As with yesterday, I spent the day with the public health office. Unlike yesterday, instead of starting with active case detection (which is done on Mondays), today we seemed to be having a special on dog bites, and because this is the developing world and dogs aren't vaccinated against rabies, with dog bites come rabies vaccines (in the States, the most common exposure to rabies is in bats, but in the developing world, it's still dogs). With this patient, he had been bitten by his neighbor's dog yesterday, after the dog bit a goat. After the dog bit the patient, the owners killed it, which makes sense, except when you consider that you can test the dog for rabies to determine whether or not the person needs to be vaccinated.
Since we didn't have the dog to test, the default is that the patient gets rabies vaccine, which is not cheap. In most parts of the developing world, one course of shots (five shots) is about 5% of the average family's annual income--and about half of all people have had a course at one point in their lives. Fortunately, Malindi has a supply of vaccines, which is free (when the alternative to getting the vaccine is getting a disease that is 100% fatal, it's best not to bring finances into the equation). So I saw the patient, saw the bite (which had been cleaned at a local clinic yesterday) and decided that he needs shots, so I gave him the schedule for the shots (days 0, 3, 7, 14, and 28), wrote it out on a calendar with circles for the days he needs to return for the next shot, and set him up to get a tetanus vaccination as well (since he had no idea when his last tetanus shot was, if ever). We also recorded all his information for the Ministry of Public Health and Sanitation's records of where the vaccines were going to.
After all this, we headed to a meeting with the Wellcome Trust's chief engineer (Wellcome Trust is the organization we visited down in Kilifi) and their contractor, because they are building an extension of the CCC, to create a lab that they will use for clinical TB research. This is the part of public health that I'm definitely still learning. It's one thing to say, "Okay, we want to build a lab," but it's another entirely to draw up blueprints, go the site, evaluate the site, determine where the wiring and plumbing is, etc, etc. I'm glad there are people who know this stuff, because I don't.
For lunch I got to meet with a student from Jeremy's NGO, Aiducation International (http://www.aiducation.org/). It's an organization that, through donations, sends kids to secondary school (tuition for primary school, or 1-8, is covered by the government, but secondary school, 9-12, is not); as far as I'm concerned, educating kids does more for a country than all the shipments of medications ever could. Anyway, this student, Henry, recently returned from a year as an exchange student in Michigan, so it was fun talking to him about living in the States and being back to Kenya. Like any teenager, his favorite restaurant is Burger King, and his favorite thing about being in Michigan was playing and watching basketball. I think it was a good educational experience as well. He hopes to return to Michigan State University for college to study physics or engineering, and wants to be a pilot. Here's a picture of us outside the Hilton (a nickname, not the real name of the restaurant):
After lunch, I did my typical lounging around (went for a swim, read on my iPad, etc). I know, it's a difficult life I lead. Tomorrow I'm back in the public health office, to see what fun preventive medicine things we can find this time.
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