The Vectors of Diseases: Bats, Flies, Mosquitos and Mice
Last night a couple of bats hovered in our room driving us batty. I am not sure what it was but it drove one of them crazy while I tried to read with the headlamp, it hovered and then stuck itself on top of my mosquito net, peering in. Could it really since bats are supposed to be blind? I was not too thrilled about the rabies carrier so close to me. As I tried to open the door to let it out, it flapped around me threatening to fly right into my face. The door was left open all night and the bats flew around and also flapped noisily in the rafters just outside the room. Our sleeping area was quite pleasant with the door open letting in a cool breeze. In the bathroom for our bucket bath there were three different kinds of toads greeting me as I walked in waiting probably for a feast of insects there.
In the morning I ran on the road away from Koch. After running past a few compounds it petered out. A cow path meandered through this endless flat land. A big water hole was completely dried up. The area that I ran on seemed to be wetland in the rainy season. Soon I saw a number of curious looking man-made mud craters of various sizes surrounding a borehole. Looking into the hole, I could see water about twenty to thirty feet below. Far away a group of girls and women were drawing water from another borehole. Indeed there were about a dozen of them here, some were dried up all surrounded by these craters, not sure if the craters were made to contain water for the cattle or for other purposes. Later James told me they were made to contain the mud so it did not block the bore hole. Last month two young boys went down one of the bore holes to retrieve a lost item only to be trapped and suffocated in the hole. Rescue came too late for them. One could really fall into one of the boreholes wandering around this area in the dark. The water that was drawn was tinted a light brown.
I ran back to the village passing a water pump surrounded by a group of village girls drawing water into their Gerry cans. The children probably have no schools to go to. Some are herding cattle and the girls are doing chores. Literacy is around 27% among adults and only 1.6% of the children are enrolled in secondary education. Over here in the bush I have not seen a school yet, a boy had a collection of cow dungs stacked up on his palm as he waved at me.
After a breakfast of tea and chapatti with locally made peanut butter, we walked to the hut of the Director of the Baow Payam (township), an unsmiling man looking rather stern. Johnson reminded him that Daniel from MTI came and met him a few weeks ago to do an assessment of the health need of this area. We are the first team to be sent and then to be followed by others for a period of six months. Again the meeting with the various heads is all very necessary for a project to be accepted and supported by the community. We hope that being the first team we could pave the road and make it easier for the teams that follow.
The sun was getting hotter, I was wishing that I had brought my hat and Bonnie her sunscreen. We walked back to the Baow Primary Health Care Center which is next to our compound. Already there were many patients waiting under a Neem tree right in front of the Primary Health Care Clinic sitting on a dead Neem log which was their long bench. In this small block of building there are six rooms and a small waiting area: two consultation rooms, a laboratory, an injection room, a pharmacy and an immunization room. I took a peek at the pharmacy and found several bottles of amoxicillin, co-trim, paracetamol but most of the shelf spaces were empty. UNICEF of WHO is launching a big immunization project to immunize children between 0 to 5 years against polio.
The building next to the Primary Care Clinic had to be demolished because of structural safety and so now the nutrition clinic is being held under another Neem tree, mothers bringing their children to be monitored and to be fed Plumpy Nut. They will also bring home more Plumpy Nut to supplement their diet.
The nutrition administrative service is housed in a corner but it is filled with boxes.Right next to it is the maternity ward run by Scavio, the midwife.It has two Labor and Delivery rooms and a ward of eight beds which was quite full later in the day and a baby was also born. Next to this is the mixed medical ward of about fourteen beds run by the Community Health Nurses (CHN) and the Clinical House Officer, this morning it had three patients, a few had been discharged earlier.There were no sheets on the beds because the patients would take them home and they would also take the mosquito nets as well if the CHN was not vigilant.
Andrew Walhok, a CHN, saw patients with me in the same room acting as my interpreter. He is a Nuer but a short one and we are in Nuer country. There were several pregnant women with abdominal pain, some were quite young but already had several pregnancies. Many more children had diarrhea and as I feared they did not stock Oral Rehydration Solution (ORS), Andrew had to give them instructions on how to make their own. An old woman with scarification on her face was blind very likely from an untreated trachoma infection of her eyes when she was small. There were several cases of conjunctivitis among the children troubled by swarming flies around their eyes. There was no tetracycline eye ointment. And of course malaria and thank goodness they do have Coartem.
A fierce wind picked up whipping up a sand storm outside. Women and men covered their faces with their dresses and shirts, but others seemed to be unaffected by it. The tukuls in the distance all but disappeared. Later the pharmacist brought in boxes of amoxicillin which must be lying among boxes I saw at the nutrition office or perhaps even in Koch Hospital where we saw all those boxes. At the bottom of the boxes were mouse droppings, the boxes had been lying around long enough for the mice to be comfortable.
The afternoon sun actually was so hot that it burned the skin as I walked back to the compound wishing for an ice bath. It was well past two and lunch consisted of rice, posha, goat stew and curry. I heard the pleading bleat of the young goat this morning while we were having tea as we left out of the corner of my eyes, I glimpsed the carcass of the goat hung limply from a young Neem tree. I ate the rice and drank almost three liters of water by the afternoon. After our late lunch, we finished sending off the rest of the patients who were waiting for their lab results before calling it a day.
It was not a day for Scavio, the midwife here and Bonnie. They delivered a healthy baby during the day. In the evening, they delivered a post-term baby who might have swallowed some meconium and they had to resuscitate him for twenty minutes. The other baby was not too lucky, it was about twenty-five weeks, prematurely delivered and the mother was quite upset and took the baby home and Scavio did not think it would survive. Under the best circumstances in the developed country its survival was not completely assured and the neonate would be in the ICU setting for a long period.
The moon was almost full tonight.