THE TREATMENT OF JIGGERS

I started out the day with really not wanting to get out of bed, and I think I took it out on Brad as we were chatting online. Time zones are tough--he stays up late and I get up early, because those are the only times neither of us is at work.

But I eventually did get out of bed, and even managed to make it to breakfast on time, which isn't hard, since they always start serving food ten minutes later. Breakfast is supposed to open at 8, but they usually open the doors around 8:10, which gives me just enough time to shovel food into my mouth before I have to get out of there by 8:20 to make it to the hospital in time for rounds. The fact that they arbitrarily assign room numbers to tables every morning doesn't help my situation much, since I have to spend a few minutes figuring out where I'm supposed to sit that day.

I digress. The day started out in the pediatrics ward for consultant rounds. 'Consultant' seems to be the word in British English for 'attending'. At Malindi District Hospital, the wards are managed on a daily basis by the clinical officer interns I talked about yesterday, and the consultants come through twice a week to make sure the plans make sense. Unfortunately, it turns into your typical rounding situation, with the senior guy pontificating about something while everyone else just wants to keep moving. I'm not a fan of rounds at baseline (I could never do internal medicine, where they round multiple times a day, for fun), and rounds when the docs are speaking to the parents in Swahili really aren't any more fun.

After ward rounds, I followed the consultant to the NBU (newborn unit), where I got to see where they take care of sick babies. This is an incubator, and I don't know if you can tell, but there are two babies in there--twins born at 32 weeks, their birth weights 1.8 and 1.4 kilos. So, small babies.

I had just finished NBU rounds when Metsanze, the clinical officer who's arranging my schedule, called to say that the public health office got word of a patient with jiggers in the men's ward. 'Jiggers' are what we call 'chiggers', and it's a huge public health problem in Kenya, and preventable (by wearing shoes and washing your feet every once in a while). Actually, Miss World (from the US), Miss Venezuela, Miss Kenya, and Miss Botswana were recently in Kenya to do some good-willing about it. It was even in the news

My jiggers patient was not cute little children, though, but an old man who apparently does nothing but lie in bed. Jiggers are small bugs that crawl into the skin, usually on the feet, and burrow pretty deep into the skin there. They have a hole to the surface where they lay eggs, and from those eggs come more little jiggers which do the same thing. Since this man never got out of bed and no one was washing his feet, the jiggers he had kept laying eggs and producing more jiggers that burrowed and laid eggs, etc, etc.

Not a great picture, but I think it gives the general idea, once you realize that each of those black dots is a jigger. It was actually worse on his heels, which makes sense (that's the part that would be on the mattress if he was laying on his back).

So we got to work. The first step is to soak the feet in 3% hydrogen peroxide. Unfortunately, they only had one bottle of 6%, which was cut in half with water, so there wasn't much liquid there.

This is Dr. Katana, the public health officer, explaining something to me as we worked on the soaking step. Just a side note here, 'Doctor' is a title, not a degree. Dr. Katana has a bachelor's in public health, so he's had the same amount of formal schooling as the clinical officers. He has a few years' experience in the field, though, and is working on his MPH.

Anyway, this is when we were really getting into it. After soaking the feet, each jigger has to be pulled out with forceps. We spent two hours and finished one foot, and I'm not sure we got them all out. And this is without an operating room or anesthesia. At this point, he doesn't have much skin left on his feet (and I was getting down to the Achilles' tendon on his heel). I don't know if he'll ever be able to walk again, not that he was doing any walking when we started with him.

So that was my workday, finishing around 2:30, when we took a break for lunch. We had biriani, which is a Kenyan dish of some sort of meat, stewed in a spicy sauce and served with rice (I asked Metsanze if I wanted to know what it was, and he just laughed... not really that reassured). I know it's something small and four-legged, because I had a section with vertebrae and ribs. Maybe something around the size of a rabbit? I'm not sure. Anyway, aside from the mystery-meat aspect of it, it was pretty good and gave me the fuel I needed to return to the office and get some work done on my presentation before calling it a day and heading back to the hotel for a swim.

Tomorrow: Dr. Katana and I tackle the man's other foot and his hands (which are also jigger infested). I might do something touristy as well, but I'm leaving for safari on Sunday and I still have five weeks in Kenya to see touristy things, so I'm not in a hurry.