The Surgeon's Toes, and other highlights of my day

Nancy Jepkemboi and I (photo taken on Tuesday by Laura)

We finally got permission from Silas (the dad of the kids down the road) to take his children to see a doctor and spray his house and yard with insecticide to kill the rest of the jiggers. The kids came to our center early in the morning so the spraying could begin without them being exposed to the poison. Plus, I wanted to be sure that they were nice and clean before taking them to see the pediatrician. But before they came, their dad made sure they were cleaned up. He's coming around, I'm telling you!

Their wounds needed to be cleaned, however, so we got a couple of basins with warm water and Dettol (antiseptic), and soaked their little feet in it. One by one, Ruth, the interns and I scrubbed their little feet. Mud is caked into the holes in their feet, and we literally had to scrub it out with a nail brush. It hurt me to do it, but it didn't hurt them. Not for the most part, at least. We embalmed their feet, if you will, in Triple Antiseptic ointment, put on their dirty little socks, and got ready to load up the car.

The urine running down (Brian) Kiprono's leg as we were finishing up should've given me a clue that the kid's not really potty trained, but what can you do? I asked (Joanna) Jemutai to hold her little brother on her lap while we rode to town, but no sooner had we left our compound, or he was on the seat. Good thing I have removable seatcovers.

First, we picked up Anne Chebii, a colleague who works in our town office. I realized I'd need another pair of hands. Anne and I then took the kids to the pediatrician, where we waited for about an hour before he could see us. He suggested that we see a surgeon, but prescribed antibiotics for the three youngest ones, plus medicine for Joanna's fungal infection on her face. He charged me only for one consultation rather than four, which was nice!

Off to the surgeon's office, just a few doors down. Here we waited for another two hours for the surgeon to arrive. Since there was a cafeteria downstairs, I took the kids to lunch. We ordered ugali and chicken (there was no beef, which would've been easier for them to eat), and I got them all a bottle of soda, too. They beamed at the sight of the food! I soon realized, however, that it would be a total mess to stay at the table. These kids had probably never eaten at a table. We moved outside and sat on the grass, and boy, were they happy. They gobbled down the food like it's their last meal, cleaning every single plate so only the bare bones remained. As they stood washing their hands, I saw a huge puddle form at Richard Kiprono's feet. Now, his sweat pants were drenched in urine, as were his cute little Bubblegummer shoes. Off with the pants, it was!

Back at the surgeon's office, the man was surprised that we had been sent to him. "It would take me at least four hours to remove these jiggers," he explained to me, "and in four hours, I can do several major surgeries which I'd charge 150,000KES for each (more than $2,000). It's not the right thing to remove these surgically. What you have to do is simply spend an hour a day digging out the egg sacks..."

He explained that he himself had a worse case of jiggers when he was a kid, and proceeded to take off his shoes and socks to show me how deformed his toe nails were as a result. I know, totally bizarre! The point is, though, that he had empathy, but couldn't help us. He told me that he'd read up more about specific medications that would help. He asked me to bring in copies of the articles I had found, and commented that these truly were the worst cases he has seen since his childhood. "Eldoret doesn't have jiggers," he explained. "It concerns me that these children look so bad. I might have to contact the government to go and spray the entire area in order to contain this disease."

Point is, I'm not exaggerating when I tell you that these kids are in bad shape.

Little Richard fell asleep on my lap while the surgeon and I talked about the options before us. And as the doctor talked about various topical anesthetics I might be able to use to make the removal process less painful, I felt how my lap became a warmer and warmer from the little one urinating on my lap. I tried to focus on what the doctor was saying without letting him read my mind. Thoughts flashing through my mind included, "I hope the urine stays just on my skirt. I wouldn't want to get up and leave a wet seat behind. I'm glad I'm wearing a thick denim skirt - it's soaking up more urine than a cotton one would've. What did he just say about which medicine might work??"

