Steve informed us that the girl with heart problems died last year - without ever getting to a hospital. In fact, he said that about 25% of the people we saw in 2009 have died since then.
We have known for some time that a major problem of these episodic village clinics is that are just that - episodic. We have wanted to implement some local 'crash training' if we had a way to continue contact. Steve's brother and sister (Emmanuel and Bridget) live in Chifuka. He contacted them prior to the clinic and they agreed to come and undergo some basic training. I was excited! The goal was very simple - basic first aid / wound care and when to get someone to hospital. We did not have anyone ill enough to warrant immediate transfer, but I was able to point out things / signs / symptoms to look for to help determine the urgency of medical care. Actually, most of the people looked remarkedly healthy (for village folk). I think the availability of clean water is a huge factor in this. We also saw many elderly. When you consider that the average life expectancy here is now ~30 something, to see so many 70, 80 and even 90 year old people was amazing! We did see a family from Mozambique - the Mom had 8 kids, 3 of whom were 'sick' - one with what appeared to be a massive sinus infection, the other two with nasty skin infections. The leprosy lady came back, carrying her grand-daughter on her back, never having gone to see about treatment. I had a long talk with her about losing the rest of her fingers (toes gone already), nose and ears AND risking giving it to her grand child. There was one very 'small for age' child that I believe has malnutritional issues - he has been seen and followed for that, but with no follow up for 7 months - Bridget will make sure that child gets to the hospital for re-evaluation! I also saw a young teen age boy with a mass growing on the back of his neck - I have no idea what it is, but opened it to make sure there was no infection (there wasn't). I was hoping for simple cyst like fluid (none) - but he needs follow up for surgical removal - again, hopefully my 'team' will encourage that with his parent. We diagnosed many elderly with significant hypertension; people of all ages with multiple fungal infections; many 'general body pain' patients, and lots of stomach pain. The mainstay of the diet here is ground maize, cooked into nsima that is eaten every meal (thinned out, it is porridge for breakfast). Many people complained of abdominal pain after eating nsima, but not after eating other foods. Unfortunately, nsima is not only the traditional food but it also one of the cheapest, most available foods. I treated these folks with omeprazole for their stomachs, but told them to stop eating nsima - which made both me and the translators laugh and the patients look at me as if I am crazy. At least they know what to do if they really want the pain to stop! Unfortunately there is alcohol abuse in the community (they make their own from fermented corn) and even some cigarette smoking as they grow tobacco as a cash crop. I was able to instruct Emmanuel and Bridget on the importance of continuing to address these issues with the patients after we were gone. I did the initial chat, but hopefully the 'health team' will continue to have discussions with these folks. At one point, Joseph (who was acting as pharmacist and wound care tech) and Charles went out to the 'masses' to do some basic triage. I got any obviously ill persons in the classroom. Joseph called out all the folks who just had general body pain - all got some ibuprofen (about 70-80 people). They also seperated the people who needed salbutamol (an asthma drug) refills and refilled their meds (maybe 5-6 people), and handed out an additional 60-70 vitamin packets to folks, folks that didn't look ill and weren't going to be seen but would probably benefit from vitamins. All these folks (and the folks seen by me) were de-wormed. They also seperated out all the rashes for me to see. How many did we see? I have no idea. We did a little registration sheet, but mainly so that Joseph ('pharmacy hat') would know what meds to give them. It did work out well, though, as now Emmanuel and Bridget have a name and a notation for follow up on those patients that need it. Joseph did some wound care with Emmanuel and Bridget, teaching them the correct way to clean a wound; although next time, I am bringing bars of soap!!; and then had them demostrate on other patients. We left them a big sack of cleaning and bandaging supplies, and the slips of paper with people's name and needed follow up (some of what they do will be encourage these patients to go to the hospital to get more blood pressure meds or whatever, some will be to check on wounds). We also left them a box of gloves and a big bottle of hand sanitizer. Emmanuel's phone has picture taking capacities, and he can contact Steve, who can then contact me. Pray that this system works! We need eyes, hands and brains in the village after we leave!
We left in plenty of time to drop everyone off and get home before dark. We had fewer meds and supplies to take home, but added an additional person in the back seat (for a total of 4 in the back seat - those of you who have been in my car knows that is a painful experience). Joseph and I finally arrived home to find NO WATER. Ah, 'it will come' I am sure.
Please be aware that some of the photos may be a little disturbing to non-medical people!
Fungal infection of the scalp.
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