Anna, Sue and the Provincial Hospital
Sue is a student nurse from the UK and has traveled to Kisumu for three weeks to learn about health issues and health care practices in Kenya. She’s traveling with Anna, a friend, who works at a college assisting adults with disabilities. They both hail from Gloucester County and live near/in the Cotswold, close to Burton-on-the-Trent (which I write about in January blog posts). When I mention the provincial hospital, they’re keen to visit and ask if I can arrange it.
With Parham and Karen now in Nairobi, I’ve lost my connection to the hospital. But we decide to go to the hospital and meet with Margaret, the head nurse of surgery. Perhaps she can arrange a tour appointment or maybe we’ll luck up and she’ll take us on rounds. But Margaret isn’t working this afternoon. We decide to walk the halls and, instead of going into the rooms, we’ll simply stand outside and I can update them on the patients I recognize. It’s the best we can do, so we walk slowly.
The first door we pass is the room of the young university student who is paralyzed from the knees down. He was to get his wheelchair and leave. I’m dismayed to see his face through the door. We go into the room and I introduce everyone, then tell them about his case, how he was mugged and beaten, damaging his spinal cord. "Why are you still here?" I ask. "You were supposed to get your wheelchair and go back to school." He points behind us, to his wheelchair. "But they want me to get around on crutches before using the wheelchair." Well, that sounds reasonable. But they must first straighten his legs for him to use the crutches. And to straighten his legs, they need a splint and crepe bandages, the expandable bandages people wrap around sore ankles and such. The hospital has the splints but not the bandages. Our friend, Austine, the physio therapist, told this young man there are no bandages.
I’m irritated and ask Sue how much bandages cost. "One pound," she says. So for less than two dollars, this man can have his legs straightened so he can use crutches so he can get in his wheelchair and go home. Less than two dollars!!!! And we’re thinking they probably sell the damn crepe bandages in the hospital pharmacy. I tell the young patient we’re going to look for Austine. In the stairwell, two men follow and introduce themselves. Like most Kenyans (especially the men) they want to make friends with white people, get our phone numbers, get our emails, know where we live so they can stop by, fly home to UK/America/Canada with us.
"What are you doing here?" I ask the more out-going guy. He says his father is in traction with a broken leg. His father’s cow knocked him over and stepped on him. "Can we meet your father?" I ask. Sue and Anna understand this is a way for us to visit patients and get their story without hospital personnel’s permission. He and his friend are more than happy for us to meet his father, so we all turn and walk back up the stairs and down the hall and enter the same room where the paralyzed university student resides. Big laugh. His father is a long, skinny old man who fought in the Second World War. He must be 85 years old, but strong, and doesn’t understand a word of English. He happily shows us his leg and we ask to see the x-rays. The break is in his shinbone and the fracture is so severe, the bone pieces are parallel. "A cow did this?" Sue says, not really asking. The son says, "He loves his cows," and we all agree cows are mighty fine things, as long as they’re not stepping on you.
We leave and pass the burn room. I point out Janet’s bed. Janet is a 23-year-old woman who had an epileptic seizure and fell into the fire, burning her face, head and shoulders. She has an iron half-hoop frame over her bed, one to fit her adult body. At the foot of the bed is a much smaller hoop frame, child-sized. When we visited last week, Karen and I stopped to talk to Janet and to see the baby girl sharing her bed. The little girl had been burned on her arm and leg, supposedly she pulled hot water onto herself, though she seemed to be just an infant. Janet’s head is bare and her face and shoulders are white/red splotches. She doesn’t wear clothes under her hoop and though her mouth is disfigured from the skin tightening as it heals, she can still speak. Janet's eyes were burned in the fire and she cannot see. Doctors aren't sure she'll regain her sight. We don’t bother her today.
Downstairs, we pass the room where a teenage girl sits nude, covered to her waist by a sheet. I think she’s the 16-year-old we visited last week and stop to tell Anna and Sue the story. (Note: If you’re squeamish, you may want to skip ahead two paragraphs.) When Parham, Eric, the Kenyan medical student, and I were touring last week, Karen joined us after her rounds in maternity. She said, "You guys want to see a membrane coming out of a vagina?" We all looked at each other and said, "Yeah." As we walked, Karen explained how the girl had just arrived after having a Caesarian (not sure where the operation took place or who performed it). Karen says, "The surgeon must have perforated her bowel, because feces was coming out of her Caesarian incision. The baby didn’t live. Now there’s something that looks like a membrane coming from her vagina."
