Tuesday, 13 December 2011

Elective 40. Rabies planes and miracles.

Today started off by being woken up at 5am, freezing cold, with rain pouring into my room through my holes which serve as windows. The lovely rich smell and new sensation of being cold didn't stay pleasant for long, as I soon realised I couldn't close my windows (broken bits of blinds made of glass), and had to move my clothes away from the windows to stop them from getting any wetter. I made a nest in my bed of them, as there are no blankets. At a more civilised hour (6.30), we were picked up by the four by four (borrowed from the school, remember the hospital still has no transportation of its own) and driven for 2 hours to a lone hut. I was not feeling too well this morning so dosed up on paracetamol and ibuprofen before the journey. After arriving at this single hut, by a patch of ground used as an airstrip, Kiwi flew to another location in a plane, while Dolittle and I helped out at this lone hut. This way we were helping at two medical safaris as a group. I am not sure how much use we were. Before we left the safari, a 12 year old boy was bought to us who had had a large bite taken out of his face by a "Crazy, ill dog". We managed to get him onto the plane to take him to a large hospital. Hugely lucky that it arrived at the right time I was feeling a lot worse for the journey home, which was not helped by being squashed onto a seat with far too many people, and having Dr BT fall asleep onto me throughout he journey. I had a very high temperature, perhaps sitting in the sun for so long started leading me towards sunstroke.
The lone hut that we carry the clinic out in, in the middle of nothing, under a tree. A very strange location, but hundreds of people turn up over the day, so clearly a popular location!

To start at the start of the story, the schools 4x4 now doesn't have a working battery, so to start the journey we have to have four people push it to a roll, when the engine can then be started. Despite this little difficulty at the start, the rest of the journey is great, and the journey was very scenic. We admired the beautiful scenery, which was mostly sparse scrubland (beautiful in its emptiness) with the occasional person walking, seemingly hours from the nearest habitation, and occasional villages where people spilt from the houses to watch the car (a real rarity this deep into rural Africa) go by. My favourite location was a vast lake bed which we sped across, where the mornings rain had caused slight puddling in patches. It was just a vast empty space. The road all the way was an uneven dirt track, which couldn't have been traversed by a normal car, often Covered in obstacles such as cattle being herded across, and chopped down trees or bushes. One of these spiky bushes proved too much for the 4X4 and we had to stop for 30 minutes to fix a puncture.

A view across the huge dried out lake bed, you can just about see a hill in the very distance on the left. Everything here is so vast!

Once we got there, the same pilot who flew me on safari in my first week was waiting, so Kiwi took a plane with him, like I did 5 weeks ago (it sounds so long, yet feels so recent), and I stayed with the 4X4 at the hut with Dolittle.

The preacher sings songs with fun actions with the children who are waiting, before we can start the clinic

Our day starts off positively, there is no person playing phone music through a megaphone, and a preacher is instead employed in making lots of noise. Despite all of the people waiting to be checked by us, he needs to give a sermon to the adults, then sing with the children before we can go ahead. I love all the African songs, they always sound so happy! When we start, we are  weighing babies and pregnant women, plotting their heights and weights on their respective charts, while a nurse sorts the charts into those needing a vaccine and there who don't after we have filled them in. The weighing is done under a tree, which is close to the hut (from where the first picture was taken) as the hut is used for antenatal examinations and vaccines. This does mean we are left in the sun for a long time. After a few hours, interrupted only by being asked if we are happy to eat the lunch provided by the village (Yes. Of course. Its rute to turn down food, and I am getting pretty hungry), the supply of people needing to be weighed begins to peter out, and I am asked to go and help with the antenatal checks in the hut.

I head over to the hut where a nurse is examining pregnant ladies inside. A large single window in the side means each lady covers it over from the outside with her kanga before entering, to give her privacy during the examination. I examined a few women's bellies, checking the position of the foetus (head or feet first), foetal heart rate and so on, while the nurse asked the questions and gave HIV tests and took haemoglobin measurements with a little meter. After a few women had been examined, the nurse just left, not saying anything. I waited a minute, hoping she would come back through the door, but when the next woman started hanging her kanga outside the window, I left the hut to stand outside, so I didn't end up expected to examine women on my own. I cannot talk nearly enough Swahili! I stood outside the hut for 15 minutes or so, and when the nurse didn't return, I went to sit with Dolittle by the scales. We waited for over an hour, talking about meaningless things such as what animal we would like to be (swift for me, butterfly for her), all the while surrounded by waiting children and pregnant ladies sitting on the (sun drenched) ground. These people intermittently tried to communicate with us (likely saying, please give me my card back so l can go home) but we didn't understand.
The equipment we are using doesn't give very accurate readings - this scale which gives results in Kg has to be used to weigh little babies, meaning any results cannot be taken too seriously. I love the fact that it says 'made in west Germany' at the top, showing its age... 

