 times, 8 times. Only one woman had not had a child. At 66 years of age, she's now the guardian of a 4-year-old and a 6-year-old, children produced by her husband's second wife. Her husband and the second wife both died from AIDS. Many of these women have outlived all their children. Some only have one or two adult children still living. All of them are responsible for young grandchildren living in their homes.
But I love sitting with each old Mama and talking to her through the interpreter, finding out about her house, toilet and bathing facilities. Some of them have pit latrines in their yards, but a handful did not. They simply use the fields near their homes. None of them have piped water. Most use rain water and river water as their source. Some purify their water with WaterGuard or by boiling it. But several of the women simply drink and cook with the water as it comes out of the river or rolls off their roof top.
It's common for people in Africa to clean their teeth with sticks. At one time, a certain tree was used because it's twigs had a medicinal property. But as those trees became inaccessible, people used any type tree to clean their teeth. As a result, many of the old Mamas we see have fungal infections. They do not use toothbrushes or toothpaste (can't afford it and probably wouldn't use it if supplied to them). One of them reported using her finger to clean her teeth each day. Their homes may not have a bathing area inside so they bathe in the river or bring river water home and bathe in the yard, surrounded by walls of woven grass for privacy.
Of the 14 old Mamas I interview, only one reports having an income. All the others say they are too old to work, or they can no longer see well enough to work. Those who are able keep a home garden. The one woman with an income makes it by weaving and selling baskets at the weekly market for 50 shillings each. All the women own their homes and a few have cows, goats, sheep and chickens. Some women have nothing but their home. Not one of the women owns a car or bicycle. They all tell me they have pain in the feet, lower leg, knees and hips. Some have pain into their shoulders. It was a very common complaint and an understandable one since their old bodies have worked hard for decades, ploughing and tending crops by hand, taking care of livestock and birthing many babies. They're all suffering from arthritis, though they often thinks it's malaria, which they think they have all the time! And many of them have cataracts. One woman has a protruding throat which Parem later confirms to be an enlarged thyroid.
My station is on one side of the living room while Karen's station is on the other. Parem is in the bedroom. But the walls do not go all the way to the ceiling and we can all hear each other as we talk through our interpreters. At one time I'm hearing, "Ask her if she ever feels...." and "Tell her to raise her arm like this." It makes me chuckle. As Karen is interviewing a client, Elizabeth calls from the bedroom, where she's assisting Parem with the physicals, and says, "Karen." It sounds like the voice of God and we all look up. Then Elizabeth says, "Speak slower so they can understand." Karen looks up toward the corrugated tin roof and says "Okay." Shortly, the Godly voice speaks to me. "Cindi," it says, "Are you asking if their income is per day or per week?" I look up and answer God, saying, "Whatever way they can calculate it!"
The ladies have arranged lunch for us, which was totally unexpected. At 3:30, they insist we stop working and go to an adjacent house. They've prepared beef, stewed with potatoes, and rice and ugali. These women could never afford such food for themselves and we're all touched they've gone to trouble. We eat heartily and it is delicious. After lunch, we decide to rush through the remaining interviews. We must get the equipment back to Aga Khan Hospital by 5 pm or they may never let us borrow it again. So Elizabeth and I finish taking the full medical histories on all 14 women while Karen and Parem examine two women. The physicals take quite a while since they're so thorough, though Parem argues they're not really thorough. But these physicals are more than these ladies have access to otherwise. We'll return next week to complete the physicals on the older widows and we'll then begin the physicals for the younger widows.
Dropping the equipment at the hospital, I watch with delight as Parem walks the halls and is astounded at Aga Khan's shiny floors, uniformed doctors, chairs at desks and no blood on the walls (this is a private hospital). We go to Mon Ami for drinks (cold beer, fruit juices and milkshakes). As we sip our respective drinks (mine is a cold White Cap beer), we all agree it's been a great day. We didn't accomplish as much as we had hoped (naively, we thought we could examine all 30 women in one day) and it was hard work, but we agree from our hearts it sure was a great day nonetheless.
Elizabeth has arranged with Aga Khan Hospital to borrow the necessary equipment, so we stop by and pick up the blood pressure machine, weight scales and scopes for checking out ears, eyes, noses and throats. We purchase a thermometer and tongue depressors at the hospital pharmacy. Here's our system: I'll begin by taking and recording their blood pressure, temperature, heart and breathing rates. We'll also measure their height and weight. I'll also ask them questions about their occupation, income, possessions, number of pregnancies and deliveries and basic hygiene practices. Karen will continue the medical history interview by asking about past illnesses and surgeries and current maladies. Once the chart is complete, the ladies will visit Parem to have a complete physical, including eye chart exam, hearing test and pelvic exam.
The larger group will congregate under trees as Jackie and Angela educate them about diet and health, particularly diet and nutrition related to HIV/AIDS since all the younger widows in our group are HIV positive.
When we pull up in two cars, the ladies are waiting and give us the traditional Luo welcome. They stand, clap and sing as we climb out of the cars. We're in a compound of five houses. Two houses have been set up for the exams; one belonging to an older widow and the other belonging to a younger widow. We decide to begin with the older women since they've been waiting and are getting tired. They range in age from 60 to 85. The old widows cannot enter the bedroom of the younger widows, it would be too much like them lying on the bed their sons slept in. Because of this cultural consideration, we set up in the older widow's house to begin examining the women.
