Friday, August 5, 2016

Of Schnoz and Schmeckel

I *think* the title of this blog post is my attempt to outdo Steinbeckian titular alliteration - in Yiddish no less - but pay my cleverness no mind; what I'm really referring to is the work Toa Nafasi does post-assessment.

To refresh, after testing all the Standard One kids in the first couple months of the school year, our Toa Nafasi staff are able to determine who is doing poorly.  From there, we conduct interviews with the parents to find out a bit more about the child's history: Mama's pregnancy and labor, her relationship with Baba, other family members and the nature of the home environment, the child's milestones and general development, significant illnesses or other issues that might contribute to some kind of problem at school.

In past years, we've gotten a bunch of the typical concerns: stomachache, flu, malaria, UTI.  We tend not to do much with these cases unless the child is chronically ill; after all, Toa Nafasi is concerned with Education, not Health - except where Health impedes the flow of Education.
We also get some hearing and vision issues, which we test at KCMC, provided a parent accompanies the student and is present for the doctor's examination and recommendations.  Since Toa Nafasi's inception, we've seen a lot of conjunctivitis and earwax.  Last year, we helped two young students with severe hearing impairment to receive inner-ear surgeries as well.
Other shida (problems) which have presented during the course of Toa Nafasi's tenure are: epilepsy for which we work with the Peds department at KCMC; various skin conditions and allergies, dealt with at KCMC's fine Dermatology clinic; and bone deformities and physical disabilities, again treated at KCMC in the Occupational Therapy department.
This year, we have added the Dentistry department to the list.  Several of the kids have truly rotting teeth which I'm not convinced detracts from their performance at school but certainly doesn't help.  (Neither too does the soda the parents buy the kids while we wait at KCMC.  Last week, while we were there, one little tyke was double-fisting a Coke and a lollipop as we were waiting to hear from the dentist how many teeth he's gonna yank.  When I chastised the Mama, who no doubt had just bought the sweets to quiet down a complaining and tired little patient, she said, "Leo tu."  "Today only."  Better be, Mama, because dental on the Toa Nafasi dime is a one-shot deal!)
Anyhoo, as in past years, we continue to discover children with nyama puani, literally translated as "meat in the nose."  I believe that in prior years, this condition was explained to me variously as adenoids and/or tonsils.  Not knowing what either adenoids or tonsils really are, I kind of just accepted "nose meat" as a viable condition, afflicting multiple children in the Kilimanjaro region of Tanzania and perhaps beyond.  See:,
This year, faced with another nose meat situation for young Neema, I actually took the time to figure out what the heck everybody was talking about.  Turns out it's really a deviated septum and all these little kids are requiring septoplasty!  Good to know!!  (I should assure my readers here that I never had any doubts as to whether what the docs were doing was legit vis a vis nose meat, since all was explained in Swahili to the parents and they gave their consent, and each child is the better for the nose meat removal, but I do feel a bit more informed knowing now what all this schnoz talk is about....)
Neema had her surgery early last week and is currently laid up at the Ear, Nose, and Throat ward in KCMC recovering.  We hear the procedure was a success and she has been relieved of any unnecessary and unwanted meat in her nose.
Another interesting new condition that we stumbled upon this year is known as "hypospadias."  (And here I must render an aside that THE HUMAN BODY IS ENDLESSLY FASCINATING.  Any aberration is possible!  And most are fixable!!)
So moving from the schnoz to the schmeckel, we can say that "Hypospadias is a birth defect of the male urethra where the urinary opening is not at the usual location on the head of the penis.  It is the second most common birth abnormality in boys, affecting approximately 1 of every 250."  WHO KNEW?!
Since neither Hyasinta nor I is in the habit of checking students' schmeckel health, here's how this situation went down....
We were conducting parent interviews at one of the satellite schools, Mnazi, when we met Mama Twalibu*.  She seemed unsurprised that she had been called in about her child's poor performance in school.  We went through the usual questions and when it came to significant illnesses, well, let's just say it took a while for either me or Hyasinta to fully understand.
Mama called Twalibu over to "show" us the problem but before he could drop trou, we told her it was not necessary that we see said schmeckel, but that we would try our best to help Twalibu who was born with two holes on either side of his penis rather than one on the head.
I don't think there was anything hugely life-threatening about this state of affairs except that the poor child had already endured FIVE botched surgeries to fix it!  And the parents were saving up for a sixth which would have cost them nearly a million Tanzanian shillings (about $500usd), after which point, who would know if this was truly meant to be the final operation??
Additionally, I extrapolated - in my overly empathetic Sarah way - that the kid must have a lot on his mind.  Any difference from your peers is hard on a kid, physical differences even more so since they are so noticeable - I should know, half my body is covered in freckles - but a difference *down there*?  Big shida!  Poor thing was probably agonizing in self-doubt and tortured by his classmates.  Or so I conjectured.
Also, the two holes must have been a rather messy business and here in Africa where the toilets are already dirty ruts in the ground with no clean water and soap to wash, he is open to more infection than the average child.
And when he becomes sexually active, it appears there's a lot of different ways hypospadias can play out....  I'm sure you can imagine....
We took Twalibu and Mama to my doctor, the good Dr. Makupa, where he was given excellent service (I could not bear to subject Twalibu to KCMC for such a delicate task) and referred to a Dr. Mbwambo's clinic in town.  Mbwambo, like Makupa, provided Twalibu excellent and timely service and the little guy is currently recuperating at the clinic, hopefully to return home next week WITH NO NEED OF ANY FURTHER SURGERY.  Schmeckel accompli, Hyasinta reports Mama is very happy and we shall go visit the patient tomorrow!
So, friends, wherever you all are, all around the world, take heart in knowing that Hyasinta and I are here in Moshi, a fearless two-woman team, going around fixing schnozes and schmeckels for under-performing kids in public primary schools in rural Kilimanjaro!  Hapa Kazi Tu!!
*The name has been changed to protect the schmeckel owner's identity.

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