After we talk to the girl, with Eric interpreting, she lifts the sheets and very plainly there is a string of dark gray, moist tissue extending about eight inches from her body. "Is it her Fallopian tube and ovary?" Parham asks. No one knows. They’ve only seen healthy, pink ones. "Is it fixed?" Parham asks. "Yes," says Karen. But they decide to test it. Parham puts on his gloves and tugs gently. Fixed. I’m asking myself how I’m able to stand here while this poor girl has lost a baby, survived a perforated bowel and now has doctor’s mystified with this strange anatomical displacement. I'm not sure at all how I'm able to see such things without running, screaming from the building. We're told even the tiniest of cuts on the bowel can cause great damage and ultimately death if not corrected. Because she’s nude, I give her a small t-shirt that says "Canada" across the front. Jacquie had left it to be donated and the girl appears to need a shirt. She smiles gratefully. A woman sits next to her bed, caring for her. We later learn it’s not her mother but the mother of another patient in the room.
After filling Sue and Anna in on the girl's story, I then tell them about going to Dr. Okeyo’s office at Aga Khan last Friday. He's an OB/GYN and head of TICH's Health Sciences Department. Dr. Okeyo had a poster of the female reproductive system on his wall. I studied that poster. The fallopian tube and ovary were EXACTLY what we had seen lying on that girl’s bed. I told Dr. Okeyo and Dr. Michael Clarke the details about the girl’s perforated bowel and strange "discharge." (Dr. Michael is a microbiologist by training and currently heads the IT department at the University of Ottawa). "Was she butchered?" I ask Dr. Okeyo. Without hesitation he says, "Yes."
Sue, Anna and I stand in the hall and are able to confirm the young girl on the bed is the same girl from last week. We see her incision. She’s sitting up, as though she wants us to visit. But without someone to translate Luo to English, we feel inadequate and move on. We pass the E.N.T. room and I tell them about Michael, the boy with the ear infection that advanced into brain infection. As we near the end of the hall, we see our two Kenyans friends who had introduced us to their cow-injured father. They are standing outside the room of our favorite patient, the young mentally and physically challenged woman with the broken leg.
Turns out his sister is in this room caring for her daughter, who we saw last week while putting sheets on our favorite patient's bed. The man's niece looks to be about 16-years-old. Both her wrists are broken. Talking further with the man, who translates for his sister and niece, we learn she was at a funeral when she was attacked. Luos hold "parties" during funerals. Sometimes these go on for four or five nights and they last all night. There is lots of loud music and alcohol at these "disco funerals." The combination of nighttime, music and alcohol leads to sex, which spreads HIV, causing many communities to ban disco funerals.
This girl was walking home from the party and a "thug" attacked. A "thug" attacked her with a machete (called "panga" in Kiswahili). She put her hands up to protect her face, which is how her wrists were broken. He also cut off her right index finger. Her right thumb was left dangling but has been reattached. Flies crawl on the big, black stitches around her thumb and on the knuckle where her index finger was. She has a panga wound in her left thigh where the knife blade sliced her open. It is healing nicely, though. And her leg was broken just below the knee, so she's in traction. They tell us the man who attacked her was caught and is in jail.
Our favorite patient lies on a bare mattress. The only item left from our visit last week is the pillow without the new pillowcase. I ask the girl in the next bed, who speaks excellent English, if they’ve been keeping our favorite patient's sheets clean. She says the sheets and blanket are now being washed. She also says they’ve been feeding our favorite patient, who’s wide-awake and taking Anna’s finger into her palm and squeezing, trying to put it into her mouth. "She needs a toy to chew on," Anna says. "She needs something that’s her own, that’s comforting. Everything goes straight to her mouth." Well, that’s absolutely brilliant and I can’t believe I didn’t think to bring her some kind of "pacifying" toy. I mean, didn’t we all note she’s in a primitive development state, almost like an infant. And don’t infants get teething rings, pacifiers and other rubber goodies for chewing? Anna says she’ll get our favorite patient a toy. The nice man who’s visiting his niece says he’ll make sure the pink sheets and the gray/pink blanket are returned to the girl’s bed. We leave strangely at peace.
Happy Post Script: Anna and Sue went back to the hospital and gave the young university student crepe bangages. They also took our favorite patient a soft toy, which she likes to lay her face on, and a teething-type toy with spinners and other movable, shiny parts. Anna gave the girl the toy and it went straight to her mouth. Then she removed the toy and gave it back to Anna, who placed it on the side of the bed. The girl then reached for Anna's hand, guiding her to the toy. Anna gave the toy to our girl again and, again, she put the toy to her mouth, watching Anna's hand and the toy the whole time. "It was a little thing," Anna tells me, "her taking my hand. But it meant so much to me." Crepe bandages and shiny toys. In Kenya, little things are often mighty powerful.