I asked about tetanus shots, and he referred us to the third stop for the day: ER. There, a friendly nurse gave each kid their shot. The three youngest ones took things in stride. They cried when the needle went in, but the tears stopped almost immediately. Joanna, however, put up the biggest fuss I'd ever seen. She was paranoid of a needle, and two nurses and I ended up having to hold her down! I never thought I'd ever do anything like that! But the moment the needle came out, she was all smiles. She remembered that I had told them I'd buy them each a candy if they'd endure the shots!

The last stop for the day was to get their heads shaved to prevent any diseases on their heads, and the kids looked really cute with their clean-cut little heads! They were beaming when I dropped them off at their home with some fruit to take with them.

Thank you to each one of you who have expressed care for these precious little ones. The journey ahead is still long, but they're already doing much better than when they first walked into our lives 11 days ago.

Once they're healthy and their home is jigger-free, we'll talk about options in terms of hiring someone to help at their home every day and to take care for the two boys so the two girls can go to school. But these are issues for which I'll seek insight from my Kenyan directors. I want to do what's best for the children, but also what's best for the dad. I don't want to enable him and make him dependent on us. Instead, I want to find ways to empower him to be a better father.

Some sights I don't want to forget:

1. Their amazement the first time they used a toilet. They're used to outhouses, or quite frankly, to simply go in the field. Before we went to town, I asked them to use the chou, and they literally gawked as I flushed it after them, as in, "No way! Where did my 'stuff' just go??"
2. The excitement on their faces when they realized we're going to ride in my car. "The big car!" they told each other as we walked over, smiling from ear to ear.
3. Their curiosity as we were in the doctors' offices. They'd sit on the doctor's chair, look through his stuff, peak through the windows at the world a floor below them...
4. The care among the four of them. The girls, especially, are really looking out for their little brothers. While little Richard's feet were being soaked, he literally had to stand in the basin of water. Joanna leaned forward and whispered in his ear in Swahili, "Don't be afraid. You can't fall over. I'm right behind you." It was so endearing!
5. Little Brian's smile... He's really crept into my heart more than the others, and wherever we'd walk, he'd come and slip his wound-scarred hand into mine. As he and I sat waiting in the surgeon's office while the others were still eating, he took my hand in his and started rubbing his arms, a "please tickle my arm" gesture. As I did so, he leaned back against me, smiled, and fell asleep.

In about 2 weeks' time, a team will come to do a VBS. These kids will be invited to join. Will you please pray that God will prepare their hearts so they can know how much Jesus loves them? I've been praying lots for them, including soaking them in prayer as I wash them and treat their wounds. I have no doubt that God will heal their little bodies, but even more so, that he'll heal their hearts.

On digging out sand flea egg sacks . . . and almost being robbed!

The day started full of promise! A great time with God. Wonderful breakfast with a good friend. And then we headed out to see our little friends down the road. Armed with Dettol, needles, Triple Anti-bacterial ointment, soap, and a huge portion of courage, my friends and I headed out to see what we can do to help the little ones.

As I rounded the corner into their maize (corn) field, little Jepkemboi came running and through her arms around me. It melted my heart! This is the same little one whom I could hardly get to smile last week!
Laura, Mary, Ruth and I settled in for the task before us. Laura had my camera, so she was able to take some photos of the process. (You can see some of the pictures on my Flickr page.) We had only removed 13 egg sacks from the little ones' hands and feet when I couldn't deal with it any more. The kids were in a lot of pain!

Tomorrow, I'll be taking them to a pediatrician who will refer us to a surgeon. The pediatrician said they'd be able to remove them surgically (with local anesthesia). I counted and estimate that each of the three youngest kids have between 80 and 90 lesions! And even while we were sitting there, we killed at least five or so sand fleas (jiggers) that were trying to dig into the little ones' skins. These fleas are very, very small. There's a picture on Flickr of one of them on Kiprop's hand.

I've been careful, using gloves the whole time. However, it would be easy for one of those fleas to dig into your skin even while you're just sitting there, working. Something has to be done about the fleas in the garden and in the house.

