The lady that helps me in my house, Maimouna, has eleven children, ten of them still living. She had five children with her first husband who died from TB when she was pregnant with the fifth child. Now she has had six children with her second husband.
Karimun is child # 4 in the 2nd batch of kids and he is about 12 years old. We have known him all his life. I wish I had a picture of him on this computer to post, but I don't....and I forgot to copy one off the other computer.
About 3 weeks ago he came down with a headache and fever that came every evening and generally didn't feel well. We gave him a chloroquine treatment since those are all signs of malaria. It didn't do any good, so they took him to the dispensary. She told him he'd already done a malaria treatment, but they gave him more malaria medicine, but ran no tests. That is not unusual here, sad to say. Malaria is the #1 disease in Niger and probably 9 times out of 10 treating for malria is the right thing to do. Even if it turns out that you don't have malaria, the treatment is good to do because you tend to get malaria when your body is weak, so it will serve as a preventative.
We were gone to Niamey for a week and he was still sick, but the family did not take him to the dispensary. They were apparently waiting for us to come home. I don't know why.....money, waiting for our advice, a ride. Probably all three. So the day after we get back, Sunday, our house lady started saying how sick he was and hinting that we should take him to the dispensary. We decided that since it hadn't been an emergency while we were gone we weren't going to get in a panic over it. So, the next day she took him to the dispensary herself (which is what we wanted her to do). They gave him more malaria medicine, this time an up-dated more effective kind. I believe that was Monday morning.
By now his fever wass very high and he pretty much had it all day, not just at night. He had also started vomiting. Every day he slept on our porch while his mother worked. Wednesday he dragged himself to kids' club because he knew I was going to be giving prizes to kids who had perfect attendance. He was sitting there with the other kids and I thought, "Wow! He looks terrible!" So that night at prayer meeting I asked for prayer for him. One of the ladies who attends said, "Maybe he has typhoid". So after prayer meeting I looked up typhoid in my trusty Where There Is No Doctor and sure enough, the symptoms were all there....and pretty much the same symptoms as malaria. Except that typhoid doesn't respond to the malaria treatment.
So, the next day we told Maimouna that we thought he had a terrible disease. There doesn't seem to be a word for it in Songhai. I suspect it's so common that they just use the general term for all illness for it. John said that he would go with them to take him to the dispensary and ask for tests for malaria.
When he got there he got a male nurse who, apparently, hates people. There is a rumor that he's on drugs. Whatever, there is no excuse for the way he treats people. It's like because he has more knowledge than the average illiterate, poverty-stricken patient he sees, he can throw his weight around and be mean to them just to prove that he's better. John told him that the child was on his third treatment for malaria and was not getting better and we'd like to have some blood work ordered. He got mad and started yelling about how we shouldn't even bring him in until the treatment is completely finished. He has no concern about how awful the kid looks or about how the treatment should be starting to work 4 days into a 5 day treatment! John just said, "Fine, I'll take him directly to the hospital." At that the nurse sat down with his prescription pad and started writing out tests to have done at the lab.
John then took Karimun to the lab to get the work done. He asked what tests had been ordered and the lab tech said malaria and parasites. So John asked if he could also do typhoid. The lab tech agreed. An hour later John got the results for the malaria and typhoid.....malaria negative, typhoid positive. (The next day we got the parasite results...also negative.)
The next step was to take the results back to the nurse and ask for a prescription. When John gave the lab results to the nurse, he was livid. He started yelling about how he wouldn't give a prescription because he had't ordered a test for typhoid. In essence, he refused to treat this horribly sick child. So, John just took the lab results back and left the dispensary. He went to the pharmacist, who we know personally, and asked for the medicine to treat typhoid. He didn't want to do it because he can get in trouble for giving out medicines without a prescription, but because it was John and when he heard the full story, he did.
The next day, Friday, John went to talk to one of the head doctors and told her the whole story. She said Karimun should not have been treated that way and thanked John for telling her. She also wrote out a proper prescription. By the way, she seems very competent and does her job the best she can within the limitations she has.
When we left Saturday morning to come to Niamey, Karimun still looked really awful. Like a living skeleton. I wanted to post a picture of him, but didn't feel like I could go over there and say, "Hey, Karimun, I want to get a picture of you to show my friends how awful you look."
We understand that in the poorest country of the world, the medical system is going to have to operate with a lot of restraints on it. We can understand giving a malaria treatment once, maybe twice, without running tests. What makes me so mad that I start shaking is that there is no justice for the poor. It is not right that they are oppressed under the medical system. They have no way to bring this man to justice. If they didn't have an "anasara" to fight for them, their child would still not be receiving the proper medicine and would very possibly die. And what about all those people who don't have an educated, "powerful" white person to fight for them? How many of them die needlessly? And part of it is to do with this religion where everything is God's will so you don't fight anything. And then there is just the general injustice in the world....America where people get heart and kidney transplants (which is fine) and Niger where people can't even get treated properly for typhoid.
The whole thing has been very stressful. Please pray for Karimun and pray that none of the rest of the people in his family get it. We are probably ok because we've had the vaccine (pills) against it. Also, it is passed feces to mouth and he hasn't been handling our food. His mom does, though.....But, we rinse our dishes in scalding water and last week she only fixed food that had been well cooked.
By the way, he probably got it from drinking water from the resevoir. That is the grossest water you could ever hope to see....people, cows, sheep, goats, and donkeys urinate and defecate in it, people do their laundry in it, and all sorts of trash washes into it. We've been telling all the kids, "Look what happens when you drink that water!" I think some of them have been scared off of drinking it, but others will probably continue. How many cases of typhoid will we see before it's all over?