Below is an update from Jason Ullyott who is serving as a doctor for Mercy Medical Clinic in the Rukwa Valley, Tanzania. He and his wife and their two children made a year-long commitment to serve in Tanzania at the clinic while Doctor Mark and Jodi Guilzon are in the States on home assignment. Jason and his family are impacting people on a daily basis in more ways than we will ever know and we are thankful for their sacrifice and willingness to serve our Lord and Savior.
It’s been a while since I wrote an update from the clinic. Life is busy as usual, and at the clinic everything is fairly status quo. As we have become used to life here, writing an “update” is harder. Interesting patients, or difficult patients, of course, but I’m not always sure what is new and interesting, because not much surprises me anymore. However, I recently had several cases that reminded me of how incredibly different, and difficult, things can be for people here. Sometimes it’s enjoyable coming to understand the many crazy cultural differences, but sometimes it’s difficult when trying to practice medicine.
When seeing patients, after cutting through layers of culture and language, and trying to get some consistent answers, maybe I arrive at a diagnosis, and maybe a treatment plan, but patient education is as always most important (and most difficult). Much of the education, however, is dealing with common local myths and practices.
-A simple example is the uvula. You know, the hangy thing in the back of your mouth? People here believe that if you have a chronic cough for more than a couple weeks, it must be the uvula. The solution? Cut it out! Sometimes they ask if I can cut it out for them.
-And that irksome soft spot on the baby’s head? Nothing a little sulfa medicine can’t fix.
-And the frenulum that connects your lip to your gums in the middle? Definitely a problem. But mama or grandma can cut it out with a large piece of grass. Yes, grass, long green grass.
-Or breastmilk. Often if a baby is sick, they believe the milk must be tainted or dirty, and so they stop breastfeeding. Sometimes if there is a problem with a first child’s birth, the following children get no milk for the first few days of life.
-Or: A 5month-old had some diarrhea. The “mganga wa kienyeji” or “traditional healer” or “witch doctor” depending on their practice, told them it was typhoid. (As a side note, if you have a fever OR abdominal pain, OR any other symptom, and you go to any local “doctor” which often means the owner of a hole-in-the-wall that sells drugs with no medical training, they tell you you have malaria and typhoid. They then proceed to sell you 4 bottles and 3 bags of various medicine and give you a couple shots of quinine for good measure. But since this was a traditional healer, he mixed up some secret recipe of burnt roots and leaves and who-knows-what-else, stuck it in some sort of tube/hose, and gave the poor child an enema to treat the typhoid. Now the child has a wound on his back side and his condition is no better.
-Worse is the 2-week-old who was “constipated.” Is there a problem if the child has no bowel movement for 2 days? Of course! Fortunately this child didn’t get hosed. Instead he got the bottles of medicine. Septra, Flagyl, Castor oil, and some “local” medicine to boot. Poor child now has diarrhea and his condition is no better. Another child developed Stevens-Johnson Syndrome, a terrible skin reaction to a bottle of Septra, then received a second dose of the sulfa medicine before coming to see me, at which point his condition was getting worse.
-And then there’s the mother-in-law. You see, a mother of young children of course lives with her husband. And his other wives. And his family. Which includes mother-in-law. Now, mama has to cook all the food, work the rice paddy and corn field, wash the clothes and dishes, carry the water on her head at least 1/4 to 1 mile away, collect the firewood to cook the food and carry that on her head also. But fortunately there’s babysitting! Mother-in-law (a.k.a grandma a.k.a bibi) provides the best of child care…and health care. Bibi sees her 1-year-old grandchild tugging on her ear. After attempting to clean it out with a stick, Bibi puts little scraps of paper or leaves, granules from an opened up medicine capsule, COW FAT, or maybe some antibiotic drops of her choosing. When mom arrives with child at Mercy Medical Mission Kapenta, the crazy white doctor asks her what she has been putting in her child’s ear that he sees and cleans out with his fancy ear tool thingy. But of course she completely denies putting anything in her child’s ear, because BIBI had him all day! That was a couple weeks ago. Yesterday, the 15-year-old fourth wife of the same husband came in with another pediatric ear patient (same bibi/mother-in-law), escorted by the 31-year-old son of the third wife! Do the math…
-One more: When young children, maybe 2,3,4 month olds (they can’t fight back) have a fever, they get burned. Bibi or mganga wa kienyeji takes the red hot end of a burning stick from the fire and cigarette burns the child symmetrically on the forehead, back of the head, temples, chest, back, and flanks.
Like most dispensaries, health clinics, and hospitals in Tanzania, we follow typical western medicine, and it is well accepted. But people out here in the bush still experiment with both. Their older generations still follow traditional medicine, while the younger generations are changing faster in response to modern development and media. In the end, they are all seeking to eliminate their pain and suffering, just not sure which paradigm to follow.
The weather and pace of life are changing here. The rains are ending, and the lush tropical feel will soon give way to dry grass and fire. Harvest has just begun, and the hundreds or thousands of gunny sacks of rice and corn, and lesser sorghum, millet, and sesame are bringing laborers, trucks, and goods for money to be spent on. Since last September or October money has been scarce, but for the next few months people will be relatively well fed and have money to spend. Life in the village will be wild, and the music from the bars are picking up, as well as patients at the clinic.