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| Susan, Nancy and Winnie behind |
This is St. Patrick Dispensary, located in the largest informal settlement (slum) in Mombasa. It is called Bangaladesh because it is near the ocean. The rains and floods cause people to struggle with poor dilapidated shacks that often get washed away...much like the very poor country of Bangaladesh. St. Patrick parish is staffed by St. Patrick priests from Ireland and they opened this clinic four years ago with the help of Judy Walter, the Maryknoll Lay Missioner/nurse whom I live with. I go to this clinic once a month to consult and teach the staff, one of whom is Winnie, a clinical officer (similar to a physician assistant in the USA). Seated next to me is Nancy. I saw her in the clinic yesterday and asked her if I could tell you her story.
Nancy came to the clinic over a year ago with hot painful swollen joints of her wrists, elbows, shoulders, fingers, toes and ankles. She is a 39 year old single mother with a nine year old son who comes to collect her medicines for her when she is unable to walk. At one time she was a community health volunteer but could no longer work due to her illness. I was asked to see her and the diagnosis of rheumatoid arthritis was confirmed in the laboratory. I explained her illness and began her treatment. She was to return the following week but didn't show up. We sent the social worker to look for her. She didn't have enough money so she didn't come.
Chronic illness is not well understood here. People think they should be able to take medicine for five days and if they aren't better they go look for someone else to treat them...often a local herbalist. It took repeated sessions with all of our staff to help Nancy understand that she has a chronic illness and that we will not charge her for her treatment. There are some people who need complete charity care and Nancy is one of them.
A few months ago a 25 year old woman came with the same problem and diagnosis...rheumatoid arthritis. We called Nancy to come talk to her and help her understand more about the illness. She responded to the treatment well and then she disappeared. Nancy was concerned and asked if we had seen her. Now Nancy has come full circle. She not only realizes the chronic nature of her illness but she is looking out for others who are in the same boat. I'm in that boat too. I told Nancy that I have a similar illness (Sjogren's syndrome) and I have to take the same medicine she takes every day for the rest of my life. Her eyes got big and I could sense a connection between us.
Nancy has become the model patient. She takes her medicine religiously, brings all of her records to each visit, asks questions and corrects us when we don't get some detail of her condition right. She has not responded as well to treatment as the other young woman but she is a whole lot better and we are still trying to get her to go into remission. There are only two rheumatologists in the entire country, both are in Nairobi 500km=300miles away. I have been very fortunate to get advice from my own rheumatologist in Champaign Illinois by email to guide me in her treatment.
Otherwise life in Mombasa continues to be peaceful and we hope it stays that way.
PEACE OF THE FLOATING BOATS TO YOU!
