The Medical Scene

Here is a semi-comprehensive list of the crazy, fascinating medical situations I saw/watched during my days at the Maseno hospital (most of which are never encountered by real doctors throughout their careers in the developed world - woot for being well-versed in tropical medicine!):

1. A three-year old the size of a baby, pooping worms. They were upwards of 6-8 inches long and white!

2. The induction of a woman well over nine months pregnant with her eighth child by sticking a catheter up her into her uterus and tying the other end of it to her thigh to keep it taut to force her muscles to dilate.

3. A little boy (named Washington - I blew up a balloon for him and took him for a walk around the hospital yard to celebrate my 4th of July in patriotic style) with an abscess that took over his entire foot and oozed puss in amounts I before hand didn’t think possible. The Kenyan doctor shoved gauze pretty much inside his foot as his form of “bandaging.”

4. A lady with shingles all across her abdomen - she looked like she was going to pass out from the pain every time she moved. She also had HIV/AIDS, just like pretty much every other woman there.

5. A guy with tetanus. We had to keep him in a dark corner room with the door shut at all times because light and stimulation made him go CRAZY. We couldn’t have him thrashing around and freaking out with all the swelling going on around his brain.

6. A woman and her 15-year-old son, Jennifer and Daniel, with jiggers on their feet so bad they couldn’t walk.

Both mother and son were developmentally disabled, something common within our orphan program (which also dealt with single-parent homes unable to keep the kids fed). Women with disabilities are used for sex and often have children they cannot care for, many times with disabilities themselves.

Daniel's toes rotting off.

Both of them were rail thin, and Jennifer particularly was severely malnourished and was in the hospital as much for that as for her jiggers. Once we stopped the jiggers from spreading (that does not equal healed) and Jennifer had gained enough strength, they got to go home. Daniel ran to the jeep he was so happy to be getting out of that place where everyone poked his feet all the time.

7. A young man with rheumatic heart disease caused by a rheumatic fever. This was my very first day going on rounds, and I was shocked when the med students let me go right on up to him and listen to his chest like I actually belonged there (a feeling I started to get used to as I did indeed have an all-access pass to the hospital). He had two different murmurs going at the same time in different valves. It would take valve replacements for him to live - something that doesn’t happen in rural Kenya and probably not in Nairobi unless you’ve got the big bucks. He was sent home to die.

8. Rampant TB. Oh man, if I test negative the next time I have to get a TB test, I will be beyond shocked.

All it takes to have TB in your system is to breathe in one single TB spore. Where I was, especially in the women’s ward, everybody was coughing and hacking all the time and about 95% of them had TB. It is something that goes along with and is made much worse by AIDS. Just because I will probably be testing positive for TB from now on doesn’t mean it’s active. The odds are actually slim that it would be active, but for me not to have it in my system would be a shocker.

9. A chest X-ray that was so bad it made every doctor, including the Kenyans, give a great big stunned “Holy Shit” every time they held it up to a window to check it out.

Normal chest X-rays are supposed to be a healthy black. This one was almost completely white with little flecks of black in it. White = TB, and this lady was told immediately that she had HIV before they even had a chance to test her. TB that bad has to have something else helping it along.

10. Thrush. A lot of it. It’s a yeast infection of the mouth and any person (they were always women) who came in with it was automatically given and HIV test (which was always positive). Thrush is another condition that goes hand in hand with HIV/AIDS.

11. A hemorrhagic fever (similar to Ebola). This two-year-old little girl, Rose, came in practically dead. She had a raging fever and was pretty much non-responsive at that point. She hadn’t eaten in a long time and I doubt her mother was able to get much water past her lips.

They knew it had to be a hemorrhagic fever because they took a blood draw from her back and it never clotted. The tiny spot where the needle went through her skin bled for days. Dr. Hardison and the Kenyan doctors poured over old volumes on tropical fevers but she died before they ever got close to figuring out what was wrong. One of the Kenyans really thought it was black fever but Hardison said it absolutely wansn’t. Like so many others, we’ll never know.

12. Three different kinds of meningitis. I think there are only four, so that’s almost a complete set.

On my last day there, I saw the woman who was the worst off of them all. One of the most obvious signs of meningitis is a stiff neck. This lady was writhing in her bed, making sounds I have only otherwise heard come out of animals, with her jaw clenched, head jutting forward, and neck so stiff I had no idea how she could breathe.

Any time you tried to move any piece of her body, she sounded like a wounded animal. All she could do was grunt. I couldn’t imagine the pain. Dr. Hardison stuck a tongue depressor between her teeth to try and pry her jaw open so he could take a look at her throat and mouth. The poor woman snapped the frigging tongue depressor in half with her teeth. Those things are wood. We tortured her only long enough to dig the bigger shards of wood out of her mouth so she wouldn’t swallow them and slice her throat open on the way down. If she lived it would be an absolute miracle.

13. And last but not least, a lady who was on death’s door, the most stereotypical emaciated image of AIDS I saw during my three months, and pregnant.

Her sister brought her in because she was almost dead and wanted to find out if there was anything else to do for her. Her eyes were completely sunken into her head and her face was all cheekbones and no flesh. I’m thin folks, and I looked downright husky next to this woman.

During her initial exam, Dr. Hardison was pressing on her belly as doctors always do and gave an astounded “there’s a baby in there!” It takes a lot for someone who works in that hospital to sound surprised (see #9). They knew she was at least 20 weeks because they could feel the baby up by her belly button when they pressed. After a sonogram on our portable kit, the head measurements showed the baby to be at 7 months gestation. 7 months.

Her belly was concave, she was so thin. They fact that there could be a baby inside of her that far along may be the single most incomprehensible thing I saw during those months. Considering the fact that she didn’t have the strength to chew food, I have no idea how she could have possibly mustered the strength required to give birth. I assume that both mother and child are gone now.

The common thread through most of these situations?

AIDS, AIDS, and more AIDS.

It was less prevalent among the men and (thank God) the children, but almost every single woman who came through our doors was infected. Women have a higher likelihood of being infected because they are a receptor during sex. That combined with a culture where women are seen as sexual objects with no rights over their own bodies and married men tend not to be faithful equals a disaster for those unfortunate enough to be born female.