Monday we (Joseph, Carson and I) went to Kamuzu Central Hospital (KCH), the big government hospital here in Lilongwe. Our plan was to volunteer in the Casualty Department (ER for us Americans). We had visited with the doctor over the ED and surgery, Dr. Muyco, earlier in our trip and he was agreeable to this plan. However, he was not around Monday, so we found the charge nurse to get clearance. It is strange how people can just show up, say they know Dr. Muyco, and start 'working' in the ER. I was paired with an intern, Dr. Elaim Banda. I think I may have made him a little nervous at first, but we got along fine. He was a smart guy and I enjoyed comparing notes, how differently we treat problems in Malawi versus the US, etc. Of course, not only do we (US doctors) have the diagnostic tools to help us, but we also have basic supplies, many of which they did NOT have at KCH. Joseph and Carson were also in the triage 'room' (actually a big room with 4 stretchers) - the patient starts out in triage and then is examined and a plan formulated - admit, refer for further testing, refer for an appointment with another area (i.e. surgery, etc.) or a procedure. We saw hypersplenism in a couple of patients, a ventral hernia, hypogonadism in a young male, a couple of RTA (road traffic accidents) - one that morning and two from earlier in the month with continuing problems. I saw some patients on my own; Dr. Banda picked out patients or their families / guardians that spoke English. Joseph and Carson sutured a facial laceration that extended through the vermilion border and helped me with an incision and drainage of a big, big abscess on a child's head. We also saw a poor guy with HIV who had a 'spot' cut out of his leg - now his entire leg was swollen and the 'spot' had grown and was bleeding. I cannot attempt to describe the way this tumor looked or smelled, but it was obviously Kaposi's sarcoma and it was a huge, fungating, expanding, foul smelling, bleeding mass. He was in distress from the swelling and the pain. In the US, he would have been admitted, maybe even the ICU - here, he was sent home to return to the general surgery clinic (excuse me, but what on earth are they going to do with him???). To look into his eyes.... he was truly a dead man walking and he knew it. I admire Dr. Banda and the other doctors there who do this impossibly difficult job day after day. We also saw a young boy with a mass growing out of his head - it looked like a little brain on a stem. Very weird... Dr. Banda had never seen anything like it (neither have I)... he got referred to the general surgery clinic, too, for evaluation and removal. The good news - they had film for the xray machines (apparently had been out of film for a couple of months), the bad news - no gauze, no tetanus shots, and very little small suture material. They brought out some HUGE suture material for the facial laceration. We stayed and 'helped' (although you wonder how much help you really are, fortunately Carson had rotated through there before so knew some of the protocols) until lunch time.
Monday evening, the Maseko clan - at least some of them - came to Lilongwe to drop Mebble off to fly back to the states. We all met up at the Pizza Inn, had dinner and a nice visit. Pizza Inn has pretty good pizzas, and a nice play area for the kids!
Today (Tuesday) we planned a clinic in the prison. We didn't get started as early as we would like, as our translators had to register for college classes. It was different in that there were only 4 of us - like when we first started these village clinics! I had Esnart as my translator, Joseph was the pharmacist with Charles as the translator. Joseph was trying to keep track, he thinks we saw ~150 patients. The prison here is so depressing. The men's cells are meant to house 60 - they currently have 200 in each cell. You apparently can be put in the prison for long periods of time, waiting for your case to come up for trial. Most of the folks here cannot afford a lawyer, so their wait can be long, You get 2-3 meals a day, porridge for breakfast, then nsima (cooked maize flour) and beans for the other meals. They have a clinic with a clinical officer who is there some days, but there is no medicine (the government is apparently running low on funds and meds, and the prison is at the bottom of the list). There is an VCT nurse who supplies ARVs (antiretroviral medications) for the HIV patients, but it is questionable if they actually get the medications on time. Also, if they test positive for HIV, then they have to have a CD4 count - another delay in their treatment. No one seems in much of a hurry to get these folks on treatment. They have a way to test for TB, but the lab tech has been on holiday, and KCH has been out of films for xrays, so who knows how many of those coughs I saw today were actually TB? I saw more cases of scabies - horrible, total body involvement scabies, than I have ever seen before. I also saw cases that I am sure constitute ARV failure - some of these guys were actively dying in front of my eyes. I was in med school and residency early in the AIDs/HIV outbreak - I have seen people acutely dying of AIDS, but I haven't seen that in years in the US. I saw it today, and it is heart breaking, especially when you know that there is help available for some of them. I also saw more Kaposi's sarcoma than I have ever seen before. It is tragic. The set up was one big room with a half wall separating Joseph and I. The prisoners lined up on a bench, usually 8-10 at a time in the room, with one guard in the room with us. No handcuffs or shackles. Outside was a group waiting to be seen of 200-300. When we had to stop seeing patients (they have to be back in their cells at ~3:30 PM) they rushed the door. They were desperate. I don't think they wanted to hurt us, they just wanted their problems addressed. At the end, when the other prisoners were dispersed, two men were brought in with additional guards and in shackles. They had been sentenced to life in prison and were scheduled to go to the big, 'final' prison in Zomba. We ended up running completely out of scabies medications. I saw more skin lesions, on more private areas, then I ever want to see again. I looked into the eyes of the sick and dying and had no real medical treatment to offer them. Some of these guys were young, some were very old. They all looked malnourished, which is probably one of the many reasons their HIV is out of control. They were dirty and their clothes were in tatters. They have limited soap for bathing, and they must wash their own clothes, by hand, usually without soap. They depend on 'well wishers' to bring them almost everything - extra food, soap, clothes, books, paper, etc. That prison houses ~26 women (several with their children under the age of 5) and ~2000 men. Charles has a prison ministry there, where he preaches and teaches. He is a much better man than I!
After that grueling day, we returned home to shower and then have dinner with Jim and Diane Young (she is the other doctor at the ABC clinic) and their kids. We had a great dinner of chicken curry and rice - it was mild enough that Joseph really liked it.
Please note - you cannot take photos in either KCH or the prison, so you guys have all been spared what my eyes have seen -and is burned into my brain - over the last couple of days.
Thanksgiving / Praise - our safety; our friends here; our supporters in the US; our awesome translators that are such a help and a blessing to us.
Prayer: for all the sick and dying folks at the prison - that they may come to a saving knowledge of Jesus Christ; for us as we wind down this trip; for the students at ABC as they begin college again; for the Maseko family, a precious family that is striving to do so much for their country of Malawi.
Pictures:
Playground at Pizza Inn with Emma and Angellah
The kids - tallest is Lindiwe, next Tristen and the little one is Alpha
Two of 'my' students at ABC - Wongani and Charles.
No comments:
Post a Comment