Tunaitikia mtu mmoja tu. Wengine wangoje nje!” 

This was my refrain in Swahili for the entire day as I ran the surgical outpatient clinic during the new normal times of Covid-19.  

And so, anyone who dared protest was met with a firm but polite reminder that we were trying to ‘komesha korona‘ and flatten the curve. 

Of course some would put up a spirited fight. To which my answer would be a simple stare, hidden beneath a veneer of the now ubiquitous face mask and my omnipresent spectacles. 

“Can he speak in English? Swahili? Kimeru? Then just leave”. Usually after this, there is no further bargain. 

It was time to see the 17th patient. 

As soon as I saw him from the door, I knew I would have to accommodate the relative. 

He was in his sixties, clad in a shuka and a jungle green top akin to the ones worn by the police reservists. The ornamentals enriching his ear lobes, the neck and the limbs told me he must be a plain Nilot from either Isiolo, Marsabit, Laikipia or another of the neighboring counties. 

He wore akala. You know those sandals fabricated from old tires?

This was a dejavu moment for me. I have worn such in the past. Damn those sandals! They are the reason I bear scars on the inner side of my ankles. It so happens that when you walk, depending on your style and gait, you could hit your inner ankle with the opposite foot as it swings. It is such a painful experience.

Just when you think you have mastered the perfect gait and style, and the wound has started healing, you hit yourself again. At the same spot. If you are in the wilderness looking after livestock, flies of numerous species congregate on these ankle wounds. It seems they can somehow sense the smell of fresh blood, decaying tissues or the broth that is pus. Whether the instinctual needs these wild flies seek to assuage are of thirst, hunger or reproduction, I have no idea. All I know is that the encounter hurts even more. Even if you have a handkerchief or a torn piece of old cloth tied around your wound. And of course their probosces are dirty, leaving you guaranteed of wound infection. 

Beautiful Bracelets

I looked at this chap like he was a victim of such predicament. I even thought  for a moment that he was here to see the surgeon because of such. But his ankles looked healthy. They had neither handkerchiefs around them nor a swarm of flies circling in vicinity.  Instead,they had beautiful bracelets. The type any western tourist will pay an arm and a leg to buy at Maasai market.

This doesn’t mean that his gait was perfect. He was an expert at a safety modification that is as old as the sandals themselves. A smaller piece of the strap material, say six to eight centimetres long, placed perpendicular to the sole to lie directly covering that bony protuberance we call the medial malleolus, the focal point of the occupational injury I have expounded on above.

He sat on the wooden chair next to the door and placed his walking stick between his legs. One and half meters away I sat on my swivel chair in front of the computer which contained his biodata. 

His son stood next to him, clasping at two radiology department envelopes. From their sizes I could tell that one contained CT scan images.  The son was dressed like any millennial in a Kenyan city-maroon slim fit chinos and a turtle neck sweater. His feet were covered in Levi’s sneakers worn over well chosen low-cut funky socks. 

The only connection to his rural home in Wamba was his language and the belt he adorned that was decorated with white and blue beads up to the buckle. 

The old man complained of abdominal pain and distention for months. He felt his stool was hard. He needed be to assisted. 

His son did much of the translating but once every so often the patient would break into some descent Swahili, giving the translator some needed rest.  

He got on to the couch and I descended on his abdomen with the voraciousness that every doctor bears when approaching a difficulty diagnosis. The abdomen is a jungle, we say. 

Marks on the Abdomen

On his tummy skin I found various marks, we describe them as therapeutic marks. His were those made using some heated pieces of wound to treat pain. His belly had some fluid-ascites in medical parlance. There was no area that hurt. But I noticed what looked like surgical marks along his right rib cage. I had to counter check with my urbanized young translator. 

“Did he have surgery?”  

Alikuliwa na simba akiwa mtoto.” 

Well, if I was to translate this into English, I would say “He was eaten up by a lion…” 

So why was he here? Did the lion leave some left overs? Any way, I digress.

But that is the beautiful Swahili with local accent that the different ethnicities of Kenya can identify. Another thing to tie the modern young man to his roots. 

The CT scan had revealed a growth in the right lobe of his liver. He needed a needle thrust through his right rib cage to get some biopsy for diagnosis and planning of treatment. 

I jotted down the request card. As I signed it off I thought , the needle will have to go through one of these lion bite marks.

Another day in the village surgeon’s clinic!