Working Class Hero

Work. I don’t even know where to start.

It has been quite a while since I’ve addressed my work situation. Namely because the past week has quite rough in that area. My new diet plan: “get Giardia in Africa.” It works, guaranteed to shed pounds in days. I lost a 10lb bag of salt. Can you imagine what it’s like carrying around an extra 10lb bag of salt everywhere you go? I’m on day #6 of my illness and day #6 of not eating. Basically, I have a little parasite living in my intestine that steals all my food so I don’t get any. Matt was kind enough to send me a photo of what the little buggers look like under a microscope so I know what’s living inside of me. How sweet and thoughtful. They look like old men.

Being sick and on the foul smelling wards while standing for four hours at a time and not eating for days all combine to some hard days. The week was kind of a blur of being miserable and leaving early to go home and sleep. I knew someone was looking out for me one day, however, when I left work early because my stomach hurt so bad I couldn’t even stand up straight. I was actually crying walking home because I didn’t know how I was going to make the 15 minute walk when a woman, whom I had only met once before, pulled over and offered me a ride. Talk about the best moment of my life!

I’m still on the Umoja ward at MTRH. We were supposed to be able to rotate through the women and peds sides, but our Kenyan counterparts who were supposed to arrive on January 15 to work with us, decided they weren’t going to come until FEBRUARY 15 which is just a week or so before we leave. Therefore, if we leave our teams, nothing gets done about the meds so we feel the weight on our shoulders. Let me tell you, with HIV/AIDS all around, that weight can get pretty heavy at times.

I felt terribly defeated one day last week. It was actually the day after Obama’s inauguration. We admitted the night before so we had many new people on our ward. I felt everyone was in pretty bad condition, but for the most part were fairly stable. I then left for lunch and upon returning an hour and a half later, found three of my patients dead in their beds. My head was spinning. How could three people go in such a short period of time? Two of the deaths were difficult to take in, however, they were both elderly men who had lived long lives to be proud of. One had an exacerbation of his congestive heart failure while the other had a suspected pneumothorax with a collapsed lung. Both were in respiratory distress. The third death was outraging. A young man came into the hospital because he had become drunk, threw up, and aspirated his own vomit. In the states, this would have been easily reversible and the patient would have been fine if everyone acted quickly enough. He had inhaled enough to clog his lungs and we weren’t able to get a suction machine and oxygen to him. Though he was looking “okay” when I left, he apparently vomited again and suffocated on the wards. What a way to die. Especially in a hospital. As if to kick me when I was down, I got to watch my fourth patient of the day die when he hemorrhaged and slowly faded out over 10 minutes with painful gasping of air. Change we can believe in is needed here.

My favorite day this past week was on Tuesday when I went to the inpatient psych ward with Michael and Thad, two Brown University residents who are conducting research here. Anyone who knows me knows my affinity for psych so I was pretty excited to go. I can’t even begin to describe what this was like. First off, the “psych ward” is an open dirt yard with a wooden fence around it. That’s it. The patient spend all day and night outside in the dirt. Upon walking in, I was greeted by NINETY patients in this small enclosed area. Of course by my walking in I caused a scene and when this many patients get riled up it’s quite a show. EVERYONE came running at me. Some wanted to shake my hand, some wanted to touch my hair, some wanted to yell obscenities at me, others just wanted to stare. One guy found a cookie in my pocket (in case I was getting faint or dizzy) and told me, “God loves me and I love you, so give me my daily bread.” My two favorite people were a woman who stood about ten feet away the whole time and just yelled over and over, “Muzungu! Muzungu! Work harder!” and a young boy with a pervasive development disorder who looked half awake with a silly grin on his face that stole the doctor’s sports jacket, ran to give me a hug, then dropped in the dirt to roll the doctor’s clean jacket in the red soil.

Interviewing the patients one at a time with the team was also interesting. I can’t even begin to explain what it was like. First off, mental illnesses here are so incredibly taboo that no one talks about it. When they present in the midst of an episode, they all show up at the ER claiming they have malaria. Depression is not talked about here, so most everyone in the ward has schizophrenia or bipolar disorder in the manic phase. The other big thing is substance abuse. Mainly alcohol and glue sniffing. Another thing is no one admits to problems with alcohol. If you ask someone if they have a problem with alcohol they say “NO!” However, if you side step a bit and ask questions from a different angle, you’ll find out they drink an average of 12 bottles of beer a day and changa, which is homebrew.

While we’re “interviewing” the patients, they’re up and wandering around the yard and occasionally come back to see if we’ve become any more entertaining since they left. One woman decided we were so boring she needed to entertain us by dancing and singing in her native tongue. It took three guys to sit her back down. Another guy stripped down and started chanting prayers to God – which was obviously him. One interesting thing I noticed on a lot of the patients was the presence of burns around their ankles and wrists. When I inquired about them I came to find these were rope burns from being tied down. When the patients are manic or psychotic and not in their right minds family members literally tie them down. This is for their own safety. The example given was that if a lion was around, the patient wouldn’t know to be afraid, and would instead try to approach it and possibly their own death. I’m glad we don’t have to worry about lions in Indiana. One custom that really bothered me on rounds though was the medical team’s laughter at the patients. In the states, this is absolutely forbidden and terrible when it happens. Here, everyone laughs freely which is sometimes enough to make your blood boil. Often these differences in culture are hard to take in. A working class hero is something to be.