White Knuckles and Skinny Babies

I didn’t blog yesterday because it was a pretty uneventful day. Went to the hospital to watch the village health workers interview the standardized patient (we do this at Einstein as part of our training too) and then Sarah and Maddie peer pressured me to go for a run. I told the girls that Deus told me the road we were on lead to the Congo border and when I got back we realized I was right. Had we all been in better shape we could have found ourselves in a pretty interesting situation (sorry mom!).

Today (Saturday) was our first day out in the community. It was also my first time on the back of a motorcycle and the roads here are terrible. Since this is going to be a necessary mode of transportation here, I am not going to vent and scare my mom but please ask me about it when I am home and I will gladly share all of the terrifying details. Needless to say, the white-knuckle component of the title was inspired by my trip today.
So, Katrina (fourth year), Deus and I took a 30-minute ride toward the volcanoes and out into the more rural villages. We were seeing patients that are part of the chronic care management program so patients met us for medication refills and to be examined. We made three stops and each clinic location was truly different from the others. The first was held at a very nice farmhouse in a rather large town. Most of the patients at this location suffered from asthma, diabetes and hypertension. I got to take blood pressures and listen to some interesting lung sounds and observed as Katrina and Deus instructed patients on proper medication schedules. I kept getting distracted by all of the farm animals but I don’t think anyone noticed or minded.
The second clinic was located outside of a small home in a more rural setting. One of the patients at this location was a woman who had lost sight in one eye as a child. Last year she lost sight in her other eye so she was functionally blind. Katrina described this woman as having a very poor quality of life. BUT thankfully, Jerry’s program was able to provide the funds for this woman to see the eye doctor and later to have cataract surgery. She is now able to see and I was able to meet her and her two young daughters. It was great to see what a profound effect medicine can have in a person’s life here.
The last stop was the most difficult for me. We headed even further out of town and ended up at the base of the volcano. Some background information: malnutrition rates in children in Kisoro are at around 50%. Illnesses related to malnutrition like Kwashiorkor occur at rates of 2%. The interesting thing is that it is not clear if the malnutrition is due to lack of food/money or if it is due to lack of knowledge about what the right foods to be eating are (there are lots of carbs available but protein is hard to come by here). The home where the last clinic was held was built out of mud with a tin roof. I entered the room and first noticed that there was no electricity so it took my eyes some time to adjust. Then I looked around and saw that most of the patients were young women with babies on their backs. Katrina explained that in this village there is a high rate of malnutrition so screening would be a large part of our time there. Thankfully, most of the babies had gained weight since their last visit and most looked great. One child though did not appear well. He was two years old and looked severely underweight. While his MUAC was within the normal limit, there was just something wrong with his overall appearance, he was so small. While the other kids squirmed around and interacted with their environments, this boy remained stationary and seemed to struggle to keep his eyes open (lethargic). His mom had a cough and a two month old child that she was nursing while we examined the boy. The mother informed us that her son had been coughing for one month and that she had been struggling to get him to eat. He had visited the nutritionist in May and been given the nut butter weight gain compound we use here but she said he wasn’t eating it. His respiration rate was fast for his age group. In the US this boy would have been sent to the emergency room to be evaluated. Since it is Saturday here there is no one at the hospital to see him so he will have to wait until Monday. I really hope that he gets the medical help that it seems he needs.

On a brighter note tomorrow is Sunday and will be our first full day off since getting to Kisoro. I think we are going to head to the lake because the view is supposed to be spectacular.

SIDE NOTE: Please see facebook for my photos, my internet is too slow to post them here.