Thursday, October 25, 2007

Wolaita, Ethiopia: 10/25/07

Ruth and I are sitting in her kitchen enjoying the music Shelley sent to us. There is so much to share about today that I don’t think it is possible to get it all said. We stayed up late, late last night talking about everything, then got up early to drive 1.5 hours with Dr. Mary to a Wolaittan village called Gadalla, where she practices medicine every other Thursday. It is like a county seat, but for a smaller area.

On the drive in, we saw a donkey cart carrying a pallet with a sick woman on it. Children chased us yelling “Mary, Mary.” When we arrived, we found the sick lined up outside the clinic. The first ones on homemade stretchers and the others sitting or standing in line. We handed out cards to those in line, which guaranteed they would be seen. Those who were late must return in two weeks. People traveled for hours and even days to get to the clinic.

The government buildings are constructed primarily of mud mixed with dried grass and are quite dark inside. I had to use my flash, which gives the photos a look that is not really accurate.

We set up in an empty room that is the clinic. Someone brought in a bench, two chairs and a small table, which later in the day became the pharmacy. We left all but one window closed to protect the medicines and food we brought, and make a place to get away from the people for a break once during the day.

Patients were seen outside by Dr. Ruth, who made notes on scraps of paper until the paper ran out, then used her hand. They really need packs of post-its or small pads of paper to write prescriptions on. Helping her was Sebastian, a German medical student and two boy translators, who are in a school Mary runs where they learn English. Also helping was a man that I suspect Dr. Mary hired because he is older and has trouble finding work. He carried the scale, and acted as sort of a guard; sometimes chasing people back with a switch he made from a corn stalk.

I took photos while holding the baby, but I will get to that later.

Cases that needed a second opinion were sent over to Dr. Mary and her young translator in the clinic. Dr. Mary speaks Wolaittan, and it appeared the boy would clarify, or translate into Amharic when needed. Dr. Mary saw these patients, organized medicines and handed out food to those in her food program.

Next to this place was another small building that serves as a school. The children bring small stools or sit on the dirt. There is a chalkboard with the English alphabet on it. Wolaitan language uses the same letters we do, but the vowels are pronounced like they are in Spanish. When we arrived, sixty or so children were crammed into the room, doing lessons by chanting. I think the noise made it difficult for Mary, so it was good when they finished. Dr. Ruth also had challenges hearing the people outside because there were so many people gathering and talking around her. She often had to ask people to be quiet. Each time, some people would take it upon themselves to police the others. Men would smack the women, talking or not, who would in turn slap the kids. Five minutes later it would be noisy again. Relentless flies buzzing, kids playing on the donkey carts, cattle munching the banana leaves behind the clinic and donkeys yelling at each created a distinctly soundscape unlike any I’ve heard in South Carolina.

I’m trying to think of words to describe the problems we saw, but the words like “heart-wrenching” have been so overused, they don’t touch what we all felt. Here are some snippets of the conversations.

Ruth, “how often does he get to eat meat?”
“once, maybe twice a year.”
“any papayas or mangos, or vegetables?”
“no, just corn or bread or fake banana”
“well, with his condition, he needs some vitamins or he will go blind. Is it possible for him to buy some fruits and eat them on a regular basis?”

Ruth, “how long has she looked like this?”
This was about a woman who looked like she was nine months pregnant with twins.
“Ten months. She had a baby, but no blood came, then she swelled up like this.”
“The baby was born and looked normal?”
“did the baby live?”
“I will get a can, will you see if you can get her to urinate in it?”
Six people carry her stretcher behind the clinic and come back with the can.

There is no privacy. People gather all around the person being examined and watch everything. Maybe this is good as they may learn some methods of healing and prevention. One woman pulled her shirt aside to show me her breast. Most of it was gone and the remainder looked as if it had been horribly burned and blistered. At first glance Mary said cancer, then they made more observations and diagnosed her with localized TB in the breast.

Diagnoses in the field must be made without lab work, by observation and conferring with each other and medical books. Sometimes the people need to go to the hospital. If the case is dire, and Ruth refers them, they can be seen using the benevolent fund.

Ruth, “she needs surgery for this hernia, do you have bus money to get her to Soddo Christian Hospital?”
“okay, well, she can wear a scarf tied tightly around it, then, when the pain gets very bad, which may take some time, you must try and find a way for her to come have surgery.”

To a girl, who for over one year had one eye horribly swollen and protruding from her face, “I will give you this card, and you go to the hospital with it, and they will see you.”

One boy we took home with us. He is ten, and had trouble breathing. He was bone thin and the skin sucked in and out of his lower ribs when he wheezed.
Ruth, “how long has he been breathing like this?”
“two years now”
“and what color is his spit?”
“it comes out with pus and is yellow.”
One look at his father’s ragged clothing and lack of shoes and I can see why they put off the trek to the doctor. I wonder what it cost them to not work for a day? I saw not one of the patients or family members eat or drink all day. They decided it was TB, confirmed on an x-ray even I could read when we got home to the hospital. Sweet boy was scared. I think he had never seen a “city” before. He liked my camera, though. We bought him a soda and gave him shoes and a shirt and will check on him again tomorrow. He is on oxygen and has an IV. I can’t imagine what he is feeling.

Dr. Ruth and Dr. Mary are amazing people. Dr. Ruth is in her element in this situation. Each person she meets must feel they are the most valuable person on earth when she talks with them in her sweet voice. Though outwardly calm, I can see her mental gears running hyper speed while she diagnoses, then tries to figure out what her patients have the means to do that will help. I saw her do this in the Dominican Republic, dispensing orders like these for diabetes, “if you can, you must try to drink three glasses of pure water each day,” and, “if I give you shoes, will you keep them on always and protect your toes?”

Mary’s love for the people is more evident in the many things she thinks to do to help them. She spends so much of her own money, I don’t know how she manages. One of the many things she does is make up vitamin packs. Each day’s dose is wrapped in a triangle of newsprint. The pack contains a malaria preventative, folic acid and vitamin b. She started just with the women, and found that men also really thrived on the folic acid/b combination.

She also had large milk cans filled with homemade Bisquick that she distributes to families that are malnourished. It can be mixed with water and baked traditionally to make nutritious bread and contains protein powder, and milk solids along with other vitamin enriched flours.

Today was the first time Sebastian had seen rural medicine in an area of extreme poverty. I felt for him. He is young, and I’m sure what he saw today will stay with him for a lifetime. He was very tired when we got home – I think emotionally. He did a wonderful job, too. In Germany, he was able to attend med school for around $800 a semester because it is governmentally subsidized (and, interestingly, there are no entrance exams), and he will have a job after taking this time off to do this work. His girlfriend is in Ghana working in an orphanage while he is here. She contracted a bad strain of malaria her first week and used up all her malaria meds treating it, so he is worried about her.

After they finished seeing all the patients, the people lined up to get their medicines at the makeshift pharmacy. Dr. Mary charges them a very small fee, which I think is a good idea because it maintains the value of her service.