April 4th, 2006
Another outbreak of Kala Azar has brought MSF (doctor's without borders, Medecins Sans Frontieres) to Bihar, India. Bihar is one of the largest farming communities also the poorest and has the one of the highest illiteracy rates. We, the trained MSF, have been brought in by plane, train, motor bike and boots to visit the poorest of the poor. The ones most desperate for help.
Kala Azar is parasite. It's transmitted by bites from female phlebotomine sandflies—the vector (or transmitter) of the leishmania parasite. We're here to educate and kick it's ass and teach people not to sleep in the same quarters as their oxen.
I hurried to greet a head surgeon from China who had flown in to help teach local doctors. "Hello, you must be dumbass." I wanted to quickly shake that name and also not be rude. "Yes sir. Franklin Dumas." I replied. "I'm going to be your surgical assistant while we're here." He was short, thin, and had an intelligent look about him. "I am Dr. Cho. I am glad to have many hands to help." He turned and walked away with his hands folded behind his back. "Sleep a lot. Have early breakfast. There will be many, many sick." he said walking over mud on stepping stones made from bricks. I was not stepping on those bricks. I was about ankle deep in brown water with no idea of it. This was the moment I realized Dr. Cho had a lot of humor in him. I was Dumbass.
I walked around people in volunteer shirts outfitting hospitals. Some laying straw, others setting up miniature refrigerators with generators for medications. There were people carrying heavy body bags together already. They had been going door to door for weeks before our arrival to find people who had fever and other symptoms of Kala Azar. I could feel how green I was at this. A newbie, traveling to a foreign country for glory. I was Dumbass.
After a long day of laying straw, making beds, setting up hand-crank washing machines etc. I went into the heart of the village to eat and greet. Everyone recognized us from our MSF t-shirts. The people of Bihar were sitting in the open air parts of straw huts. They had woven fans fanning themselves and naked babies. Their smiles were comforting and genuine. I watched four men putting a ring in a calves' nose. The ox did not feel bad about it at all. There were men carrying heavy buckets on a yolk across their tired shoulders. The smell of hay, fresh dung, and human excrement was new for me.
After finding the tent for MSF workers, I sat at a table to eat. A tall, platinum blonde with a tight crown braid sat next to me. She smiled "You look afraid." Her accent was thick and Dutch. She was a gorgeous person that looked like she had seen a lot and had much work in her. "It's a culture shock." I held out my hand "I'm Frank Dumas. You can call me Dumbass, I think it's more fitting." She laughed heartily and said "Well Dumbass, I am Astrid Fleming." We ate quietly together after this. Both of us had a lot to think about I suppose. Astrid pulled a bag of candy from her side pack. "Do you want Bilar?" I was puzzled but happy with her "What Is Bilar?" I asked. "It is like, eh, licorice candy." We sat and shared Bilar again, quietly.
A Chai Walla came into our tent and offered us lovely tea. I happily took some. I only speak English, so I bowed to show gratitude. The man had a long white beard with a wide smile. Astrid said "Tack min vän." and bowed too. It was a great cultural experience.
When leaving I heard a woman singing. She was standing on a large concrete block and many people had gathered to listen. I did too. She had a beautiful red sari that flapped in the wind as she sang. It sort of took away the ox dung smell just watching her. A man wearing an MSF shirt came up beside me. He had a wonderful Australian accent. "You know what she's singing, yank?" I nudged him with a grin "Hell no, but it's nice." He crossed his arms and laughed. "Yeah, she's singing about why having nets over ya beds saves lives." I stopped smiling, intrigued. "Ya mate, she is Si Bhat. She is a communication and education advocate for us."
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I lay awake in my netted bed. What would tomorrow bring? Would there be heavy body bags for me to lift too? It was a long, quiet night. Being alone with thoughts made things very loud in my head, though. I just wanted to turn it off so badly. I'm trained! I know what to do! Stop worrying. -------------------------------------------------------------------------------------------------
At 0400 hours I was up, cleaning up and packing my side pack. Gloves? Check. Bands? Check. Capped hypodermics? Check. I feel sort of ready. I went out to the surgical tent to find Dr. Cho. He was already hanging saline bags and preparing beds. "Sir, isn't this work for the nurses and volunteers?" Doctor Cho turned to me and with dead seriousness he said "It's work for all of us. Go look outside." I did. There were sick already waiting outside of the clinic around the tent, the queue already seemed endless. "What can I do doctor?" I asked, sweating. "You can do without asking, Dumbass." Dr. Cho smiled a sneaky smile and kept prepping.
Volunteers opened doors.