With Parham and Karen now in Nairobi, I’ve lost my connection to the hospital. But we decide to go to the hospital and meet with Margaret, the head nurse of surgery. Perhaps she can arrange a tour appointment or maybe we’ll luck up and she’ll take us on rounds. But Margaret isn’t working this afternoon. We decide to walk the halls and, instead of going into the rooms, we’ll simply stand outside and I can update them on the patients I recognize. It’s the best we can do, so we walk slowly.
The first door we pass is the room of the young university student who is paralyzed from the knees down. He was to get his wheelchair and leave. I’m dismayed to see his face through the door. We go into the room and I introduce everyone, then tell them about his case, how he was mugged and beaten, damaging his spinal cord. "Why are you still here?" I ask. "You were supposed to get your wheelchair and go back to school." He points behind us, to his wheelchair. "But they want me to get around on crutches before using the wheelchair." Well, that sounds reasonable. But they must first straighten his legs for him to use the crutches. And to straighten his legs, they need a splint and crepe bandages, the expandable bandages people wrap around sore ankles and such. The hospital has the splints but not the bandages. Our friend, Austine, the physio therapist, told this young man there are no bandages.
I’m irritated and ask Sue how much bandages cost. "One pound," she says. So for less than two dollars, this man can have his legs straightened so he can use crutches so he can get in his wheelchair and go home. Less than two dollars!!!! And we’re thinking they probably sell the damn crepe bandages in the hospital pharmacy. I tell the young patient we’re going to look for Austine. In the stairwell, two men follow and introduce themselves. Like most Kenyans (especially the men) they want to make friends with white people, get our phone numbers, get our emails, know where we live so they can stop by, fly home to UK/America/Canada with us.
"What are you doing here?" I ask the more out-going guy. He says his father is in traction with a broken leg. His father’s cow knocked him over and stepped on him. "Can we meet your father?" I ask. Sue and Anna understand this is a way for us to visit patients and get their story without hospital personnel’s permission. He and his friend are more than happy for us to meet his father, so we all turn and walk back up the stairs and down the hall and enter the same room where the paralyzed university student resides. Big laugh. His father is a long, skinny old man who fought in the Second World War. He must be 85 years old, but strong, and doesn’t understand a word of English. He happily shows us his leg and we ask to see the x-rays. The break is in his shinbone and the fracture is so severe, the bone pieces are parallel. "A cow did this?" Sue says, not really asking. The son says, "He loves his cows," and we all agree cows are mighty fine things, as long as they’re not stepping on you.
We leave and pass the burn room. I point out Janet’s bed. Janet is a 23-year-old woman who had an epileptic seizure and fell into the fire, burning her face, head and shoulders. She has an iron half-hoop frame over her bed, one to fit her adult body. At the foot of the bed is a much smaller hoop frame, child-sized. When we visited last week, Karen and I stopped to talk to Janet and to see the baby girl sharing her bed. The little girl had been burned on her arm and leg, supposedly she pulled hot water onto herself, though she seemed to be just an infant. Janet’s head is bare and her face and shoulders are white/red splotches. She doesn’t wear clothes under her hoop and though her mouth is disfigured from the skin tightening as it heals, she can still speak. Janet's eyes were burned in the fire and she cannot see. Doctors aren't sure she'll regain her sight. We don’t bother her today.
Downstairs, we pass the room where a teenage girl sits nude, covered to her waist by a sheet. I think she’s the 16-year-old we visited last week and stop to tell Anna and Sue the story. (Note: If you’re squeamish, you may want to skip ahead two paragraphs.) When Parham, Eric, the Kenyan medical student, and I were touring last week, Karen joined us after her rounds in maternity. She said, "You guys want to see a membrane coming out of a vagina?" We all looked at each other and said, "Yeah." As we walked, Karen explained how the girl had just arrived after having a Caesarian (not sure where the operation took place or who performed it). Karen says, "The surgeon must have perforated her bowel, because feces was coming out of her Caesarian incision. The baby didn’t live. Now there’s something that looks like a membrane coming from her vagina."
