I spent the day attending patients in the remote clinic in Ochuna. It is a much smaller site than Matoso, and is not open for emergencies or deliveries. It is less than 5 km from the border with Tanzania, and many of our patients come to us from very rural areas of Tanzania. Malaria is even more common than it is here for some reason–probably poverty, poor nutrition, and maybe fewer mosquito nets.
It takes 45-60 minutes to get to Ochuna, and today I rode a motorbike with another staff member who helps at Ochuna frequently. He does data gathering, registration of patients, immunizations, dispensing in the pharmacy, –and driving, obviously! On the way, we saw men from the Rural Electrification part of the government installing electric lines in the village of Othoo. Imagine, all of this part of western Migori County (and much of Kenya, I’m sure,) has no electricity, no water system, no trash pick up.We are truly living in the wild, wild west. And just because they were putting in lines does not convince me we will have electricity soon. Poles and wires have been in place in Ochuna for two years, but the transformers all failed, apparently. So they sit.
For the first half of the day hours, from 9:30 until 1 pm, I saw patients with Mary, the nurse. We saw a bad scrotal abscess in a three-year old that probably started with the itchy rash of scabies. (Scabies is also rampant in Ochuna and our patients in Tanzania.) One family of a mother, her 4 girls ranging from 5 to 11, and her one year-old son–all the kids had scabies, and the mother and one of the daughters had malaria, as well. We saw a girl who fell down yesterday and felt a foreign body in her knee. Mary pulled out a splinter 2 cm long! We saw one child, about 2 years old, who had such severe malaria that we immediately referred her to a hospital. (Fever measured 38 degrees C, respiratory rate 60-80/minute, lethargic and dehydrated.) Mary suspected they would not take the child for lack of money, and there is no ambulance in Ochuna, so we also gave the treatment for malaria so the mother can at least try to give at home. I suspect the child will not survive the next 12 hours, but only God knows.
From 2-4:15 I saw patients with one of the medical assistants translating for me. Many of our patients were sick with malaria or just fever, but we saw one child with dysentery (bloody diarrhea). She got zinc tablets, ORS, Bactrim antibiotic, and Whitfield’s ointment for her scalp fungus. Many of the ladies came for their depo-provera shots, and Mary put in some long-term implants. We talked about PReP (pre-exposure prophylaxis of HIV) with one woman, not so much for her but for her husband, who is negative, because the first wife is positive. Mary knows the husband, whom she says will not come to the clinic for testing or treatment, but I was glad we got to discuss it with the second wife. Luo family culture is very complicated sometimes, with its odd blend of acceptance of sexuality as part of life (often resulting in early sexual intercourse–especially for girls–and multiple partners throughout life as far as I can tell), polygamous marriage, and Christianity with its attendant shame and secrecy.
We rode home again on the motorbike, taking about an hour and arriving back in Matoso hot, sticky and dusty. Time for a welcome cold shower!