A BOUT OF MALARIA: PART 2

I decided that I wish for anyone reading this to read these facts first before they continue on to the rest of my long-winded story.

The total cost for me to see the doctor, have the lab tests and to receive the medication:

8 dollars Canadian.

Total number of children under five that die each year from parasite:

34, 000.

At times the world can be most unjust.

So it’s now 4:00pm and I have finally finished my last class for the day. Actually, its more like 4:20pm, but I was technically supposed to have finished class 20 minutes ago. My problem is that I am never quite sure what my schedule is and, sensing my uncertainty, my students always assure me that “class is over when you hear the 2nd bell, keep talking!” The 2nd bell never comes, obviously, and I end up going way over my allotted teaching time just talking with the students about life. I would say that it’s the best problem that I have ever had.

Truth be told, I was also technically only scheduled to teach in the morning. However, my co teacher informed me that there was to be a funeral that afternoon for the husband of the Kitchen worker and that my co-teacher would very much like to attend. Seeing as how I am only slotted to teach one class per day, I was more than happy to cover her so that she could attend.

This should also act to show what my state-of-health was at the time. Was I feeling 100% well again? Not quite. The whole day has been clouded by a mental fog, similar to that feeling you have when you first wake up and are not quite totally with it yet. My day has seemingly been spent trying to wake up. As well, that slight but pulsating headache just won’t seem to go away. However, none of this is crippling and an afternoon in front of the students is still definitely do-able.

Did I mention that I had decided that my homeroom students were going to play ‘doctor’ in class today? Working in groups, they were to assess the symptoms displayed by their ‘patient’ and were to decide on an appropriate diagnosis, giving a detailed explanation on how the came to their conclusion. Of course, I never told them that the symptoms I had written on the board were exactly what I had experienced the night before. The final verdict? In a unanimous show of hands, this patient was agreed to most definitely be suffering from malaria. Super. That certainly won’t cause me to worry all day.
Needless to say, I decide that I must see a doctor that day. I talk to my co-teacher, Shimba, and he tells me that I have two options. One, I can visit the public hospital just down the road. The good thing here is that not only is it right down the street, but it will actually very cheap to see a physician. The problem is that waiting time at this hospital averages around 3-4 hours from start to end, assuming that there are no extraneous situations. My other option is to head off to the Kakamega Highway hospital, a private clinic that would actually be on the way to my house. The good thing about this option is that wait time tends to be very minimal, and one does not have to worry about this facility suffering from a lack of resources. The problem, however, is that this hospital will cost at least twice as much as the public one. Now, while I am absolutely intrigued to see what a Kenyan public hospital is like, to experience its realities, I decide that now is not the time and hop on the motorcycle boda boda, Kakamega Highway hospital bound. Hell, I’m sure ill have ample opportunities to infect myself with something before my time is up in Kenya, plenty of chances to check out the public option.

I arrive at the hospital and am quite shocked at how unsuspecting this establishment is. I have passed by this building many times by now and never realized that this was as private hospital. In case you need to find it yourself, simply just walk to the main 4-way intersection in town, where the large billboard advertising some sort of cleaning product is situated. You’ll see a small army of boda boda riders on the corner, waiting for their customers. If you walk south a bit, past the billboard and just before the small two story brown building hosting the computer training academy, you’ll see another identical building behind a fence. It might be hard to see due to the many plants and trees lining the fence, but written on the side of this building in hand-painted large green letters is the word ‘hospital. Medical salvation.

This hospital is nothing like you would see back home, but very similar to those that I have experienced in developing countries. With only a few fluorescent tube lights turned on in an effort to save electricity, you immediately walk into the dim waiting room. I imagine that the room would be very dark if it weren’t for the many windows and large front door that is open, letting in all of the day light. Four 1970s looking long benches with lime green vinyl upholstery are situated in the center of the room, facing the wood-paneled caged-in reception booth. Plastered all over the booth, as well as on much of the room’s walls are an assortment of posters advertising various public health notices and suggestions. Be sure to have yourself checked for Guinea worms if you are suspicious, displaying somewhat graphic pictures of an infected shin. Be sure to have your child treated for malaria, as it is a serious danger to children under the age of 5. Discover the many parts of your body that might be afflicted by various illnesses, thanks to a hand-drawn informative poster. Read from the many printouts about the many different specialists that are available. And so on, so forth.

You will also see then many religious artifacts scattered around the room, from a calendar featuring an empathetic looking picture of Jesus to an assortment of plaqued scripture quotes. It is most comforting to know that Jesus has got my back. Need to kill some time in the waiting room? Just sit back and watch the small television tuned into an American music video channel. I am greeted by the face of non-other than Nicki Minaj, rockin her latest club beat. True to Shimba’s word, there are very few people waiting to be attended to and in no time I have signed in and am on my way to 1st floor to have my malaria test done.

