Jonathan’s Blog

Maisome Part III

Only in retrospect do I realize how smooth the clinic in Bumbire actually ran. The Maisome clinic on the other hand is a heart-breaking example of rural African medicine. The clinic itself is a well constructed building whose design shows real forethought into the needs of the community. There is a large outdoor waiting area, a registration counter, the doctor’s office, the lab, and a pharmacy counter all organized to promote the efficient flow of people. Wooden panels in the walls connect each of the rooms, so presumably charts and specimens would be passed back and forth. That is, at least, if there were a staff. Unfortunately, only 6 months after the clinic was built, the health care officer and nurse in charge stripped the building of its pipes and shelves and took off in the night. Now there is no running water (despite the massive tanks beside the clinic), and the beds in the ward are without mattresses. And now this shell of imagined greatness is run only by a staff of two: a part time nurse and Mgupta, the health care officer. Mgupta is a friendly, short, bald man who wears an oversized black suit and gives off an unmistakable used-car salesman vibe. As a health care officer, he has more training than Flora back on Bumbire—or at least just enough to blurt out phrases like “compleecations of diabetes” at inappropriate times. Bob comes to Maisome for three days out of the month, but for the rest of the time the clinic is run by Mgupta armed only with a monocular microscope and a manual centrifuge. When Bob would ask for amoxicillin to treat a urinary tract infection, Mguptu is quick to yell out from behind the pharmacy desk “out of stock”. Mguptu orders all of the clinic;s medicines and as supplies would indicate, only believes in injectable penicillin. Once again we had to go into the Bumbire stockpile.

Because I know so little Swahili, and the clinic was very busy, I had the honor of using the newly purchased microscope to look at blood, and stool specimens. Since there is no electricity I use a flashlight as the light source. Mgupta uses a mirror, which is nearly impossible.  I ruled over the lab. The microscope was at the end of a long counter next to which was an assembly line of patients’ charts, each topped with a small bottle of urine, a match-box (or in some cases a leaf) with a sample of stool, and sometimes a blood smear. Some patients preemptively bring a stool specimen, apparently knowing how much Mgupta likes to use his microscope. The patients at Maisome have been far more interesting than those on Bumbire—probably because they’re all waiting to see Bob. Yesterday we saw a guy with 6 months of hemiplegia (presumably from a stroke) who was adamant that someone had placed a hex on him. He had cuts all down the paralyzed arm and leg where the witch doctor had set to reverse the curse. The man said he paid a goat for the service. We spent a good hour examining this guy, but by the time it came time for him to pay us the equivalent of 4 dollars he said he didn’t have any money. The AIC can’t convince Mgupta to collect before services are rendered. We also saw a 3 year old with malaria so severe he had a hemoglobin of 4 and his urine had turned black (a true case of “blackwater fever”). Mgupta doesn’t have the equipment for a transfursion, so we could only give him malaria meds and refer him on to the closest hospital on the mainland.

For me the most gratifying experience is to find a parasite in the blood or stool and being able to give a simple, affordable medicine to treat it. Unfortunately most of the time we just don’t have the capabilities to either diagnose or treat what afflicts these people. Some wait hours or even days to be seen, so we make sure that everybody, no matter the complaint, leaves with something, even if only a placebo. In this way I suppose the clinic in Maisome is a lot like those in the U.S.