Philip's eyes were downcast. He was encrusted with layers of clay, and he smelled like sour dirt. Every centimeter of his malnourished body was disfigured by ichthyosis and by the swollen masses of lesions that are produced by "jiggers." Jiggers are caused by fleas in the soil. Their larvae infest and infect the skin, turning it to lumpy, painful shreds over time. We usually see the condition in patients' extremities, not enveloping their entire bodies. But Philip had been sleeping for years on the dirt floor, where jiggers dwell, of his one-room mud house. His legs were also swollen bilaterally -- perhaps by infected lesions, perhaps by elephantiasis. We will know after the lab results come in today.
Last night, we simply bathed Philip. Shocked into silence by disbelief and galvanized into action by grief, I lugged buckets of water to Ward I. We washed and rinsed Philip, sponged him for 15 minutes with a chemical treatment that will -- after repeated applications -- suffocate the jiggers, rinsed him again and helped him dry. Philip was quiet, compliant and understandably embarrassed. We then applied petroleum jelly to his entire body, in an effort to address the scaly skin around the shreds. Before finishing rounds, Dr. Hardison gave Philip clean clothing, beans and ugali (finely-ground cooked cornmeal) for supper, and gently tucked him into the first bed he may have ever slept in.
Philip's story is still piecing itself together, but he was orphaned at an early age. His father died before he was born, his mother soon thereafter, and he was raised by a grandmother who suffered from a progressive dementia. Philip tried to provide for her and for himself by cutting and selling firewood. His grandmother's condition deteriorated to the point that she was incontinent. They reportedly lived in squalor, their mud house caving in around them, their clay floor infested with bacteria and jiggers. His grandmother died before receiving any treatment, and Philip was left alone.
He is safe now, but frightened and overwhelmed. We pray that Philip will stay with us long enough to fully recover. He has been promised housing and a job in his village, guarding a kiosk/shop with a cement floor (hence, no jiggers). There's that Hope again, "that thing with feathers that never stops at all." But we have to wonder how many more Philips there are in the world... As Gerry reminded me last night, "He is our starfish."
[Please look it up if you don't remember the wonderful starfish allegory. I can't retell it now; thanks to your love and support, I will be leaving soon with the mobile medical team for the Saturday Orphan Program in Ebwali.]