Ian of Korogocho

At six in the afternoon, I am in pediatrics to check the two children operated on this morning. They have a little pain, they don't like the cast that blocks their leg and foot. The fingers are warm and they can move them at my request, which is a good sign. I ask the nurses to give them a sedative and I go in guest house to relax a little. I'll be back to see the little ones before night.

I make two cups of tea: Henry has arrived to drink it with friends and have a chat before going home with the boda-boda (this is how the motorcycle taxi is called in Kiswahili, an agile and low-cost means of getting around in the impossible traffic of large African cities). A gecko is clinging to the corner between the ceiling and the wall in front of me, motionless, it seems to be looking at me: it is hunting for mosquitoes and flies. Suddenly I see it snap lightly on its prey. Well, one less mosquito.

The weather is changing: I see black clouds coming, sunset is approaching and a rainy evening is announced.

As we sip Kericho Gold Tea (excellent tea from the plateau, north of Nairobi) we talk about Ian, one of the patients seen in the clinic today. He is twenty years old and comes from Korogocho, one of the most crowded and degraded slums in Nairobi, whose name means "confusion". Phelgona, a nurse who lives in Korogocho and with whom I have been collaborating for many years, also the mother of a disabled boy, had told me about it. He informed me that Ian cannot walk, lives as a recluse in a shack and is occasionally assisted by an older sister. His mother died when he was a baby, his father never knew him.

We sent our ambulance to pick him up and now they bring him to the clinic in a wheelchair. He was born with "spina bifida", a malformation of the spinal cord and spinal column which caused paralysis of the lower limbs. He points to his right foot, which is wrapped in a cloth that was white several days ago but is now a color between greyish and green.

I carefully remove the cloth stuck to the foot, because I fear it will hurt him, but he, who has sensed my concern, tells me not to be afraid as the disease has taken away the sensitivity in the lower limbs. We exchange a glance: I feel an instinctive sympathy for this boy, I "feel" that the thing is mutual. The boy is awake.

The foot is swollen, with the skin torn and punctuated by fistulas from which foul-smelling pus comes out. This is a nasty infection that will surely involve the bones as well. It is very likely that the cause was a splinter of wood even though he does not remember being injured.

I also feel a strong ammonia smell which does not come from the foot but is due to urinary incontinence, a consequence of his underlying disease. As a remedy for chronic urine loss, use a piece of spongy tissue that acts as a diaper.
Not even talking about a shower or bidet in Korogocho, where he lives.

Henry pulls the wheelchair up to the bed to be able to medicate him and, without being helped, he jumps onto the bed with only the strength of his arms. An athletic leap that leaves me stunned.

We medicate him, wash him with Amuchina and accompany him to radiology.

When I receive the x-rays I realize that the situation is desperate: the bones are worn out by the infection, in particular the heel is eroded in several places and has a porous appearance, like a sponge.

Together with Henry (who speaks Swahili) we explain to him the need for surgery for his foot, because the serious infection that involves him, if not treated, could cause much more serious trouble, putting his own life at risk. The radical solution would be amputation, but he decisively refuses. He wants to go home and come back after three to four days for the next medication.

If I have won his trust he will come back.

And in fact I find him in the clinic on a Monday morning, brought by our ambulance. He only came to clear the foot of the pus that still comes out of the fistulas, not for the amputation. The next morning I proceed with the cleaning operation together with Lino, who arrived from Italy over the weekend. He is the orthopedic colleague who for ten years has been helping me for two weeks in the most complex operations that require the presence of a second operator. I am very fond of him, we are in perfect harmony in behavior and approach with our patients and my esteem for him is increased by his great professionalism. He is an excellent surgeon, the one to whom I will gladly leave this activity when it is time to retire.

Speaking with Lino about the difficulties of moving the boy inside the slum, we came up with the idea of ​​buying a manually propelled tricycle (like a handbike) which would make it much easier for him to move around, even in the city.

We discharge Ian after three days with a prescription for baths with Amuchina and medications which the nurses of the orthopedic clinic will take care of.

The time has come for us to return, it is the end of the mission.

Ten days after my return I receive two photos of Ian from Henry: the first portrays him beaming on his tricycle, the second is in the lawn in front of the surgery with his foot soaked in a basin full of Gik (that's what they call here Amuchina).

Upon my return six months later, Ian is one of the first patients to show up for control. He shows me his operated foot smiling: the fistulas have closed, leaving small scars on the skin and even when squeezing with your fingers, no pus comes out. I am amazed and happy for him, frankly I did not expect such a positive result. After so many years I am no longer surprised by anything: it is useless to look for an explanation for certain healings that I see only at these latitudes. The x-rays are certainly not those of a normal foot but if he continues like this he is on the right track.

I was for the amputation, he did not want to give up his physical integrity, while maintaining a "useless" foot. Ian, in the end you were right.

Antonio Melotto

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