Meet Ongia, the sharply-dressed lab technician in charge of all medical testing at this hospital. A very kind and welcoming man, he greets me fondly when I enter his small, white-walled corner workspace and invited me to sit down on the small, again lime-green colored bench. Not quite abiding by the strict standards of the Canadian medical system, there are four windows along the walls facing the outside hustle, fully opened to let in all the sights and sounds of the busy road. A single exposed light bulb hangs from the ceiling and smell of disinfect mixed with who-knows what other chemicals wafts through the air. The floor has been covered by generic tiles, now cracked from years of use and dirt firmly embedded in the grout. A long desk of unpainted wood sits in the corner, acting as a host to the stacks of boxes containing needles, syringes, and other medical supplies. Essentially, this is a room for just one technician, one microscope, and an endless demand for tests.

Ongia explains that testing for Malaria is actually quite a simple process. In the past this test might have taken a number of hours, potentially requiting an over-night process, but now it can all be done in less than one hour and requires just a few basic lab supplies. As well, he tells me about a new technique that has been developed in the US that should reduce the wait time to a matter of minutes. This new technique, called RDTs (rapid diagnostic tests), involves a kind of strip, onto which a person would place just a small drop of blood. In a matter of minutes one will see two things. One, a line will appear that acts as a control and indicates that the strip is of working order. Two, another line will appear which would indicate that the patient is infected with malaria. No 2nd line, no malaria. It’s just that simple. The only problem with his new technique is that one cannot determine what strain of malaria one has, requiring more detailed testing in a lab, but at least a person can know immediately if they are infected while at any location, not requiring in a lab.

The test I will be using works like this: First a small drop of blood is obtained from the patient, which is then smeared over a glass slide. Ongia retrieves a piece of a wooden 2X4 that has four rows of notches cut out, placing it on the open windowsill and inserting the glass slide. He explains that the blood must first be dried, achieved by simply baking it in the sun for a few minutes. While we wait, Ongia explains that what he will be looking for is the trophozoites amongst the blood cells, one of the active stages in the parasite’s life-cycle. He explains that when the malaria is at this stage of development it acts to capture the red blood cells in the body, essentially sucking away the heat to fuel its development, explaining why I got so cold the night before.

How do we see the parasite in the blood? After the blood has dried in the sun, the dried specimen is stained using a technique called a ‘Giemsa stain’, which will allow us to see the parasites inside the blood cells. The slide is literally dipped in a tube containing the blue stain, which will allow us to see the interior of the parasite, followed by a dip in a pink stain, which acts as a contrast color. The stained blood must now be dried, so back to the window sill it goes. About 10 minutes later it is good to go and is placed under the microscope for observation. Under 100X magnification, the technician peers into the microscope.

The verdict? Negative! Whaaaat????

Before I can leap out of my seat in joy, however, Ongia informs me that false negatives are not uncommon, as our ability to see the parasite depends on its level of development and it might still be there. He suggests that a consultation with a physician might be helpful. Slightly elated, I thank Ongia for his effort and promise to stop in one day to visit and head off to find me a doctor.

Eventually the receptionist is able to track down the doctor and I have a short visit with him. As he is explaining that Ongia’s suspicions are correct, he is writing out a prescription for Dihydroartemisini, or malaria treatment, as well as a renewal of my malaria preventative medication. Five minutes later we are finished with each other and I am on my way out. Total time elapsed: Approx. 1 hour.

I wish to interject with a side note, that sometimes it is foolish to maintain your ethical integrity. Originally the consultation with the doctor was to cost me 400KSh, but after I put a sad look on my face and explained how that was a lot of money, the receptionist cracked and sent me to him, free of charge. However, after finishing with the doctor and as he walked me out of the hospital, I had a momentary feeling of guilt for my frugalness. Who am I to try and skip out on the bill for such an important medical consultation? I inform the doctor of my desire to pay for his time and hand him the 400KSh. Where does the money go? Straight into his pocket. I might have been more confident that he was planning to enter it into the financial records at a later time if it had not been for the fact that the financial book was sitting right in front of him as he pocketed the cash. Corruption can be found just about anywhere.

I walk across the street to the nearest chemist, (aka pharmacist), and hand over my prescription. I receive a box of 9 malaria treatment tablets, as well as a months supply of my preventative medicine. I am briefly worried that this pharmacist seems to speak very little English and does not seem to understand that I wish for him to explain how to properly take this medicine, but decide that the internet has all of the answers to life and ill just look it up later.

So there it is. A bout of malaria realized, diagnosed and treated all within 48 hours. Not a moment too soon, if you ask me.

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