Tuesday, June 30, 2015

"The Wax Pack" Versus "Babies With Scabies"

As always, I like to deliver on my promises and last week I said I would provide a brief chronicle of the last few weeks during which Vumi and I have spent countless hours helping students requiring medical care.  We don't have all that many options for *affordable* *quality* *healthcare* here in Tanzania, so we have just defaulted to the *best* hospital Moshi has to offer: Kilimanjaro Christian Medical Center.  Looks nice from the outside, huh?  As for what lurks within??  "The horror, the horror...."

During the interview period when we call in the parents or guardians of students who underperformed on Angi's assessment, we ask a series of questions (also devised by Angi) that we hope will elucidate why the child is failing in school.  

These queries concern the child's motor skills, cognitive skills, and behavioral/adaptive skills as well as the environment in which the child lives at home and the manner of his/her birth and mama's pregnancy prior to delivery.  Because some of the questions are a bit sensitive, Vumi does the bulk of the questioning with me piping in or slipping her a note on the side.

Sometimes, we uncover issues with vision or hearing.  Sometimes, the culprit is poor nutrition or a chronic illness that has not been dealt with properly.  Sometimes, the problem is psychosocial and we have to call in a counselor to talk to the child and his/her family.  Sometimes, there are other medical needs which we deal with on a case-by-case basis.

Recently, one such exceptional medical need was adenoid surgery which we have now provided for two poor bubbies who were doing poorly in school simply because they couldn't breathe.  This is Jeremiah Sunday (sounds like a Flannery O'Connor character, no?); he was the latest surgery patient.  Last year, it was France Julius (http://toanafasi.blogspot.com/2014/09/its-fun-to-stay-at-kcmc.html).

After the surgery, the kids are obviously completely gaga when they wake up and have no clue as to where they are or why.  Last year, France raised holy hell upon waking and had to be restrained by his mama, the nurse, Vumi, and myself.  I wasn't around for Jeremiah's awakening, but Vumi reported he was so aggressive, he knocked out two of his own front teeth!  Poor, poor bubbie....

There's other good stuff too....  As my sister, the doctor, said when she came to visit me way back in 2009, "There's some reaaaally interesting epidemiology here."


I'll try not to be too graphic in this post, but you guys know me; I delight in the gross-out effect!  And this year's roster of kids with shida (problems) was GROSS!!

First off, we had a record number of children whose parents complained that their kids did not hear well, perhaps up to ten children.  One girl, Elisia, is doing well in school but when we assessed her, we discovered ourselves - very easily, in fact, because she is nearly deaf - that she can't hear a thing!  So, even though she's doing okay for now, I included her in our mass trip to the Ear, Nose, and Throat clinic so we could get her treated and fitted for hearing aids since I imagine the issue will cause her problems down the line once lessons start getting harder and teachers more severe.

Of these ten or so munchkins, really only this girl Elisia has actual shida with her hearing and we are dealing with that accordingly.  She probably will NOT get hearing aids, but rather have a surgery that should take care of the problem entirely.  Inshallah.

The rest?  WAX, WAX, AND MORE WAX.  Never in my life have I seen such large masses of earwax!  Coming out of such tiny people!!  Chunky, gooey, icky, sticky WAX!!

Check out the photos below of Elisia sitting in the patient's chair ready for her examination and then lying on the wax-removal table.  Don't forget to get a gooood look at the earwax collection jug by the side of the bed.  The Msarangans definitely added to that day's tally!!


Also common amongst the students at Msaranga Primary are various skin disorders like eczema (an allergy) and psoriasis (a disease), ringworm (a fungus) and scabies (an INFESTATION).

