During my vacation from medical school I stayed with Benson Riungu, a Kenyan clinical officer. His name means ‘man of Africa’. He is from the Meru tribe and is the eldest of eight siblings. He trained at the Presbyterian Chogoria Hospital in the foothills of Mount Kenya working in outpatients and as an anaesthetist. (The anaesthetic used there was ether, which precluded the use of diathermy.)
Man of Africa
In 1985, Benson set up his own dispensary in his home village of Chaigu which is further down the valley. He speaks Kimeru, English and Swahili. He is a church elder and a school governor.
Benson’s dispensary serves 12,000 people who have an average life expectancy of 60 years. In this area, most have medical insurance, but on occasion he accepts payment in the form of maize. He travels to his dispensary and to home visits on foot and consults for 12 hours a day, six days a week.
The dispensary does not have electricity, so he treats the evening patients by torch light. Frequently patients will come and wait in his small holding to be seen after he has returned home at night.
Benson using his microscope
Benson does his own lab work, using a sturdy black Watson and Barnet microscope which I learnt was rescued, refurbished and recycled by the technicians at Liverpool School of Tropical Medicine 25 years ago. The microscope uses natural light and works with field stain and oil immersion.
The most common abnormal lab results are malaria parasites, amoebic cysts, worm ova and salmonella. Benson undertakes minor surgery, trauma care and dental extractions. His equipment is cleaned using an improvised pressure steam steriliser.
A large part of Benson’s practice consists of the treatment of infections and infestations although the management of chronic illnesses is becoming more important. He regularly prescribes for patients with malaria, lung infections, skin infections, diarrhoea, intestinal worms, trachoma, rheumatic heart disease and mumps.
Benson buys in and dispenses his own drugs. I found that he has not seen polio, leprosy, cholera or measles for many years because of the improved living standards and the vaccination programmes.
He refers cases of TB, HIV, hepatitis, cataracts and tetanus to hospital. Sadly these diseases are well known to the villagers. A local man, upon recognising he was developing the symptoms of tetanus, caught the first matatu bus to Nairobi. Unfortunately the bus conductor also recognised the typical tetanus facial expression ‘risus sardonicus’ and took advantage of the urgency of the situation and charged him an extortionate fare.
Benson refers obstetric work to government dispensaries, where most women deliver. The Meru, traditionally do not need contraception again until the infant can walk and carry an avocado to his father; infants’ gross motor development here is good. Contraception, in the form of pills and injections, is easily available and acceptable.
Cambre and I in the dispensary
A typical family would have three or four children. A child born after a sibling who has suffered neonatal death is named after a wild animal. The women carry their babies on their backs using kangas (printed cotton sheets). The babies sit with their hips abducted so congenital dislocated hips are unknown here. Young children walk around barefoot and are therefore at risk of jiggers (a female sand fly infestation).
Further public health work could have a large impact here. Already, the incidence of malaria has been significantly reduced by pouring kerosene into the mosquito breeding areas. Childhood vaccinations and HIV screening are now available at government clinics. However, village water is still taken, untreated, from the river Nithi.
Sanitation is compromised as most, but not all, families have pit latrines. Food hygiene is limited; for example families slaughter their goats and prepare the carcasses at home.
The oldest woman in the village
I found the Meru are very kind and generous people. I was touched when a grateful patient presented me with two eggs. Later, Benson explained this was a traditional gift to aid my fertility needless to say this is not one of my current priorities!
It was a privilege to watch the 'man of Africa', who is clearly loved and respected by his patients. As an experienced clinician and pillar of society, relying on his bedside skills, he makes a big difference to his village’s health. I am very grateful to my tenuous chain of contacts who gave me this awesome opportunity.