Sunday 31 July . Finally a rest day. I (Rifka) tried to sleep in but the sunrise was too beautiful and the rooster was crowing . David made coffee and lots of fried potatoes for breakfast. We also had scrambled eggs, chapatis and fresh papaya.
Saturday was very different than expected. I (Rifka) thought I would have a rest day but instead I was asked to accompany the nurses to help do male circumcisions (female circumcisions –FGMs– are not done here). In old times, boys between the ages of 6 and 10 were circumcised in August as part of a ceremony that involved slaughtering a bull. Now people aren’t wealthy enough to do the full ceremony, but continue the circumcisions.
Wilfred, the nurse who was my translator 2 years ago showed up. He is now working up near the Ethiopian border where he said the biggest problem is malnutrition. He is on vacation for the next month but came back to this region to do circumcisions on young boys on his own time. The three male nurses gathered all the equipment from the clinic and we drove about 45 minutes to small village called Mekelingi. They set up in a small building with 2 tiny rooms. They set up their equipment which had been all sterilized on a clean cloth on the floor. Two circumcisions were done at the same time. Rifka helped with the anesthetics and handing instruments to the nurses.
The first boy was brought in and he lay down on the table with his lower legs off the end. His penis and surrounding groin area were cleaned with alcohol and betadine and then a local anesthesia was given. I’ll spare you the rest of the details, but it was done quickly and cleanly. Most boys cried but a few didn’t. During the procedure there usually wasn’t too much pain. Four of us from Kisesini helped by trying to talk with the boys and sometimes held them if they were very scared. By the end of the procedure they had calmed down and were able to get up off the table without problem. They were dressed in a sheet, wrapped around them like a toga and tied at the neck.
It took about 3 hours to do 11 procedures, but we had to stop in the middle and resterilize the instruments. They were cooked over a small propane stove in the pressure cooker.
Fri July 29. Evening time. We are mostly outside. One of the MPH students is playing air hockey on an ipad with 2 of our interpreters. They are delightful young men about 25 years old and will help us with anything.
Profiles of the Poorest
Today David and I walked about 4 miles around to 2 different very poor households. One woman was widowed and is trying to raise her 3 children by herself. Her home is about 8 x 8 feet. She cooks outside over wood. She has 3 chickens but no garden. Then we went to another home with an old grandma, who is 77. She barely gets around with a stick because she has such bad arthritis. They need everything, food, bedding, clothes and school fees for the kids. I came back covered in red dirtI came back covered in red dirt.
We went to the river where people get water. They dig a hole in the dry sand at a bend in the the riverbed. If they dig deep enough (sometimes 10′ down), water seeps into the bottom of the hole. People patiently scoop water off the bottom of the hole, filling a bucket, pouring each small bucket into larger ones tied to a donkey. The donkey can carry four 20 liter cans and he may have to walk several miles to get the water home.
The land is very dry and dusty. There are aloe plants and other cactus. The plant that makes the fiber the women weave into baskets looks like the century plants we have in Albuquerque. Mango trees are the only lush tree in sight. They are beautiful bright green and tall.
Today’s Clinical Impressions
I (Rifka) worked in the clinic in the afternoon. I did get to see a few very healthy babies. It was great to reassure the moms that they were doing a good job and just had to keep breastfeeding their babies. One of the moms had started supplementing her 4 month old with goat’s milk and the baby had a little diarrhea. I explained how important it was not to give anything but breast milk for 6 months. Later, I saw a 32 year old man who had lost a lot of weight and had a large growth in his upper abdomen. We are taking him to the nearby town of Machakos for more testing.
Every day I have a better sense of what are common complaints, what tests and and what medications I can prescribe, but everyday there is something very difficult and challenging that I have not seen before, or I feel I can not do much help.
Cloudy days mean little power
It is peaceful here and when the sun is out we can see rolling hills for miles. It has been very cloudy and it is interfering with our ability to communicate because we can’t charge the solar batteries enough to keep our computers running and our internet connections are so slow.
Baraza, a community meeting
Rifka’s note. 7/24/11
We’re travelling with lots of stuff–may be only 20 lbs of clothes each, but we have a complete 15 watt solar electric system, and a 5 watt one. Baby blankets, bulb syringes, medical equipment, calcium, school and office supplies, two gps, one computer, 40 lbs of paper household records. lots of rechargeable batteries. I’m preoccupied with power issues. Most of the work we plan to do requires a computer and computers require electricity. The last time I was here I begged space at the Catholic Mission in Katangi and spent a day working in something like a monk’s cell with one table and one chair and a power outlet. This time, if the sun shines, that won’t happen.