Some of these conditions are curable, some not; some manageable, some not.  Personally, I think a large part of the problem is hygiene.  These kids are like kids anywhere: playing outside,  sharing EVERYTHING, putting random crap in their mouths, and then tramping home with all the muck of the day LITERALLY all over them.  They touch themselves, each other, and whatever's in front of them, don't wash their hands, and are generally impossible to keep clean.  Add to that, red African dust, dirt, and mud and you've got any number of creepy-crawlies seeking sanctuary in the  old epidermis.
One of my boarders at Gabriella, Danny from 2013, fell victim to a dread skin disease that covered his entire body.  HIS ENTIRE BODY.  (Again, my point about kids' being slapdash with personal hygiene: this lil' boo probably got rashy on his hands, then touched his face, then went to the toilet and touched other stuff, and voila!  Full-body creepy-crawlies!!)  It was so bad he couldn't sleep for scratching at night and even passed the condition on to his little sister while he was home from school.

Couple weeks ago, Vumi and I escorted Danny and his babu (grandfather) to the Dermatology clinic at KCMC where a lovely lady doc from Swaziland examined him and pronounced scabies, a rash caused by burrowing mites (cue vomit sound here).  We got a prescription for some kind of lotion for both Danny and his sister with strict instructions to wash all their clothes, sheets, etc. with harsh detergent and then hang them in the sun to dry.

Fast-forward two weeks.  Danny is still itchy-scratchy though the sister has taken to the treatment.  He cannot return to Gabriella without being cured and so he's missing days upon days of school.  This time, we take him to the local clinic in Msaranga.  The doc (Tanzanian, male, decidedly un-lovely) looks at Danny with disdain, DOES NOT TOUCH OR EXAMINE HIM, and pronounces eczema, completely different from scabies in that it is an allergic reaction and not a tiny insect.  Say whaaaa?


We purchased another prescription and this time, I am told, Danny is doing much better, but good God, man, diagnostics here are a nightmare, particularly if your doctor won't even examine you.... which makes treatment that much harder....

Anyhoo, whether they are Team Earwax or Team Skintag, one thing is clear, all my kids, their parents, me and Vumi are proud members of Team Wait-All-Day when we commit to going to a KCMC clinic.  There IS no hurry in Africa and nowhere is that saying more true (or more frustrating) than KCMC.  

We wait to get medical files.

We wait to be seen by the doctor.

We wait inside.

We wait outside.

We wait in "traffic."

Vumi waits with her phone.

I wait with my book/work.  (Fascinating behavior to the Tanzanians who seemed to regard my reading a novel AND waiting as some kind of self-imposed double torture.)

They also did not seem to understand my ENT waiting room garb which I adopted once I realized people people were hacking out of open trach tubes all around me.  Last thing I need is to be sprayed with stoma juice.

But we also wait with some of the cutest, sweetest little dumplings you'll ever meet!


This is Kennedy John .... Maro.  Yes, you've read that correctly.  Not John Kennedy, but Kennedy John, clan name Maro.

And, he is ADORABLE!  For some reason, he loves him some Mzungu Sarah and so every time he sees me, he runs up to me with both arms outstretched and throws his little body at me for a big hug!!  I don't know what I did to ingratiate myself with him thus as he faces scary new things every time we meet (urine sample, blood test, ultrasound), but for some reason, he finds me irresistable.

We spent a lot of time together, one-on-one, me and Kennedy John Maro because he had several health issues to be dealt with.  He was part of Team Earwax for a hot second, but two minutes and one giant chunk of wax later, he graduated to Team UTI.  

Poor lil' fella, he's been afflicted by chronic urinary tract infections for ages and his mama was at her wit's end.  So, we got him the whole roster of tests (much to KJM's dismay.... the blood test was especially disturbing and a layer of trust between us has forever been shattered, though forgiven with lollipops and Coca-Cola) and a course of treatment.

Once again, the big issue here is cleanliness and how to keep these kids clean and healthy knowing that they are village rugrats, rough and tumble in the brush, where even adults don't always have access to or place emphasis on clean water, proper hygiene, etc.

As usual, it's a learning curve and I am along for the ride, but man oh man, I'll tell you one thing for sure: if you can avoid getting sick in Africa, DO IT, cuz siyo mchezo! (it's not a game!!)

No comments:

Post a Comment