The houses are very neat and have been cleaned. Linens are draped over the backs of seats and couches. The walls and floors are made of mud and cow dung, considered a semi-permanent dwelling, and are smooth. Some houses have layers of cement spread over the floors and walls, making them permanent dwellings. But all the houses in this compound are of mud and dung. It takes a couple practices for me to get into the swing of taking blood pressure with the borrowed machine. I took a healthcare course 25 years ago at a vocational school and soon find the process returning!
Each of us needs a translator because none of us speak Luo and few of the old Mamas speak Kiswahili or English. Even Elizabeth, who teaches Kiswahili and is married to a Luo, doesn't know the language well enough to capture everything the ladies say.
The most challenging aspect for me is getting the ladies to put the thermometer under their tongue. They are all so obedient and earnest, but many don't want to shut their mouths. One woman keeps her head tilted back the entire time, as though the thermometer might slip. We should have learned the very basic Luo words for "sit," "stand," "close," "open," etc. We want to know how many times they have been pregnant and also how many of those pregnancies went full term. We really want to capture whether they experienced miscarriages or abortions. That topic seems a bit private to discuss with such old Mamas, though. When I do ask (through the 15-year-old interpreter) how many pregnancies and how many deliveries each woman has had, it is always the same number. I attempt to explain that it's possible to be pregnant but not to have a baby as a result. This concept just doesn't get through to the interpreter or the old Mamas. That part of our record-keeping may be skewed.
These women gave birth 13 times, 10 times, 8 times. Only one woman had not had a child. At 66 years of age, she's now the guardian of a 4-year-old and a 6-year-old, children produced by her husband's second wife. Her husband and the second wife both died from AIDS. Many of these women have outlived all their children. Some only have one or two adult children still living. All of them are responsible for young grandchildren living in their homes.
But I love sitting with each old Mama and talking to her through the interpreter, finding out about her house, toilet and bathing facilities. Some of them have pit latrines in their yards, but a handful did not. They simply use the fields near their homes. None of them have piped water. Most use rain water and river water as their source. Some purify their water with WaterGuard or by boiling it. But several of the women simply drink and cook with the water as it comes out of the river or rolls off their roof top.
It's common for people in Africa to clean their teeth with sticks. At one time, a certain tree was used because it's twigs had a medicinal property. But as those trees became inaccessible, people used any type tree to clean their teeth. As a result, many of the old Mamas we see have fungal infections. They do not use toothbrushes or toothpaste (can't afford it and probably wouldn't use it if supplied to them). One of them reported using her finger to clean her teeth each day. Their homes may not have a bathing area inside so they bathe in the river or bring river water home and bathe in the yard, surrounded by walls of woven grass for privacy.
Of the 14 old Mamas I interview, only one reports having an income. All the others say they are too old to work, or they can no longer see well enough to work. Those who are able keep a home garden. The one woman with an income makes it by weaving and selling baskets at the weekly market for 50 shillings each. All the women own their homes and a few have cows, goats, sheep and chickens. Some women have nothing but their home. Not one of the women owns a car or bicycle. They all tell me they have pain in the feet, lower leg, knees and hips. Some have pain into their shoulders. It was a very common complaint and an understandable one since their old bodies have worked hard for decades, ploughing and tending crops by hand, taking care of livestock and birthing many babies. They're all suffering from arthritis, though they often thinks it's malaria, which they think they have all the time! And many of them have cataracts. One woman has a protruding throat which Parem later confirms to be an enlarged thyroid.
My station is on one side of the living room while Karen's station is on the other. Parem is in the bedroom. But the walls do not go all the way to the ceiling and we can all hear each other as we talk through our interpreters. At one time I'm hearing, "Ask her if she ever feels...." and "Tell her to raise her arm like this." It makes me chuckle. As Karen is interviewing a client, Elizabeth calls from the bedroom, where she's assisting Parem with the physicals, and says, "Karen." It sounds like the voice of God and we all look up. Then Elizabeth says, "Speak slower so they can understand." Karen looks up toward the corrugated tin roof and says "Okay." Shortly, the Godly voice speaks to me. "Cindi," it says, "Are you asking if their income is per day or per week?" I look up and answer God, saying, "Whatever way they can calculate it!"
The ladies have arranged lunch for us, which was totally unexpected. At 3:30, they insist we stop working and go to an adjacent house. They've prepared beef, stewed with potatoes, and rice and ugali. These women could never afford such food for themselves and we're all touched they've gone to trouble. We eat heartily and it is delicious. After lunch, we decide to rush through the remaining interviews. We must get the equipment back to Aga Khan Hospital by 5 pm or they may never let us borrow it again. So Elizabeth and I finish taking the full medical histories on all 14 women while Karen and Parem examine two women. The physicals take quite a while since they're so thorough, though Parem argues they're not really thorough. But these physicals are more than these ladies have access to otherwise. We'll return next week to complete the physicals on the older widows and we'll then begin the physicals for the younger widows.
Dropping the equipment at the hospital, I watch with delight as Parem walks the halls and is astounded at Aga Khan's shiny floors, uniformed doctors, chairs at desks and no blood on the walls (this is a private hospital). We go to Mon Ami for drinks (cold beer, fruit juices and milkshakes). As we sip our respective drinks (mine is a cold White Cap beer), we all agree it's been a great day. We didn't accomplish as much as we had hoped (naively, we thought we could examine all 30 women in one day) and it was hard work, but we agree from our hearts it sure was a great day nonetheless.
posted by Cindi at 12:30 PM
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