2009 TRIP: A makeshift crutch and a smile

"Patrick, we have an urgent case that needs to be seen!", John said he stepped into the treatment room. "There is a girl with some kind of leg infection." I had been rearranging the treatment room when John approached me, preparing it for whatever would come through the door.

I wandered through Marliee's office and out into the bright sunlight. The crowd still huddled under the tent where many of them had been since early that morning. We were now on our 3rd full day of clinic in Kiburara. We had seen the crowds grow steadily each day. On our first day, there were few people hudlled under the tent especially compared to today.

Earlier in the week I had been talking with Harriet, a local nurse who had been a tremendous help to us - understanding the culture, language, disease processes, and treatment options in a way we "mzungos" never could. She related to me that on the day of out arrival at the clinic, there was an idea floating around town that kept a lot of people away until later. Most people knew that the clinic was held at the Covenant Mercies site and that it was associated with Pastor Moses Nkwatsibwe and the Kiburara Gospel Centre church in town. Because of this it had been reported around town that the clinic was only available to those who "were saved by Jesus and immersed in much water" - an ovious reference to baptism. After our first day of treating patients, it became rapidly clear that we were there to treat whoever needed care as we were able. From the size of the crowd today there was no problem correcting the initial misconception in the villagers minds.

John ushered me up the stairs and under the tent where people waiting patiently to be teated. Immediately 2 men in the front row, one of whom was her father, lifted up a teenage girl with a severely swollen left leg. They made no attempt to let her walk and it was unclear to me if she could at all. They rushed her down the stairs and to the triage area in such a rush that I was unsure if they knew that I was there to help. After some intial vitals and information, Marilee, one of the physician assistants, took her to her office for evaluation.

It was an apparent case of mild lymphatic filiarisis. This condition is a parasitic and infectious tropical disease caused by a nematode worm. In its more severe form, it can cause what is commonly know as elephantitis —thickening of the skin and underlying tissues—which was the first disease discovered to be transmitted by a mosquito bite. Elephantiasis results when the parasites lodge in the lymphatic system affecting proper drainage of lymph fluid.

It was obvious that this sweet girl had severe difficulty walking. She was escorted to the treatment room where we soaked her leg in some warm water. Her family was given a combination of effective anti-worm treatment that included, albendazole, ivermectin and doxycycline. Marilee than asked if we had any crutches. I wandered around asking anyone if they knew if there were crutches available. There were none.

I decided at this point that I was going to wander outside the complex and see if we could make a cane from a tree somewhere. One of our faithful young interpreters, Justine, escorted me out the side gait past the crowd of people waiting to get in. Behind the complex and down the hill there were 2 men cooking around a makeshift fire. They looked up when they saw us coming and began to speak in a local dialect. It was clear that they were not fluent in English. Justine stated that they were explaining to me that they were preparing lunch for us. From the smiles on their faces, it was clear that preparing our lunch was something that they were very proud and joyful to do.

Justine had explained to them that there was a girl at the clinic that needed a cane. With a quickness and determination I had not seen before, one of the men grabbed a machete and immediately chopped down a branch from the nearby bush. He then proceeded to chop away the leaves and smooth it out. From his quickness and skill, it was apparent that he had done this before. He gave the cane to me with a big smile. He was beaming.

We walked back to the clinic with our cane. I dried off the young girl's leg and presented her with the cane that was made in her honor. She smiled a joyful, thankful smile and she could now walk better. Her father shook my hand emotionally and they walked out of the treatment room together - her father feeling the need to carry her no longer.