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LIANE HANSEN, host:

This weekend, NPR launches a weeklong series on global health issues. Today's subject is health care in Africa. Infectious diseases such as AIDS, malaria and tuberculosis are seen as the greatest threat in Africa, but heart disease, cancer and diabetes also are major killers in the developing world. Treatments and medicines are scant, particularly for people who live far off the beaten track. A half-century ago, American and British physicians started a medical service called the Flying Doctors to airlift people out of remote areas in medical emergencies. This service has now become a way to reach out to Kenyans who have long done without medical care. As NPR's Brenda Wilson reports, the small planes of the Flying Doctors fleet now signal the arrival of medical specialists that locals have come to depend on.

BRENDA WILSON reporting:

It's late afternoon by the time 58-year-old Dr. John Wachira is deposited at this soggy airstrip.

Dr. JOHN WACHIRA: ...on Friday at 4 PM from here. Yeah, 4 on the dot.

WILSON: The single-engine plane has taken him, nine specialists and surgeons, the Flying Doctors of the African Medical and Research Foundation in Nairobi, to remote areas on the border of Kenya before circling south to drop him off in Maralal.

Unidentified Man #1: OK. Well, we abandon you here.

Dr. WACHIRA: OK. (Laughs) If that's what you choose to do today, all right.

Unidentified Man #1: Have a good stay in Maralal.

Dr. WACHIRA: Thank you.

WILSON: The plane then turned around and headed back to Nairobi.

(Soundbite of plane engine)

WILSON: Wachira is a urologist and general surgeon. When he's in Maralal, this poor rural area in the Samburu district has health care they wouldn't otherwise have. Maralal is home to the Samburus and Turkanas, who with Kenya's Masai tribes share a love of cattle and the nomadic life. But it's the rainy season now. The roads are flooded. Everything is green. There's plenty for the cattle to feed on, including the lawn at Maralal hospital, a spread of several low-lying, one-story buildings that has been turned into an island by the rains.

Dr. WACHIRA: (On phone) Hello, Daktare(ph). I'm fine, thank you.

WILSON: Wachira calls his office back in Nairobi to assure them that he's arrived safely.

Dr. WACHIRA: (On phone) We had a driver who was a bit courageous. (Laughs)

WILSON: The most distinguishing feature of this genial, round-faced, plump-cheeked man is his laugh. He's tall with a slight paunch and solidly built, and manages to be casual and very direct at the same time. The laugh seems to stand in for a multitude of expressions, from humor to pity to consternation, whether in reaction to the stumbling blocks he runs into, the lack of equipment, medicine.

(Soundbite of voices)

WILSON: By 8 the next morning, patients are beginning to cluster outside the screening room under a covered walkway, drawn by word of a specialist from the big city, a flying doctor. Most have waited until their condition is severe before seeking medical help, because there aren't that many doctors and specialists like Wachira come here only every two months.

(Soundbite of rustle of X-ray film)

WILSON: Wachira is examining the X-rays of a 52-year-old man who suffers from a problem fairly common to older men: prostate trouble. Wachira is pretty certain that it's obstructed.

Dr. WACHIRA: (Foreign language spoken)

WILSON: He turns to Athany Nayutu(ph) and asks if he has trouble relieving himself. `Especially in the morning,' Nayutu says. `I have to push really hard, and even then with all the pushing, I am not able to empty my bladder.'

Mr. ATHANY NAYUTU (Patient): (Foreign language spoken)

WILSON: It's been like that since 1996, Nayutu says. Wachira looks worried. He drums softly on the table and instructs the nurse to check the man's blood pressure. Something has occurred to him that has not crossed the minds of the young staff doctors who examined the man before Wachira did.

Dr. WACHIRA: Hmm. Now he's got a long-standing history of (unintelligible) and longtime complications would be pressure on the kidneys, which is--like it manifests like hypertension. So that's why I just want to find out whether that has happened.

Unidentified Man #2: It's 200 over 120.

WILSON: The reading is 200 over 120, a level of hypertension that could kill him. Wachira's low chuckle sounds almost like a groan. His fears have been confirmed. He tells Nayutu he needs to admit him to the hospital right away. He can try to shrink the swelling or remove the obstruction, but he needs to do more tests and he has to get his pressure down.

These circuit-riding surgeons are often the only ones that stand between these poor pastoralists and death. The perception is that infectious diseases such as malaria, tuberculosis and now HIV are the big killers of people in developing countries. But a recent World Health Organization study indicates that they are actually more likely to die from the same illnesses that kill people in affluent countries, such as heart disease, stroke and cancer.

Dr. WACHIRA: There's--more studies that we have, most of which are actually hospital studies, tells us that there may not be much difference in terms of some of these diseases may be almost as prevalent as we find in the Western world.

WILSON: This daylong screening Wachira conducts is crucial to the diagnosis he makes. He usually has no CT scans, ultrasounds, computers or the myriad other tools found in an ordinary hospital in a developed country.

Dr. WACHIRA: I have seen--sorry to say--how primitive, how inadequate, the (unintelligible) we have. So--and something have got ...(unintelligible), but you have got only one, let's say, weapon, which you have to attack these diseases. And there's no just extracting the history from the patient.

