WHERE THERE ARE NO DOCTORS
(A Good Health News exclusive)
(A Good Health News exclusive)
Appreciate the daily health challenges that patients in poor countries face. Most of these stories are based on the experience of our MyPH Consultants. For the purpose of the GHN newsletter, each story is structured as a series of short chapters. Only one chapter is published in a GHN issue and readers are encouraged to look for the next chapter in the next issue of GHN. All of the chapters for each of the Short Stories will be posted sequentially on the MyPH websites after they appear in GHN. Readers may update themselves on the story at any time.
Dr. Charles Muroa is a young Western educated doctor who started his life as one of three Village Nurses who have to provide all of the medical care for more than three hundred thousand people of the Komo tribe, in the rural villages of Southern Kenya (a population the size of the city of New Orleans Louisiana in the USA). In this heart-rending story, GHN readers follow young Charles as he returns to his village after high school to work with the missionary nurses that are the main source of health care for his people. Almost immediately, Charles is recruited to help two Village Nurses fight a Meningitis epidemic in one of the outlying villages. Charles knows that meningitis is a contagious disease that produces infection of the brain and a high death rate, especially among children. He fears that this outbreak of meningitis could devastate his people as this was the time of the year when large crowds were gathering in in the towns and villages throughout the region to celebrate the annual “Festival of Circumcision”.
Wake up Charles, Wake up! We’ve got a serious emergency in East Komo. I turned over in bed. I could see the look of concern on my father’s face even through my weary eyes.
What is it, father? I muttered. I was 18 years old and more concerned with sleeping late than with what was going on in the countryside. I had recently finished high school in the big city of Nairobi, Kenya and was waiting for my results of my exams before proceeding with applications for college. I wanted to be the first person from my village to go to college and I had just returned to my village in the South to help my father manage the village church while I waited for the results of my exams.
A Massai messenger just arrived from eastern region of Komo! My father continued in an excited voice as he hovered over me. The poor fellow has been running day and night, for hundreds of miles. The village nurses who are working out in the country sent word that there is an outbreak of deadly meningitis in the area around the Komoto Infirmary. They are overwhelmed and they want the church to send help immediately!
But father, you know that the visiting missionary health team that was here left for Nairobi a week ago. I am certain that they must be on their way back to the United States by now. We have no one to send!
You’ll have to go and help them, Charles. You can take the church truck and I’ll send some of the men from the church to ride with you for safety. We will pray to God to protect you and the villagers!
But father, I know nothing about meningitis! I have no formal training as a nurse!…I only worked for about six months with the missionary health team and I just carried out the orders that they gave me!… The eastern villages are more than a day’s drive away from here. What am I supposed to do when I get there?
Look son, my father insisted, we have to help them! You are all we have! You’ve been away in the city for too long. Have you forgotten that this is the time when Komo people celebrate the Festival of Circumcision of their boys and girls? They will all be gathering in large crowds in the markets and in the village clearings to watch the rituals! More than 300,000 people! Son, if this meningitis starts to spread, these people out there will die like flies! You are the only one here with any understanding of hygiene. You are one of the few men in the village with a high school education and I know that the missionary health workers thought very highly of your work.
I rolled my eyes up to the heavens and trembled with fear. Six months experience assisting a visiting team of missionary health workers was all the medical experience that I had and now I was being sent into the bush to help two village nurses fight this deadly epidemic of meningitis. I came back to my village because I wanted to help my people, but this was sheer madness!
(Stay tuned for the next chapter when Charles sets out on the harrowing trip to East Komo)
I looked across the room at my father. He was bowing his head and was praying softly. “Dear God, please help my people. Please help my son and protect us from this bad Meningitis disease that the devil has sent to kill my people.”
Ok father, I’ll go! I don’t how I will be able to help, but I’ll go. Let some of the men help me load the medical supplies that the missionaries left behind into the truck. I’ll also need a supply of clean water and some extra food for the nurses that are working out there in the clinic.
I jumped out of bed and hurriedly pulled on my clothes. I rushed past the kitchen into the courtyard where some of the men had gathered around the tall, lanky messenger from the Masai tribe. The man seemed to be more concerned with finishing the last bits of the meal than with the animated conversations taking place around him. He had run more than a hundred miles over two days to deliver the message to the church and he needed to recharge his system.
How far? I asked the sinewy Masai man. More than two days fast walk! He explained in his native tongue. Best way is through the forest.
In less than an hour, I was headed east over the bumpy dirt roads with my Massai guide seated next to me in the cab of the little Toyota truck. The three church volunteers were hanging on for dear life in the back as we bumped along, constantly praying that the axle of the old truck would survive the next pothole.
(Stay tuned for the next chapter when Charles and his Masai guide continue their trip through the bush to reach the disaster in East Komo)
What you mean by ‘Mengitis’? the Masai finally spoke. It’s Men-in-gi-tis. Very bad disease spread by wind from mouth and nose, I replied as I demonstrated a cough. Killed many of my friends in High School in the big city. Everybody frightened… locked up for days and have to wear masks on faces to stop disease from spreading. Need lots of smart people to fight disease.
