Thursday, July 13, 2006
Operation...Vaccination!
The computers today are not cooperating with my pictures, so I will post images another day.
Rural life can be as slow or as fast as one makes it. This past week I had the great satisfaction of ending each day knowing most of its moments were used to their fullest. As expected, the measles campaign took over my life. Our first day, Saturday, we had over 500 children under the age of 5 attend our clinic to receive a strong dose of Vitamin A and E, a measles vaccine, and a free mosquito net. We quickly ran out of mosquito nets and had to ask over 200 children and their parents to return the following day. Very early on Sunday morning, we began innoculating the hundreds of children that camped out on the lawn, still without signs of mosquito nets. By noon, the crowd had swelled to include the hundreds of children we had vaccinated that morning and the families still waiting for a net from the first day. When the health officers arrived with a supply of 200 nets, chaos broke out. Hundreds of mothers carrying babies with toddlers at their sides were pushing, shoving, and charging through the door to our clinic without regard to any small children they tackled or crushed on the way in. So the health officer called a meeting with all of the staff to talk out a game plan while I was in charge of the mob. If all young children in the vicinity didn't hate me already for restraining them, forcing vitamins down their throats, and injecting them, they sure did now as I yelled and tried to use my body to block the door. After 3 more failed staff plans at regaining order (including a number system), the nets were carried outside and distributed in a slightly less chaotic manner than before (forming lines was still impossible so the women that crowded closest to the table were the first to receive nets). The next three days were not as hectic but still filled with staff disagreements over setting aside nets for friends and relatives, trying to prevent mothers from vaccinating their children several times to receive more mosquito nets, recovering from kicking toddlers, and wiping vitamins off my face that were spit back by the kids. Each day we fell hundreds short of mosquito nets and I kept repeating, "Kesho, Kesho" (tommorow, tommorow) to young mothers.
Yet, the Measles campaign wasn't all frustration. The most rewarding times were in the mornings, when the hundreds of mothers and children were gathered on the lawn before we started the vaccinations. I gave a health talk on Malaria prevention and treatment with the aid of my masterpiece stick figures, a demonstration of proper use of the mosquito net, and the nurse's translation. Over 90% of the patients we see at the clinic each day present with clinical malaria: fever, chills, headache, and joint pain caused by a parasite injected from a female mosquito's saliva into a person's red blood cells (that was for all you fellow medical nerds). If left untreated, it can develop into cerebral malaria and the patient can get brain damage or die. The most vulnerable are pregnant mothers and children under 5 because they have a weakened/less developed immune system. But the highlight of the health talks was Agnes. Agnes is a respected midwife in the Shikokho community that is living healthy as an HIV positive women because she is on the (government's free) anti-retroviral therapy drugs. Though the prevelance of HIV/AIDS is estimated to be high, most people in the community are very frightened of going to the voluntary counseling and testing centers (which a fellow intern is working on getting established in the nearest clinic) because they feel if they receive a positive test result, they will die very quickly. Many people have relayed the story of the man who went to a local VCT center, received a positive test result, and promptly went to the main road to be run over by a matatu/bus (they do speed dangerously). It was moving to see Agnes address these young mothers about this sensitive issue in such an honest and personal matter. Almost every day, there is another funeral for a father or mother who died too young, leaving children in the hands of grandparents, relatives, (or if HIV is suspected and this stigma remains) to anyone who will take them. I am hopeful that the young women hearing Agnes's story know the importance of early testing and treatment for their lives and the lives of their young children.
The most humorous thing about the campaign was trying to guess the age and gender of the children. We saw many "tall 5 year olds" and somehow the nurses decided to tell the parents (without my knowledge) that I had an invisibile age detector machine (which I guess people believed mostly because I'm white and myseterious). As I examined the children to see if they still had their baby teeth (the best way I knew of estimating th age), parents became afraid, embarressed, and awestruck when I questioned them on the true age of the child. It was later that I learned why. In Kenya all women wear long skirts (pants suggests prostitution), men wear long pants, and boys wear shorts. Because most of the clothing people in my village wear is from foreign donations, it is not uncommon to see boys in pink flowered or "Lisa Frank" shorts and girls in "Bob the builder" T-shirts. Added to this confusion is that all children have shaved heads. Parents have explained that if girls have long or braided hair, that will mean less time for them to do chores around the farm/shamba. Only a few girls even in the secondary/high school have unshaved heads. But for a woman, her hair is truly her crowning glory and she will spend almost every last shilling for a good style and braid.
At times the chaos of the problems and poverty can seem overwhelming. But last night, as I looked out onto Lake Victoria from my hotel room (I am in Kisumu to get some supplies for the clinic and my health education in the schools next week), I rediscovered the order and beauty in nature. God has given us a beautiful rhythm: sun up, day passes, sun down, sun up, day passes, sun down. This reminds me of the larger symphony at work, where we are all just notes, striving to become part of the harmony and make the work as beautiful as the composer intended.
