Down and out-of-it.

This past week is most memorable for David coming down with our first tropical disease. He has Typhus, better known as Tick Bite Fever. The fever part is debateable but many of the other symptoms have been present; malaise, muscle aches and pains, joint pain, headache and a large swollen and reddened area on his left forearm where the bite occured, complete with an eschar center. I have photo journaled the whole gruesome process of his illness and recovery to be shared with one and all upon our return. No need to hold your breath but there is a couple of good close-ups of the bite site that should not be missed. The doctors at Good Shepherd Hospital have been most helpful, he received two home visits and numerous phone calls over the past week and a half. The needed antibiotics were part of the trunk loads of medications that we brought with us so our Boy Scout motto of being prepared has paid off once again. That is not to say that the hospital pharmacy didn't have the doxyclycline in stock as well. As far as nursing care provided to our patient, that was exemplary, at least for the first week of his illness until I came down with a 'common cold/flu', not nearly as glamorous as Typhus so I am a bit envious. Friday was spent in bed coughing and sneezing on my part and David forged ahead reading Madame Bovary with his ear plugs in. Fortunately, we are both on the mend and yes Mr. Haproff does make a very good nurse when called upon. As part of my recovery process I am taking today off as well, no need infecting the patients in their homesteads, they certainly have enough to deal with without having the flu besides.
Well the rains have come and stayed. It basically rained for the past week and a half. Not torrential rains but a good steady rain and pouring rain that lasted for days on end. Only the main roads here in Swaziland are paved, the rest are these red dirt, clay-like roads, so when it rains they get very slippery and muddy. The mud was literally two to seven inches deep. I would step out of the truck and sink in mud at each and every home visit. In order to get back into the truck without dragging in five pounds of mud I would have to clap my feet together to dislodge some of the wet dripping mud from my hiking shoes. Working in all of that rain was quite and ordeal. We were not able to use our usual truck for home visits because it does not have four wheel drive and the four wheel drive vehicle only has a front seat so there were just three of us making the visits rather than the usual four or five. I spent three of the four days that I worked last week being soaked from head to toe all day. I guess it is of little wonder why I got the flu.
I must say that these Swazi women are incredibly strong and tough and just keep on working no matter what the weather conditions are. So picture this, there we are, myself and two other nurses in our truck, basically sheltered from the rain and we are at an impasse. The road is basically washed-out and there is no hope of reaching the next homestead. So, Anna Mary, one of the nuses on the team rolls down the window and hollers out at the nearest homestead in SiSwati. There was no sign of anyone at the homestead since the door and windows were closed in hopes of staying dry. I ask her what she was doing and she tells me just to sit and wait. It appeared that she did not find it necessary to explain something so obvious. Well a couple of moments later a young woman appears out of the nearest homestead in the pouring rain, she has a little chat with Anna Mary and then off she goes down the impassable road on foot, with no rain jacket or jacket of any kind, getting soaked from head to toe and covered with mud. She had gone to let the patient know that we were there but unable to reach the homestead. Ten minutes later our next patient arrives with her 'papers' (all of the patients have paperwork that has their TB or ART number on it with information from their clinic and hospital visits as well as home based care) there was no sense that she was bothered by the rain and mud and was quite pleasant and seemed pleased to be seen by the team. There she sat on the tailgate of the truck, in the rain with me assessing her and calling out my findings to Anna Mary (to record them in the patients papers), who had no intention of leaving the dry comforts of the front seat. I dispensed a few medications, some tylenol for the aches and pains and nystatin for her oral thrush. Next the patient took the food we supplied, in all about 25 pounds of powdered substances and off she went with it all balanced perfectly on her head. The rest of the day continued in this fashion, at times there were several patients standing out in the rain, waiting to be seen and not showing any signs of annoyance. In fact, one of the patients who had an umbrella came by my side and held it over me while I assessed another patient. After I had finished I moved her over next to me so that she could be out the rain for a few moments and she seemed so embarrassed, she smiled from ear to ear and laughed out loud. She was so sweet and kind and obviously not use to be the recipient of such kindness.
The following day was much of the same although with more mud to deal with. At one point, again the roads were impassable so we sent another girl from a nearby homestead out into the rain to get the nearest Rural Home Motivator. The RHM as I have said helps to monitor patients in the community, they get paid a very minimal sum, something like the equivalent of $10 for the whole month. Anyways, twenty minutes later the RHM shows up, at least she was wearing a rain jacket, bare footed and basically soaking wet and covered with mud up to her knees. We explained that we could not reach several patients who lived in her area and she offered to bring the food to them for us and to have them come to the clinic if there were symptoms that needed to have medical attention. So there were are, on the side of the road, it is raining with dense fog allowing us poor visability and air temperature is quite cool. Well this very strong and eager RHM pulls a large plastic bag from her jacket and gets ready to load it up. We (actually I, the others are keeping dry in the cab of the truck) hand her 3 packages of Corn Soya, 3 packs of Mealie Meal, 3-two liter containers of milk and 3 food packs (containing sugar, salt, peanuts and beans). Each cornsoya weighs about 15 pounds, the Mealie Meal 12 pounds each, the milk 2.2 pounds each and the food packs another 8 to 10 pounds each. Doesn't she pack all of this into her large plastic bag as I look on in amazement as I keep repeating to the team 'how is she going to get this to her homestead'! My question went unanswered once again, no big surprise there. But I was assured that I should not be concerned and just be patient. Anyways, there was little hesitation on the RHM's part, she was going to lift that bag, in all about 110-120 pounds, onto her head and be on her way. Well we had to remove one of the corn soya in order to steady the bag but she remained determined to carry the load on her head. So I helped her to lift the bag in place, yes on top of her head, then handed her the other bag of corn soya to carry in her left hand while she stabilized the bag on her head with her right hand. Sure enough, off she went into the rain and mud with everything in place, thanking us for bringing her the supplies. She was starting off on her 20 minute journey on foot with a smile on her face and me bug eyed at the whole scene. Once again I was left standing there, in awe at how the world works so differently here from what I am use to in the states. Somehow I cannot see this scene playing itself out on West 23rd Street.
Peace,
Scott