The queue began to file in. I gestured for patients to lie down, to let me examine them. Kala Azar makes swollen bites on the body with fever. In extreme cases, the liver swells and makes the abdomen look large. Women cradling babies covered in bites. Men, sunbaked and overworked. Teenagers wanting to get well to go to school. All begging me to help. One man came in with a very protruded stomach. He was being helped by Si Bhat. She led the man to me and pleaded "He will die like this. He's still working the field. Help him." I knew I had many ahead of this man, but none were so bad. I led him to a bed. Si said "He has been swollen for his whole life." I was very puzzled when she said this. It was not like a sandfly bite to make one live with protrusion. He should be dead! I hurried and found Dr. Cho. "Sir, I found this man. He is an anomaly I-- I've never seen anything like it. You must see!" Doctor Cho was very busy but did not have a surgical patient at the time. He looked at Si and the sick man. "Si, how did you find this man?" she bowed and said "I had found him going door to door. I asked how he had lived this way. He was called the pregnant boy and mocked by children. He needs help. This is his only chance."
Doctor Cho checked all of his vitals. Si interpreting for him. He said he could not breathe and thought he would die. "Dumbass!" Cho called. I ran to find him "Yes sir?" Cho said "We cannot leave this man like this. Find the doctors and nurses from Bihar and we will teach them." I nodded and scrambled to do his bidding. Motioning and trying to pull medical staff away from the sick was not easy. Astrid found me. She came and helped. She was more bold than I was. "We need you." she motioned to herself and the operating theater, pulling gently on a doctor.
After everyone we could handle was in theater with Ajeet, the sick man, we began sedating him. Cho slowly explained all of the steps he was taking, his Hindi was rusty as he said. We all used hand signals and pointing to help. We all expected to remove a tumor. He had an extremely protruded abdomen. His navel looked like it would burst. I donned a gown and helped everyone do the same, the whole time Si explained why it was important.
Cho carefully made a bilateral incision near his hip to the bottom of his rib cage. Fluid from the opening poured out like a fountain. Everyone stood back, a little horrified, even Cho. We all put on splash guards and kept cutting. Cho held out his hands and pulled a horrid curled mass from Ajeet. It looked like a baby that had been flattened, rolled back up and covered in hair. The arms and legs were long, with long finger and toenails. Cho stood and stared at what Ajeet had birthed. He looked at me and quietly said "Dumas. This is something you will never see again. I have never seen this. Only read about it. This is Fetus in Fetu. A parasitic twin. He was born with it in him." Astrid fainted right into the enormous puddle of fluid and blood. Si vomited into a wastebasket.
Cho carried the monstrosity to a table to examine it. "Dumas. Please attend the patient." I drained, sutured and medicated Ajeet. I took a long while to look at him. What this man must have went through. What awaits him now?
Letting Ajeet recover, the table quickly became crowded with medical staff and volunteers. I pulled Astrid up. "You have to get clean, friend. Then come see. You must." Astrid said "I will clean, but I will not gaze upon that." She ran out quickly. "No, no Frank. I will not."
We all stared. All too afraid to touch this... thing yet. Si attended to Ajeet as he awoke. He said he never had felt better in his life. Si told him "Please don't look friend. Just rest." She left to help other sick. ----------------------------------------------------------------------------
Doctor Cho pulled out some clamps and pulled the long, bony arms away from the tightly rolled body. Gasps and cries came from the staff. Cho held up his hand for siclence. I took the clamps from him. We donned new gloves and "unrolled" the parasite. It had a horribly smashed, resemblance of a face. A crooked nose, mouth and closed eyes. We immediately let go and let the thing roll back up. Neither me nor Cho was prepared for this. Bodies would have been a welcome problem in the face of this one.
"We will chill this in a plastic contamination bag. We have to do our jobs now." Cho said without taking his eyes off of the monster. I bagged it, sealed it, chilled it. Ajeet recovered quietly as we explained to him what happened. He did not want to see still. Volunteers helped him to a bed where he could recover alone. I went back to dipstick tests for Kala Azar and giving tablets of medication with pamphlets. The whole time I felt hands on me. Fingernails touching my back. That face looking at me. Dr. Cho came to me and gave me medication for nausea. "Me too." He said stoically as he walked away.
At the days' end I went to the room with the refrigerator.
Doctor Cho was already there. His back was to me. I stayed quiet, assuming he was dissecting the thing. I didn't really want to see. I backed out slowly and went to find Astrid. She was curled in her bunk, crying. The Aussie I'd met earlier was with her. "Oi, I can't believe that, dear. I'm sorry that you had to see that." I nodded to him. He stood and said "Hey there mate. My name is Jaime. I'm from Sydney." I smiled to him and watched Astrid. We sat on the floor. "I'm Frank, Ohio, good to meet you." We both put a hand on her back to comfort her. Astrid cried "I do not want to be touched. I feel I am being touched all of the time. I can't. Please, no." We both moved and kept our vigil next to her.
Submitted June 15, 2016 at 07:27AM by Gut_Bucket http://ift.tt/1VYkd7I nosleep
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