After the nurses come back from what it turns out was the lunch break (clearly no mzungu invited), we seem to be surplus to requirements, and are left by the scales, weighing a straggler every 20 minutes or so, but mainly sitting around. Very boring, so we keep chatting, though I am secretly pleased, as I am starting to feel very unwell, sick and headache-y (though I feel I have no right to complain with all the very ill-looking people around).

After a few hours, as things are quietening down, a motorbike speeds up to the hut, and all of the mothers and children crowd around it. Assuming they are all just interested in the motorbike, a rarity this far out, we stay sitting under our tree chatting in the shade, until a man rans up "Doctor! Doctor! Emergency". I don't correct the 'doctor' as I normally would (no point wasting time) and as there are only nurses at this outreach clinic (Dr BT went on the plane with Kiwi), we hurry across to the motorbike, through the crowd of women and children, to find a 12 year boy missing a chunk bigger than his fist from his cheek. The hole starts at the right corner of his mouth, and saliva is dribbling out, uncontrolled, stained red with the blood. The fatty tissue inside the cleaks is clearly visible. We are both clearly mesmerised by this sudden appearance, as the man who initially called us over decides to go on, and says "he was bitten by a dog" I ask if the dog is anyone's pet (thinking rabies) and he replies that it used to be, but now it is crazy and has gone of on its own (I am definitely thinking rabies now!) If only Dolittle had been around to talk the dog out of its craziness! We beacon the kid over to the hut, and as we are walking there, to see what supplies are available, we hear the plane in the distance on its way back with Kiwi and Dr BT. The timing couldn't be any better!

The injured boy is loaded onto the plane while the locals watch. No such thing as privacy in Tanzania! 

I tell Dolittle to go to the plane once it lands to ask about supplies and space for passenger (clearly the boy cannot stay here), and I take the child to the hut for initial treatment (I can be very bossy!). I ask the nurses there if they have any saline/sterile water/pain relief (no to all), so the boys father ends up washing our the wound with our bottled drinking water (more sterile than the lake water), and soap powder. The initial treatment of rabies needs the wound to be washed thoroughly as fast as possible. Since I first saw him, and all through the washing of his (gaping) wound with soapy water, the boy hasn't flinched, said a word, or shed a tear. He is either very resilient (this wouldn't surprise me after some of the things I have seen) or (more likely) is in shock. He has had a large chunk of his face bitten off... After the wound is washed and all our drinking water used up, we take him to the plane, where he is efficiently bundled in with the man who bought him on the motorbike (a friend of his father [family goes a long way in Tanzania]) and flown off to the 'major city' hospital which will hopefully have the rabies vaccine and immunoglobulin needed (our hospital certainly doesn't, hence the need to send him elsewhere). Before leaving, the pilot thanks God that he arrived just at the right time. I agree, it is a wonderful coincidence, and we are so fortunate that not only was the monthly medical visit in the area when the boy was bitten, but there was a plane nearby as well. Bit I think that, if God had his finger in this, then would he let a 12 year old have part of his face bitten off? If it can be repaired, there is going to be pretty horrific permanent scars and loss of function. I do know there are no plastic surgeons where he was sent...

After all this excitement is over, I realise l am feeling a lot more ill, but we soon depart for home. The journey is awful, I can feel every jolt in my super sensitive brain case, I feel very sick and cannot take my eyes from the road. In addition to all of this, I also have Dr BT falling asleep on my shoulder the whole way (not very nice) but I suppose I am fortunate to have a lift. The boy and the man who went off to the major hospital have no way of getting back to their village. No money for transport. Hopefully they can wait a month and then come back on the plane when it next visits.

Once I arrive home at 7, making this a 12 hour working Saturday (why did we volunteer to do this!), I fall asleep on the sofa while Kiwi and Dolittle supply me with water and pain killers. I couldn't ask for better flat mates. Its just sad that I had such a rough end to a day with such excitement.

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