So, after dropping off Laura at the airport, I went to the Agro-Vet store to buy poison to spray in the yard. Since I hadn't had time to burn a DVD for Laura with pictures of her time in Kenya, I took my computer to the airport with me. And though I never leave it in the car, I decided to leave my computer bag while I run into the bakery to buy bread. After all, you couldn't see the bag under the bag with poison.

Or so I thought.

After getting bread, I stopped at a street vendor to buy another pair of shoes for the kids. But the guy gave me a ridiculous price when I asked about a pair of used kids' shoes, so I wasn't even going to barter! I just laughed, turned away, and started walking to my car.

My car's higher than the average vehicle on the street, and when I looked down the road to where it was parked, I saw a man getting out of my car . . . with my computer bag in his hands!

The car was parked at least a good 50 meters (around 50 yards) from where I was right then, and I yelled, "NOOOOO!!!!" as I dashed down the road.

EVERYONE stared. Even the guy. He dropped my computer like it was about to explode and ran for his life. Literally. (In Kenya, mob justice is still practiced, and it's acceptable. If he ran with my bag, he'd be slowed down. If other guys caught him, they could literally stone him or kill him with sticks!)

In the few seconds it took me to get to my car, a crowd had gathered, asking if I'm OK, if the guy had gotten away with anything, if I had left the car open.

I was pretty shaken up, not sure for a moment if I was safe even in the crowd... "I'm OK. He didn't get anything. He busted the door lock." As I drove off, still shaking, people were staring. Some were saying how sorry they were. One guy said, "Praise God he didn't take anything." Praise Him indeed!

The corner of my computer is busted from being dropped from about 3 feet high, but it works fine. Nothing broke. Except for the lock to my car. The guy must've busted it with a screw driver.

Until I can get the lock replaced, I'd have to unlock the driver's door from the passenger side. But think about it: If the guy had busted the passenger lock (the side where the bag was, after all), I would not have seen him get out of my car! He'd have been protected by the vehicle itself!

So, as I head to bed tonight, it's with such a mixture of feelings.

Hope for our little friends down the road.

Relief that my computer didn't get stolen.

Frustration that my car door is busted.

Joy for having had friends around for the past two weeks (first Karen, then Laura).

Sadness for being back to a place where much of my journey is walked alone.

But the journey does continue. For now, Flannel simply has to endure listening to my stories.

Flannel, and you.

To read more about tungiasis, the condition my little neighbors have, visit this site.

Not for the fainthearted

I've been reading an article on the CDC Web site, thanks to a comment on my earlier posting. And judging by the pictures and descriptions, it seems that this is precisely what the children down the road have: sand fleas, or jigger fleas. The condition is known as Tungiasis.

I looked at the pictures, and they look exactly like what the kids have! An excerpt from the article says, "The female jigger flea penetrates into the skin of its host, undergoes a peculiar hypertrophy, expels several hundred eggs for a period of <3 weeks, and eventually dies. ... Within 10 days, the flea increases its volume by a factor of approximately 2,000, finally reaching the size of a pea. Through its hindquarters, which serve for breathing, defecating, and expulsing eggs, the flea remains in contact with the air, leaving a sore (240–500 mm) in the skin; the sore is an entry point for pathogenic microorganisms. The preferred localization for jiggers is the periungual region of the toes, but lesions may occur on any part of the body."

So, tomorrow morning, Laura and I will go with Ruth to carefully remove more of the sand fleas from the children's fingers and toes and inspect their little bodies for other infections. I realized that what I thought were rocks embedded into the young boys' feet may in fact be stage 2 lesions, as the flea's egg sack is growing.

The challenge with removing the egg sack is that one can easily break the sack and release the hundreds of eggs right into the sore! So it's a tedious process, and a VERY painful one at that. I'll take some candy for the kids to chew on to distract them. We'll also bathe the little ones again.

Please pray for the little ones for continued healing! I saw the girls today, and they look a big perkier. But there's still a long journey ahead.

Please also pray for us who are going to help, for protection from the very flies that are attacking the little ones. And for continued wisdom and discernment in dealing with the issues at hand - issues far deeper than egg sacks burrowed under their finger nails...