Wadoodoo's in His Foot ...

(Click Photos to Enlarge)

I must warn you that this post is a bit more graphic than most. In my attempt to bring all of you closer to understanding the daily lives of the Kenyan natives in the immediate vicinity of Tenwek Hospital, this story is a very poignant example of how extreme their lives can be. This post can also serve as a reminder of how fortunate we are to have the simple daily necessities which we all take for granted that prevent this kind of situtation from ever becoming a part of our reality. As barbaric as this situation may seem to those of us more fortunate, I found myself in awe not only by the situation but by this 9 year old patient's display of courage in the operating room to surroundings that he couldn't possibly have understood.

This patient was brought into an adjoining OR (the same OR where I saw the arrow removed from Elvis' neck on my original visit to Tenwek) while we were finishing one of our cardiac procedures.  The patient was a young boy who had sustained a machete wound to the heel of his right foot several days earlier.

To my complete amazement, he was brought to the OR to clean his wound because it was infested with maggots.  They were literally crawling out of the festering wound on his foot as the boy sat there watching it happen.

When I entered the room, the boy was on the operating room table and Dr. Russ was talking with the boy in Swahili.  Swahili is the mother-tongue spoken by most tribes in the area.  Each tribe also has their own dialect, and some also speak English as well.  Dr. Russ was explaining to the patient that they were going to give him a spinal so that they could "fix his foot".  The spinal would involve sticking a needle into his lower back into his spinal column to adminster the anesthetic.

The patient is being held in this photo by the nurse as the nurse anesthetist placed the spinal needle in his lower back and administered the anesthesia to deaden him from the waist down so the maggots could be evacuated and his wound cleaned while he was awake during the procedure.  Dr. Russ was speaking with the patient during the entire time in Swahili.

During the spinal, I watched the boys face very closely waiting for what I had become accustomed to as the "normal" response to pain.  Many of the medications we have in the US are simply not available in large quantities at mission hospitals like Tenwek, or if they are available, they are prohibitively expensive.  Because of this, it is sometimes necessary to utilize services, equipment and/or medications on the patient's who need them the most.  It did not appear that this paitient had received any pre-op medication and he was very aware of his surroundings during the spinal.  To my complete amazement, this young boy didn't even flinch as he fixed his eyes on Dr. Russ durnig the whole procedure.  

After the spinal was completed I asked Dr. Russ what he had been saying to the patient?  He said he asked the boy what was wrong with his foot, and the boy replied, " There are Wadoodoo's (Swahili for "bugs") coming out of it".   He went on to say that "It was hard to sleep at night because of the pain from the "Wadoodoo's".

Dr. Russ also told the boy that he had this procedure (the spinal) done many times himself and had even performed it on his own children.  He told the young patient that he would have to take this spinal injection like a "warrior".

You'll need a little background to fully appreciate what Dr. Russ was telling this patient, and to completely appreciate this young boys response to the ensuing operation.  In most tribes in Kenya even today, young boys must go through a rite of passage to become a man.  This ritual occurs around the age of 15 or 16 where the boys are circumcised.  This ritual is a public display and varys from tribe to tribe, but in general the boys are circumcised without anesthesia in front of their families and entire communities.  This is a test of their manhood and they are not allowed to cry out in pain during the procedure or they will be considered cowards with life-long circumstances to their standing within the tribe.  Historically, this young boys tribe would also be required to kill a lion as part of his passage into manhood following the circumcision.  This whole paragraph would pretty much describe my worst nightmare and I'm not sure I can even comprehend the type courage that would be required to face that type of extreme circumstances.  You can see the courage that this little guy has just by looking in his eyes.  In my book, he's already a warrior.

Dr. Russ explained to me that it was the "rainy season" and since his tribe tends cattle and brings the herd into the village at night to protect them from lions (who feed nocturnally), he spends the entire rainy season walking barefoot in mud that is contaminated with cow manure.  Because the machete wound on his foot was not kept clean (i.e. no shoes and socks) it became infested with maggots.  Without skipping a beat - while I was trying to comprehend any of what I had just heard - Dr. Russ matter-of-factly informed me that he would do just fine after the wound had been cleaned.  He knew the tissue was healthy since the maggots themselves were healthy.  You see, maggots can only feed on live healthy tissue.  When the tissue starts to decay the maggots will die because they have no viable food source.

When it was verified that the boy could not feel anything below his waist they positioned him on the OR table and placed a cloth screen between his face and his lower body so he could not see the operation on his foot. During the course of the surgical procedure, about 150 live maggots were removed from this young boys foot. Most of the maggots were situated behind his achilles tendon deep inside his heel. It was an incredible operation to see, since this type of injury would never be seen in the US.

This video clip shows the boys wound prior to prepping and draping for surgery.  You can see the maggots moving on the gauze sponge after they've been removed from the wound. 

This photo shows the little boy's heel with a maggot in the center of the wound before his foot was cleaned and prepped for surgery. The next photo shows some of the maggots that were initially removed from his wound (click photos to enlarge).


When I first came to Kenya and saw the daily struggles that these people had to go through for things that we take for granted I have to admit that my first emotion was one of pity (i.e. to get a drink of water we take a couple of steps to the faucet and water is immediately available... for most of the African tribes, there is no electricity, no refrigerators to store left-overs and they walk for miles in each direction daily just to fill a jug of water so they can drink).

After experiencing this little boys response in the OR and understanding their culture to a more significant degree, I'm certain that my initial reaction of pity would only anger these proud people.  The only appropriate emotion when you fully understand their culture is one of respect and admiration for the proud warriors that they truly are.