Ah, bad magic! The Masai man replied and returned to staring at the winding dirt road The memories of how this dreaded disease had ravaged my High School were burnt into my mind. In the big city they had all of the staff, the training, the equipment, supplies and yet, more than a dozen of my classmates died! And here I was a world away from Nairobi, just out of high school, facing this Meningitis menace again with no help except for two village nurses and with lives of more than three hundred thousand innocent villagers at risk
Ever since I was a child, I had wanted to follow in my father’s footsteps and become a Minister to help the people in my village. But not with Meningitis! What could I do to help my people? How could I fight this dreaded disease with no resources?
Lord, I prayed as the miles flashed by, please help me. I don’t want to die out here! It was mid-afternoon and we had travelled through the jungles and over grasslands for more than 150 miles. It was raining hard. We passed through a thick patch of jungle and entered a clearing. The Toyota stalled in pool of water. I stared in shock at the scene in front of me. Ahead of me was nothing but a large lake of muddy brown water. The road was gone. It had been completely washed away. The truck was beginning to sink slowly into the mud.
Get out! Get out! I yelled to the men. Push! Push! I pleaded as we struggled to free the vehicle from the soft mud. The Masai jumped out of the vehicle and started probing with his stick in the soft mud. The church elders pushed with all their strength but the vehicle kept drifting towards the large lake of water ahead of them. Suddently the Masai raised his staff.
Over here! He yelled. Push truck this way!
The men shifted their weight and guided the truck towards where the Masai was standing. Suddenly they could feel the wheels of the land rover moving onto something solid.
Rock here! The Masai said and pointed his staff. I jumped into the land rover and gunned the engine. I could feel the wheels gripping something solid under the water as we began to move. I followed the Massai’s direction as he probed the water and we eventually drove out of the water and up the narrow embankment to safety. It was at that moment that we realized that the quiet wisdom of the Masai man had saved us from a certain disaster!
(Stay tuned for the next chapter when Charles and his Masai guide finally arrive in East Komo
We finally left the rain and mud behind us and followed a narrow rutted dirt road that cut across a grassy plain. The road was bordered by 5 foot high dirt walls on either side.
Arrive before sun go down! The Massai said. I rounded the next corner and slammed on the brakes. A large lion, his lioness and their two lion cubs were comfortably seated in the middle of the road. The large male lion hardly stirred. He turned his head ever so slightly to look with annoyance at the vehicle that dared to intrude into his space. What do we do now? I asked the Massai. We keep quiet and wait for them to move! The Massai man replied.
Just before sunset, I arrived at the large village clearing with the large thatched roof hut that served as the village infirmary, maternity ward and hospital. A large mass of women and children were gathered in the clearing. The Kuria people were celebrating the circumcision of their boys and girls at this time, a very significant ritual in this society.
During the circumcision ceremonies people overcrowd in small poorly ventilated houses, called huts (mud and grass) and this was a recipe for the outbreak of meningitis. Kuria is one of the smallest communities in southern part of Kenya of a population of about three hundred thousand people. It has been determined to be among the poorest community in Kenya and this is mainly because it lacks political leverage due to its minority status and failure to embrace formal education and the civilization that comes along with it.
Some of the cultural practices that have persisted in this community include female circumcision, polygamy, women intermarriage and early marriage for girls. Agriculture is the main way of earning a living, but due to lack of infrastructure and frequent draughts many people’s standard of living is below the poverty line. The lack of formal education, political neglect and poor infrastructure, some of the cultural practices have had a compounded negative effect on the health and livelihood of this community.
The most common health problems in Kuria include Malaria, enteric diseases mainly salmonella, amoebiasis and giardia, parasites, malnutrition, postpartum hemorrhages/complications and circumcision related complications (especially hemorrhages and sepsis).
Komoto health center was usually run by two nurses and a few locally trained nurse aides. From time to time, missionary nurses and an occasionally visiting doctors would come to assist on a temporary basis. Services provided included preventive health (immunizations), promotive services (education and training of community health workers), curative services (treatment for malaria, typhoid and parasites) and maternal/child health services ( perinatal and pediatrics). Because there was no permanent doctor, these nurses and their local Aides were trained and able to provide a wide range of services to this community.
This was the worst possible time for this outbreak to have occurred! I said to the church elders who had jumped down from the back of the jeep. I had to think quickly
One of the village nurses came running up to the jeep. God bless you! She said as she hugged me. We need some clean water and some masks for the health workers. We have to save the children! She exclaimed. I’m afraid that we will lose a lot of the children in these villages if this outbreak continues.
We need to get some of the village chiefs together as quickly as possible, I shouted to the village nurse.
What good will that do? The nurse replied as she headed toward the infirmary with one of the cans of fresh water. Come inside! You can help us with the children.
We need the Chiefs to help us persuade these villagers to postpone the Festival. If these gathering continue in the villages, they will grow in size in the coming days. Thousands of children and adults will be infected with the meningitis virus and these villagers will die like flies!
(Stay tuned for the next chapter Charles recruits the Village Chiefs to help him and the nurses in their race against time to stop the spread of meningitis and save the lives of the villagers)