This week in Kenya, the matatus (taxi vans) are on strike, creating great difficulty for travelers -- whether they are students returning to school, employees returning to work, or patients trying to reach medical care here at Maseno Hospital. We could use a few good old-fashioned camels about now. The local matatu drivers complain about police extortion, the local police complain about unsafe vehicles (and, admittedly, their own delayed paychecks), and the litany goes on... But, as always, it is the poor and the sick who suffer the most.
For them, getting here is definitely not "half the fun." It is a tribute to the hospital's reputation that people walk countless kilometers to be seen and treated by Dr. Hardison. Two days ago, a farmer from the interior came to us with a chunk of his badly-infected left calf missing. "A donkey bite," he explained, as he sank to a bench in pain and exhaustion. The same day, a laboring mama made it to our maternity ward in time to deliver a nonviable fetus, her second "twin," after giving birth to a live infant at home.
Today we saw Francis, a 16-year-old, who was brought in after being struck by lightning. Andrew, 63, in the adjacent hospital bed on Ward I, is suffering from gangrenous toes and diabetic retinopathy. With no popliteal pulse and gaping ulcers on his right leg, he will be referred to the district hospital for a probable BKA (below-the-knee-amputation). Floice, on Ward II, is recovering from pharmacologic toxicity. (A nearby clinic misread her "Tylenol" prescription as "Tegretol," an anti-seizure medication.) And oxygen-dependent Phoebe suffered a setback last night because of a 4-hour power outage. Her O2 sat is now 88%, but she continues to improve. With the help of the Mothers' Union, we hope to establish a sort of "halfway house" for her and other single mamas who are too ill to provide for their children.
Although underlying HIV compromises many of our patients, especially those with TB, PCP and cryptococcal meningitis, some diagnoses are "straightforward" panga/machete wounds, diabetes, malaria, enteric fever, hypertension, ashtma, cellulitis (often r/t boda-boda or piki-piki injuries), etc. Because Dr. Hardison is a gastroenterologist, we also seem to diagnose an unusual number of esophageal cancers at Maseno Hospital. We can't help but wonder if those cancers (and the asthmas, too) may directly correlate with our patients' years of cooking over indoor fires.
Against many odds (often economic), our patients find their way here. Against many other odds (also often economic), we try to care for them. We are sometimes asked by well-intentioned Western friends, "But can the hospital become 'sustainable'?" In a word, and in my humble opinion, no. Not for quite some time and not without quite a bit more initial support and reorganization, at least. As Dr. Hardison says, "I guess it wouldn't be a mission then; would it?" I have to wonder, myself, "Is any hospital in any depressed economy 'sustainable' without loans, grants, and the equivalent of Medicaid/Medicare?"
The poor are always with us, and they may always need our help. It is ours to share and celebrate the small epiphanies that happen every day, in spite of great difficulties -- and, yes, to offer our own homage, wherever we may be.