GVH Chifuka

Saturday we went to GVH (group village headman) Chifuka, to do a village clinic. This village was visited last month by the Woods, two doctors from the US who helped at ABC. Many of the people there had never seen a white person before they came, and we think the same of our experience. It is only 1 1/2 hours from the capital, but sits 2 km from the Mozambique border. Many of the villagers are actually refugees from the civil war in Mozambique (thankfully ended now), but they have chosen to stay in Malawi. The nearest hospital is 40 km. We set up in a small building. Three students from ABC went with us: Steve - it is his home village; Peter: an aspiring preacher, and Thandi: who wants to be in the ministry somehow. Steve has set up a ministry in his village, complete with committee members, with an aim to minister specifically to the elderly and disabled. We started the morning EARLY, and when we arrived, we had to go to the 'resting house' where members of the committee met us. If you have never been to Malawi, the greetings and social protocols are mandatory - and lengthy and sometimes exhausting in themselves- everyone must give a greeting to everyone else! After the greetings were exchanged, we went to the local church - a burnt brick building with a mud floor - no pews. (As an aside, those of you with big building projects in your churches - realize that many of your brothers and sisters in Christ sit on dirt floors, with dust blowing around them, to hear the Word of God preached.....). At the church there was singing, prayer, a short sermon by Peter and then I had to say a few words.. (ugh). Then members of the committee gave little speeches and the big chief spoke a few words. Actually, by African standards, it was pretty quick - only 40 minutes. Then we started the clinic - a little before 9 AM. It was an absolute zoo! I sat at one table with Peter, Jose was the pharmacist again, and he had Thandi to help him. Peter quickly learned what additional questions I would ask for a specific complaint, and Thandi had the 'take this with food' or 'shake before using' down pretty quick, too, considering they are totally non-medical in their backgrounds. We broke for lunch - again we met with the committee members and gave greetings, then they served us rice, greens, nsima and chicken (village chicken). I passed on the nsima this time - I was a little leery about the water sources here - but had rice (hoping boiling water kills all the bacteria, thankful I have had my Hep B shots!), greens (quite good) and chicken. I have eaten village chicken before - but I just couldn't get this down! Then back to the clinic, where people kept coming in. The patients: many of the older patients, especially the ladies, complain of general body pain - I am sure it is from the years of unbelievably hard work that they do! Towards the end, when we knew we weren't going to be able to see everyone, Steve divided out those whose ONLY complaint was body pain - and Jose made up bags of Ibuprofen (until we ran out, then we used aspirin - and we were long out of paracetamol - their 'Tylenol') and distributed them to the 'pain' patients. There were more twisted limbs and other bony abnormalities than I have seen at any other clinic. One man walked on his hands and feet, with his legs partially atrophied - I have no idea what was the cause of this but it was congenital. Several ladies, and one little girl, with twisted, deformed legs - many were born normal, then (at least for the little girl) - became very ill and her leg was twisted - ?polio? One of the ladies with the twisted leg blamed witchcraft. Lots of goiters, high blood pressure, heart palpitations, cough, runny nose, abdominal pains (they, too, use wood ashes in their greens - hmm, I wonder if that's why it tasted so good?). A sprinkling of malaria (it is the dry season), some bilharzia, various rashes, a couple of epileptics, two mental patients, multiple kids with worms, lots of blindness - due mainly to cataracts but also some traumatic eye injuries and a couple of ?? I don't know why they are blind. Many of these people had NEVER seen a doctor, and they really thought I could just 'fix' them. It was very sad to tell them we had nothing - and often we had to tell them that their problem was not fixable at all. We had a couple cancer patients - they had been seen outside the village and knew they had cancer, but their care is just 'palliative' (no chemotherapy, no surgery, no radiation). They came because of pain- so their 'palliative' care is totally inadequate. Several probably HIV patients - we instructed them to go for testing, but tried to treat their immediate problem; lots of patients that I would wager had TB - again, treated them, but told them if they did not get better to go to hospital for TB tests. Lots of people complaining of 'asthma' but almost no one was wheezing. I think they mean they cough and have trouble breathing - this village was so dusty that Jose and I had their version of asthma by the time we left! The cases that will haunt me: a lady came in with her ~6 month old strapped to her back - before she undid the baby I saw the problem - this poor child had a significant birth injury, probably hypoxia with resultant CP - absolutely precious child, but obviously seriously impaired - what will become of this sweet baby in the village? A gentleman with 'asthma' that had low oxygen levels, horrid cough, and every abnormal breath sound in the books - I think he had pneumonia at least, perhaps rampant TB..... and all I had to offer him was PO antibiotics! The little girl with the twisted leg, using a homemade crutch to get around. The lady with leprosy with no toes and the fingers from one hand gone - she needed to get on a years worth of medicine - at least - and be followed, but it sounded like there was no chance for her to get to the hospital! And the last, most tragic, was a lovely girl of 15, whose Mom said 'she has asthma and her feet are swelling'. This child was in fulminate heart failure, with a huge heart murmur, edema of her legs, rapid breathing with crackles in her bases. I suspect a congenital heart condition, but it could be an infective process also. We stressed to the Mom that she needed to go to the big central hospital here in the capital. But who knows if that will happen. As Jose said - in the US she would be in a pedi intensive care unit, being investigated for a cause and possible 'fix'. What could I do? Only vitamins, cough medicine and 'referral'. I really just wanted to load her up in my car and take her home (to Lilongwe) with me.

We stopped at about 5 PM and made it to the tarmac road before dark (our goal). We saw about 200 patients, I don't know how many we really helped, though. Our exhaustion was not just the work - which was pretty grueling - but the emotional stress of so much illness, injury, and deformity about which we could do nothing! The pictures: the first is of Jose and Thandi dispensing medications to the girl with heart failure - she is the one in the orange dress - please pray that her Mom can get her to a hospital and that they can at least make her a little better. The second is Jose and Steve giving out meds to the 'pain patients'. Then the leper's feet - missing toes - note the dust /dirt on the floor - it was blowing everywhere! Me with a patient and my interpreter, Peter. Lastly Jose and Thandi in the pharmacy station. Pray for this village and for Steve and his ministry. Pray especially for the little girl with heart problems.