WILSON: He has to distinguish the history of pain, trouble walking, the lump and even the exaggerations of the hypochondriac, sometimes working with a patient who's been given a diagnosis that is completely wrong.

Dr. WACHIRA: They can give the patients very wrong impressions, and they live with it.

WILSON: And in a country where there are a number of different clans and tribal groups, language can get in the way. In this district alone, Samburu, Turkana, Kiswahili and Kikuyu are spoken.

Dr. WACHIRA: Grace? Grace Lakeirboni(ph)?

Ms. GRACE LAKEIRBONI (Patient): (Foreign language spoken)

Dr. WACHIRA: Aha. (Foreign language spoken)

WILSON: He asks Grace Lakeirboni where she is from, but Grace doesn't understand him. She is Samburu. She tells him that she doesn't speak Swahili. `Tell me what you can,' he says, `using whatever Kiswahili you know.'

Dr. WACHIRA: (Foreign language spoken)

Ms. LAKEIRBONI: (Foreign language spoken)

Dr. WACHIRA: (Foreign language spoken)

WILSON: Finally, Wachira asks, `Where are you sick? Show me.' Eighty-year-old Grace unceremoniously removes the red woolen cape that is draped over her shoulders and unbuttons her dress. There is a large knot of knobby flesh on the side of her withered breast.

Dr. WACHIRA: (Sighs)

WILSON: Wachira examines the breast and the lump. She has obviously had the lump for a long time, and now it has become uncomfortable.

Dr. WACHIRA: (Foreign language spoken)

WILSON: Grace Lakeirboni has been accompanied by her youngest son. Wachira tells him to make plans to stay at the hospital with his mother for a week, and then he turns to Grace.

Dr. WACHIRA: (Foreign language spoken)

WILSON: `(Foreign language spoken),' `Grandmother,' he says, `to heal the sickness inside your breast, we have to take it off.' She says, `No. You must give me medicine to take away the sickness.'

Ms. LAKEIRBONI: (Foreign language spoken)

WILSON: She repeats the demand.

Ms. LAKEIRBONI: (Foreign language spoken)

WILSON: `Give me medicine.' Wachira says to the son, `Explain to her that there is no medicine that will take away the sickness. They have to remove the breast.' Finally, he asks her son, `Does she understand?' The son answers, `Yes, she understands.'

Dr. WACHIRA: (Foreign language spoken)

Unidentified Man #3: (Foreign language spoken)

WILSON: Early the next afternoon, Grace Lakeirboni is in the Maralal hospital operating theater, her breathing supported by a respirator the anesthetist controls by squeezing a small black bag that looks like a deflated football. Dr. Wachira begins the radical mastectomy by tracing a line in the skin with the sharp tip of a scalpel. One of the young physicians who works at the hospital has followed Wachira's every move, and now hovers with him over the patient, assisting, questioning, observing, as the older doctor presses the pedal of the machine that is used to control the bleeding by cauterizing the blood vessels--equipment that he brought with him. The day he performs the mastectomy, he does four prostate operations, all with his own instruments. The conversation in the room hardly rises above a whisper.

It is dark by the time John Wachira's day ends in the operating theater at Maralal hospital. He's had one short break for tea and time out for lunch.

The next morning he performs another prostectomy and removes a polyp from the colon of a young woman who was bleeding excessively. The patients have waited for months for Wachira to bring them relief. He wraps up his visit to Maralal with ward rounds, checking on the old woman who has had a rough night.

Unidentified Woman: (Coughs)

Dr. WACHIRA: (Foreign language spoken)

WILSON: He admonishes the nurse not to let her sleep too much. `Get her up,' he says. In three days, he has examined more than 30 patients for the first time and performed eight operations. Two patients had cancer so widespread, operating wouldn't help. You'd think that he would be tired, and perhaps he is, but it doesn't show. He packs to leave with practically the same good humor he arrived with three days ago.

(Soundbite of voices)

Unidentified Man #4: That's a very old bag.

Dr. WACHIRA: It's stuck to me faithfully for the last 12 years.

(Soundbite of laughter)

Dr. WACHIRA: So I keep it just as tight. I shall put it in a museum.

WILSON: For more than 30 years, international health organizations have promoted primary health care and preventing disease in developing countries. The point was to immunize and educate people about health so that a lot didn't have to be spent on hospitals, medicine and doctors. The Third World, Wachira says, had no choice but to accept. He doesn't disagree entirely, but he's concerned that one of the consequences is that curative services have been neglected.

Dr. WACHIRA: I'm sure many people have asked that question: Why would a poor country go to buy a CT scan when the vast majority of the people are dying of malaria, which is ...(unintelligible) preventable just by meds? It doesn't work that way. There are so many people who also die from conditions that we can't prevent, and they end up in the hospital.

WILSON: And as long as that is the case, John Wachira will be needed in Maralal. Brenda Wilson, NPR News.

HANSEN: You can follow the Flying Doctors in a multimedia presentation at our Web site, npr.org. The global health series can be heard on NPR programs throughout this week. Global health coverage also continues on "Rx for Survival," a television special premiering this Tuesday, November 1st, at 9 PM on PBS. Check your local listings.

You're listening to WEEKEND EDITION from NPR News.

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