Mlombwe Village and more graphic photos

It is a long story how we got involved in a clinic in this really out of the way spot. However, there are several people in this little village with a foot condition, determined by other doctors, much smarter than me, to be a autosomonal dominant condition called palmoplantar kerotaderma. They traced it back to a grandmother, then 3 of her 4 children, and in the third generation, it appears to have affected at least 3 but some are still young. There is no real treatment, except for the symptoms -wear shoes, treat your feet with petroleum jelly and salicyclic acid and cover them at night. The family thinks they have been 'bewitched' and that is why they have these problems. Fortunately, Charles gave them not only the explanation of how to manage their feet, but also spoke to them that this was a genetic condition, not a curse by a witch doctor. We left them nice socks to 'cover their feet at night'.
The condition starts to become apparent at about age 2, worsens during teen and adult years, and then improves as they get older. It also affects their palms but much less so.

 In this village we found the road almost impassable (some of the guys had to hack out the final part with hoes). There is no well / borehole and they must travel to the river to get water. In the rainy season the river floods, and that cuts off their foot paths to the nearest (but not very near) health center. There was no school that we saw. We used someones hut for my office and the back of the two cars for pharmacy and triage / wound care. The lab sat on the ground, as did Luke most of the time. It appears they have maize (not sure if enough for the coming year) and they were currently growing pumpkins. There were the usual goats and chickens. The did not have any mosquito nets that we saw. In fact, the house we were in had a barely thatched roof and only a straw mat for sleeping.  We saw 100 patients, did malaria tests on ~48 and had a 2/3 positive rate - almost all children, including two tiny infants. The infants appeared healthy otherwise but the age group 2-6 seemed pretty stunted. That would correspond to the years of drought and hunger.

On a brighter note, they were some of the most unassuming, gentle, appreciative people we have met here (and this country is full of gentle, unassuming folk). The children were delightful. Luke gave them a soccer ball and they were thrilled. At the end of the clinic, the three leaders of the village met with me, expressed gratitude, and then outlined the problems / challenges that they faced in this area. It does bring one to tears at times. All he asked for help with a well. I am not sure the equipment could even get into this remote area, but I have asked Charles to at least put it on the table at H2O. Pray that happens! It would be a miracle for these folks!

Here are the pictures, beware that the 'feet' pictures are very graphic.

Lidson (Henry) hacking down vegetation so we could actually get the cars into the village.

Triage out of the back of on of the vehicles. Lidson was translating for Dan, a nurse we borrowed from ABC.

 My 'office' in a mud hut, the home of one of the locals. Notice the little sliver of mirror on the wall, above it two toothbrushes If you can see it, directly behind me (ont he ground) is a chickens nest with 4 eggs. The gentleman closest to the camera is my translator, Lewis

Here is Pastor Isaac, in front of the 'pharmacy' car!

Lining up for triage. We didn't register the dog!

Grandmothers feet

Her daughter's feet. Those crevices are very deep and malodorous

Grand-daughter's foot. She appeared to be late teens, right at the time when it gets so much workse.

Here I am examining the feet. We got almost all of the affected people here, gave out the meds and have lovely thick socks to give them (thanks to Joseph Maenner, who has let me give away the clothes / socks he has left here). Of course, many people wanted to be there, so not all these pictured have the foot condition.