After we talk to the girl, with Eric interpreting, she lifts the sheets and very plainly there is a string of dark gray, moist tissue extending about eight inches from her body. "Is it her Fallopian tube and ovary?" Parham asks. No one knows. They’ve only seen healthy, pink ones. "Is it fixed?" Parham asks. "Yes," says Karen. But they decide to test it. Parham puts on his gloves and tugs gently. Fixed. I’m asking myself how I’m able to stand here while this poor girl has lost a baby, survived a perforated bowel and now has doctor’s mystified with this strange anatomical displacement. I'm not sure at all how I'm able to see such things without running, screaming from the building. We're told even the tiniest of cuts on the bowel can cause great damage and ultimately death if not corrected. Because she’s nude, I give her a small t-shirt that says "Canada" across the front. Jacquie had left it to be donated and the girl appears to need a shirt. She smiles gratefully. A woman sits next to her bed, caring for her. We later learn it’s not her mother but the mother of another patient in the room.
After filling Sue and Anna in on the girl's story, I then tell them about going to Dr. Okeyo’s office at Aga Khan last Friday. He's an OB/GYN and head of TICH's Health Sciences Department. Dr. Okeyo had a poster of the female reproductive system on his wall. I studied that poster. The fallopian tube and ovary were EXACTLY what we had seen lying on that girl’s bed. I told Dr. Okeyo and Dr. Michael Clarke the details about the girl’s perforated bowel and strange "discharge." (Dr. Michael is a microbiologist by training and currently heads the IT department at the University of Ottawa). "Was she butchered?" I ask Dr. Okeyo. Without hesitation he says, "Yes."
Sue, Anna and I stand in the hall and are able to confirm the young girl on the bed is the same girl from last week. We see her incision. She’s sitting up, as though she wants us to visit. But without someone to translate Luo to English, we feel inadequate and move on. We pass the E.N.T. room and I tell them about Michael, the boy with the ear infection that advanced into brain infection. As we near the end of the hall, we see our two Kenyans friends who had introduced us to their cow-injured father. They are standing outside the room of our favorite patient, the young mentally and physically challenged woman with the broken leg.
Turns out his sister is in this room caring for her daughter, who we saw last week while putting sheets on our favorite patient's bed. The man's niece looks to be about 16-years-old. Both her wrists are broken. Talking further with the man, who translates for his sister and niece, we learn she was at a funeral when she was attacked. Luos hold "parties" during funerals. Sometimes these go on for four or five nights and they last all night. There is lots of loud music and alcohol at these "disco funerals." The combination of nighttime, music and alcohol leads to sex, which spreads HIV, causing many communities to ban disco funerals.
This girl was walking home from the party and a "thug" attacked. A "thug" attacked her with a machete (called "panga" in Kiswahili). She put her hands up to protect her face, which is how her wrists were broken. He also cut off her right index finger. Her right thumb was left dangling but has been reattached. Flies crawl on the big, black stitches around her thumb and on the knuckle where her index finger was. She has a panga wound in her left thigh where the knife blade sliced her open. It is healing nicely, though. And her leg was broken just below the knee, so she's in traction. They tell us the man who attacked her was caught and is in jail.
Our favorite patient lies on a bare mattress. The only item left from our visit last week is the pillow without the new pillowcase. I ask the girl in the next bed, who speaks excellent English, if they’ve been keeping our favorite patient's sheets clean. She says the sheets and blanket are now being washed. She also says they’ve been feeding our favorite patient, who’s wide-awake and taking Anna’s finger into her palm and squeezing, trying to put it into her mouth. "She needs a toy to chew on," Anna says. "She needs something that’s her own, that’s comforting. Everything goes straight to her mouth." Well, that’s absolutely brilliant and I can’t believe I didn’t think to bring her some kind of "pacifying" toy. I mean, didn’t we all note she’s in a primitive development state, almost like an infant. And don’t infants get teething rings, pacifiers and other rubber goodies for chewing? Anna says she’ll get our favorite patient a toy. The nice man who’s visiting his niece says he’ll make sure the pink sheets and the gray/pink blanket are returned to the girl’s bed. We leave strangely at peace.
Happy Post Script: Anna and Sue went back to the hospital and gave the young university student crepe bangages. They also took our favorite patient a soft toy, which she likes to lay her face on, and a teething-type toy with spinners and other movable, shiny parts. Anna gave the girl the toy and it went straight to her mouth. Then she removed the toy and gave it back to Anna, who placed it on the side of the bed. The girl then reached for Anna's hand, guiding her to the toy. Anna gave the toy to our girl again and, again, she put the toy to her mouth, watching Anna's hand and the toy the whole time. "It was a little thing," Anna tells me, "her taking my hand. But it meant so much to me." Crepe bandages and shiny toys. In Kenya, little things are often mighty powerful.
posted by Cindi at 12:31 PM
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