Rural life can be as slow or as fast as one makes it. This past week I had the great satisfaction of ending each day knowing most of its moments were used to their fullest. As expected, the measles campaign took over my life. Our first day, Saturday, we had over 500 children under the age of 5 attend our clinic to receive a strong dose of Vitamin A and E, a measles vaccine, and a free mosquito net. We quickly ran out of mosquito nets and had to ask over 200 children and their parents to return the following day. Very early on Sunday morning, we began innoculating the hundreds of children that camped out on the lawn, still without signs of mosquito nets. By noon, the crowd had swelled to include the hundreds of children we had vaccinated that morning and the families still waiting for a net from the first day. When the health officers arrived with a supply of 200 nets, chaos broke out. Hundreds of mothers carrying babies with toddlers at their sides were pushing, shoving, and charging through the door to our clinic without regard to any small children they tackled or crushed on the way in. So the health officer called a meeting with all of the staff to talk out a game plan while I was in charge of the mob. If all young children in the vicinity didn't hate me already for restraining them, forcing vitamins down their throats, and injecting them, they sure did now as I yelled and tried to use my body to block the door. After 3 more failed staff plans at regaining order (including a number system), the nets were carried outside and distributed in a slightly less chaotic manner than before (forming lines was still impossible so the women that crowded closest to the table were the first to receive nets). The next three days were not as hectic but still filled with staff disagreements over setting aside nets for friends and relatives, trying to prevent mothers from vaccinating their children several times to receive more mosquito nets, recovering from kicking toddlers, and wiping vitamins off my face that were spit back by the kids. Each day we fell hundreds short of mosquito nets and I kept repeating, "Kesho, Kesho" (tommorow, tommorow) to young mothers.
Yet, the Measles campaign wasn't all frustration. The most rewarding times were in the mornings, when the hundreds of mothers and children were gathered on the lawn before we started the vaccinations. I gave a health talk on Malaria prevention and treatment with the aid of my masterpiece stick figures, a demonstration of proper use of the mosquito net, and the nurse's translation. Over 90% of the patients we see at the clinic each day present with clinical malaria: fever, chills, headache, and joint pain caused by a parasite injected from a female mosquito's saliva into a person's red blood cells (that was for all you fellow medical nerds). If left untreated, it can develop into cerebral malaria and the patient can get brain damage or die. The most vulnerable are pregnant mothers and children under 5 because they have a weakened/less developed immune system. But the highlight of the health talks was Agnes. Agnes is a respected midwife in the Shikokho community that is living healthy as an HIV positive women because she is on the (government's free) anti-retroviral therapy drugs. Though the prevelance of HIV/AIDS is estimated to be high, most people in the community are very frightened of going to the voluntary counseling and testing centers (which a fellow intern is working on getting established in the nearest clinic) because they feel if they receive a positive test result, they will die very quickly. Many people have relayed the story of the man who went to a local VCT center, received a positive test result, and promptly went to the main road to be run over by a matatu/bus (they do speed dangerously). It was moving to see Agnes address these young mothers about this sensitive issue in such an honest and personal matter. Almost every day, there is another funeral for a father or mother who died too young, leaving children in the hands of grandparents, relatives, (or if HIV is suspected and this stigma remains) to anyone who will take them. I am hopeful that the young women hearing Agnes's story know the importance of early testing and treatment for their lives and the lives of their young children.
The most humorous thing about the campaign was trying to guess the age and gender of the children. We saw many "tall 5 year olds" and somehow the nurses decided to tell the parents (without my knowledge) that I had an invisibile age detector machine (which I guess people believed mostly because I'm white and myseterious). As I examined the children to see if they still had their baby teeth (the best way I knew of estimating th age), parents became afraid, embarressed, and awestruck when I questioned them on the true age of the child. It was later that I learned why. In Kenya all women wear long skirts (pants suggests prostitution), men wear long pants, and boys wear shorts. Because most of the clothing people in my village wear is from foreign donations, it is not uncommon to see boys in pink flowered or "Lisa Frank" shorts and girls in "Bob the builder" T-shirts. Added to this confusion is that all children have shaved heads. Parents have explained that if girls have long or braided hair, that will mean less time for them to do chores around the farm/shamba. Only a few girls even in the secondary/high school have unshaved heads. But for a woman, her hair is truly her crowning glory and she will spend almost every last shilling for a good style and braid.
At times the chaos of the problems and poverty can seem overwhelming. But last night, as I looked out onto Lake Victoria from my hotel room (I am in Kisumu to get some supplies for the clinic and my health education in the schools next week), I rediscovered the order and beauty in nature. God has given us a beautiful rhythm: sun up, day passes, sun down, sun up, day passes, sun down. This reminds me of the larger symphony at work, where we are all just notes, striving to become part of the harmony and make the work as beautiful as the composer intended.
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