Volunteers’ Stories: Dana
“I seriously contemplate a self-referral [to the district hospital] as I consider my 10K bicycle ride back, in the blazing African afternoon sun, but I wouldn’t trade this experience for anything!”
Malawi is Malarious: Under 5s Clinic
Collapsing off my bicycle, we have reached the weekly rotating under 5s clinic. Approaching, there are approximately 100 women with their children receiving a lecture in family planning. The lecture is followed by a beautiful harmonious song, intermittently lead by different mothers under the shade of the banana tree. I ask Fletcher, the local health officer and leader of the clinics, the meaning behind the lyrics, and he states that the women are singing about family planning, the dangers of childbirth, and overpopulation. Now, making that sound good, takes talent! Over the next three hours we weigh, measure, and vaccinate over 100 children. The scale is designed to hang from a tree, and each mother undresses her child, wraps them in a sarong, and precariously balances them from the scale. The older children think that they are flying, and the younger ones flail and scream as they attempt to determine what wrong they have done to deserve this torture. Every detail gets recorded in the child’s health book and trended on a growth chart. In Malawi, each person at birth is given a health book or “passport” which will be a dynamic written record of vaccinations, illness, assessments, diagnosis, lab results and medications. Those determined to be underweight will be referred to the malnutrition program.
Sitting in red dirt, surrounded by man-eating ants, spiders and wasps, I am the recipient of all 100+ passports, pages falling out, and as I attempt surgical resuscitation, I can’t help but notice that every third child has the same surname. And then I recall, that each man is allowed multiple wives (and girlfriends), therefore may be the proud father of an entire football team. In fact, if the girlfriend dies, one of the wives is expected to, and does, take in the child as her own, without any Jerry Springer drama.
Children are screaming, crying, playing, pushing and peeing everywhere, and it is a blessing when we finally finish. I stand and fight the first ominous signs of my own dehydration. As the blackness clears from my periphery, I see that about two dozen women have remained. Fletcher approaches me and informs me that these are the women with sick children who wish to be be seen by me – nooooooo! With resignation I grab my stethoscope, thermometer, and the first passport waving closest to my face. With minimal pediatric experience (emphasis on minimal, not experience), I have aggressively tried to absorb the “sick child” chapter in my tropical medicine book and can only recall that a child is not just a small adult (ugh, news to me!). Being taught that white people are in fact ghosts who will eat the child if they misbehave, listening to lung sounds translates to protecting my ears from severe eardrum damage. It is the screaming children that made me happy, the worrisome ones are the listless children that allow limb manipulation, hydration assessment and temperature-taking without protest. As I assess and dictate, I “diagnosis” multiple cases of malaria, a couple of upper respiratory infections, a severe case of kwashiorkor, and a possible strangulated hernia vs. intussusception vs. belly full of worms?!?! At my disposal I had Oral Rehydration Salts (ORS), Tylenol, malaria mediation, and one type of antibiotic. Per protocol, any child with increased respirations gets five days of antibiotics plus three days of Tylenol; fever= Tylenol; fever + diarrhea= Tylenol, ORS, and malaria medication. Of course all we have are adult dosing, and the mothers are instructed to break the Tylenol tablets in quarters. Unfortunately, a common requested fall-back medication, when I refuse to give Tylenol to one mother whose child is completely healthy, a scene is created. I question the medical ethics – liver damage for cultural sensitivity? Two I refer to the district hospital and seriously contemplate a self-referral as I consider my 10K bicycle ride back, in the blazing African afternoon sun. But I wouldn’t trade this experience for anything!
Dana (Volunteer Nurse, February – March 2012)