Friday, February 21, 2014

Ox-Cart Medicine

For some time the staff at Blessings Hospital have longed for the security of an ambulance with dedicated driver to provide a means to transfer complicated patients to higher levels of care.  This prayer was answered in January by the Sarah Walker Foundation with the equipping of a used Land-Rover Defender (the famous, nose-down box that never quits) and the hiring of a driver.  This vehicle does many duties, one of which is to carry a clinician to outlying villages within our service area, where local churches offer their building as a clinic site, and then work with the chief and their neighbors to spread the word insuring that patients come.

Yesterday the clinic was at Chimbwala, some 20 km /15 minutes away.  It was afternoon.  The clinic was finished and the driver and clinician were packing up their supplies to return when an ox-cart was noticed  moving unusually slowly toward the church building, but there were no oxen!  Instead people were struggling, 4 pushing the yoke and 6 pushing from behind, to move the cart along.  In the cart was a young man who was seizing.

The patient had complained the day before of body aches and fever, but people had ignored him.  He wasn’t much better when he woke up the following morning, and in the afternoon he stayed home while everyone else went to a soccer game with a rival school.  When his family and friends returned he was unconscious and seizing intermittently.

Lacking IV supplies, the decision was made to hastily move the patient to Blessings.  Not too long later Harold Banda, our administrator (himself a nurse-midwife), and William Banda, our nurse on duty at the time, were chatting on the front veranda when they noticed the ambulance careening around the corner into the hospital grounds, lights on, flashers blinking.  (We don’t yet have a siren or true emergency lights on the ambulance, and they were sorely missed as the driver worked his way down Malawi’s principle artery in the late afternoon traffic which was returning to the capital).

William started back into the hospital thinking it was a ruse, but Harold urged him to wait and see: maybe there really was an emergency.  The staff on board hopped out of  the ambulance almost before stopping and related the essentials.  As they opened the back door to extract the gurney, the patient was seizing.  He had not regained consciousness since they first saw him.  The patient’s wife and friends shared the history, and  malaria, the most common illness in Malawi and one of the major killers, was immediately suspected.

Harold (who doesn’t regularly work clinical shifts) joined William in getting an IV started.  Some blood was sent to the lab for malaria testing, and IV Valium was pushed to stop the seizure.  Ceftriaxone was pushed as per Malawian protocol in case of bacterial meningitis, and then the malaria rapid test result returned:  Positive for malaria antigen.  IV quinine was begun, and the patient later awakened.  

The following morning a man walked into the hospital entrance, and he and Harold recognized each other immediately:  He was Harold’s head teacher in secondary school.  Questioning the occasion, Harold was
The "Man in the Oxcart"
thanking Dr. Harry.
told by the visitor that the malaria patient himself, also a teacher in the village where the clinic was held, was his younger brother.  The patient felt much better that morning, was awake and taking food and oral medicines, and was discharged with his wife and brother to finish a three day course of oral meds for malaria at home.  As is customary here where transportation is often a barrier to care, he was returned to his home in the ambulance.  

Medicine, perhaps especially in Malawi, at times presents occasions of great grief, futility and frustration.  Malaria can be stamped out, as it has in many countries, if the political will exists at national and local levels, and if enough resources are applied to the task.  South of the United States, for example, in two very different countries politically, Costa Rica and Cuba have eliminated the scourge, but they are the only ones.  In spite of the many frustrations here in Malawi, there are thankfully also occasions where all hands, including the neighbors,  do their parts well, everything works like it is supposed to, and potentially tragic or fatal situations are redeemed to life, joy, and ongoing service.  

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