Jaja pushed opened the door to the house and engaged in a long conversation with the mother, who seemed more than happy to see them.
But Evan’s eyes were drawn to the corner of the room, where a small boy was lying on a makeshift bed. His siblings were playing around him and he seemed oblivious to the noise in the room. Evan’s instincts were automatic and he went to the bed of the sickly child.
“Hi, there, Dumkata.”
The dark eyes flickered open at the sound of the foreign voice. The little boy’s hands automatically started scratching at his skin, as if he had an uncontrollable itch. It was almost as if Evan’s voice had broken him out of the half-slumber he’d been in.
Evan turned to face Jaja. “Can you ask the mother if she minds if I take a look at her son?”
Jaja answered quickly. “She was just asking me the same thing. She knows you’re only here to give the vaccinations and didn’t want to take up your time.”
“It’s no problem. I’m happy to look at him. Can you organize the polio vaccination for the rest of the family, Jaja?”
The community worker nodded and pulled out the vaccine carrier and flip book to explain things to the family.
Evan touched Dumkata’s forehead. It was just as he’d expected. Burning hot. He pulled his medical bag over and took out the tympanic thermometer. It beeped within a few seconds. It indicated that the boy had a temperature.
He pulled out his stethoscope to sound the little boy’s chest. Dumkata barely responded, he still seemed fixated on the itch in his skin. “Can you ask the mother what he’s been complaining of?”
Jaja took a few moments to reply. “She says he’s had a terrible headache for the past few days and his joints are painful and sore. Dumkata is usually running about constantly. She says this is not like him.”
Evan nodded and gestured to Jaja. “Could you help me sit him up for a moment, please?”
Something was setting off alarm bells in Evan’s head. He had the strangest feeling, and experience told him to go with his instincts.
He spent some time examining Dumkata’s skin. There were a few angry marks—just like bee stings—along with a rash that was difficult to see on Dumkata’s dark skin and some swelling in the subcutaneous tissues.
He pressed his fingers gently around Dumkata’s neck and groin, checking the lymph glands and finding them enlarged. It was clear that some type of infection was circulating around the child’s body.
“Can you go and find Violet for me, please? I’d like to have a chat with her.”
Jaja nodded and slipped out of the door. Violet had been working in the village today too but their paths had barely crossed. They’d mapped out the village and decided on separate routes to try and cover the majority of people who had requested to be seen. It made more sense for them to split up than work together.
It also prevented any awkward conversations or, more likely, awkward silences.
It was almost as if she was deliberately avoiding him. She’d never complained about working with the midwives and birth attendants. She’d just put her head down and got on with the job.
But he hadn’t forgotten the look in her eyes. Or the way she’d realized that he’d noticed. At some point they were going to have to have that conversation. If he’d learned anything these past few years it was he needed to be sure about the welfare of his team.
The little form moved on the bed in front of him. He tried to focus on the matter at hand. The niggling feeling he had in his gut about this little boy.
Violet appeared in the doorway. “Evan? You were looking for me?”
Pretty as a picture—even after ten hours on the job. She was wearing another of Olibasi’s outfits, this time in pale pink instead of the brighter colours. Her blond hair was swept up in a clip and her normally pale skin was starting to tan slightly.
Olibasi had been right about the effect of wearing local clothes. Violet seemed to be widely accepted wherever they went. Some reports on previous villages had been a little alarming. But in the past few weeks Violet seemed to be getting good results. The uptake of the polio vaccine was rising in places where it had previously stalled.
It didn’t make sense that it was all down to the type of clothes that the doctor wore. Violet’s quiet, easy nature and never-ending patience was obviously a major factor. But the fact she wore the clothes so well wouldn’t exactly be a hindrance. He tried to keep the smile from his face.
“Thanks, Violet. I know we’re just about to finish up but I wondered if you’d mind brainstorming with me for a minute.”
She looked a little surprised but took it in her stride. “No problem.” She crossed the room and kneeled down next to him at the side of the bed. “Who do we have here?”
“This is Dumkata—he’s seven. According to his mom he’s usually the life and soul of the party, but he’s been unwell these past few days. He has a temperature, a headache, sore joints with some noticeable swelling, some bites and swollen lymph glands.” He caught Dumkata’s hand as it started to scratch again. “He also seems to have an irritating itch.”
Violet nodded. “Well, it could be whole host of things with those symptoms. What’s worrying you most?”
Evan scratched his chin. “Probably the bites.” He turned to face her. “Probably my gut instinct.” He shook his head. “I’m just not happy.”
She nodded. “Then let’s be methodical about this. Is anything springing to mind?”
She bent over Dumkata and started examining his skin. The rash was difficult to determine but was widespread across his skin. It appeared mainly to be speading out from the two bite marks on his skin. “Does the mom know what caused these bites? Is there something in particular we should be considering?”
Evan wrinkled his nose. “Probably. It’s frustrating. Back home we’ve got everything to hand. Out here it’s much more difficult.”
Violet gave him a little smile. She understood completely. Back at the DPA they had a computer program for everything. Every tiny sign or symptom all calculated and computed to tell you any possibilities and what to look for next. She pulled a tiny pocketbook from under her traditional skirt. “Want a look at this?”
It was a copy of a tropical disease handbook—ten years old and obviously well worn. She’d had it since she’d been a student and had hardly looked at it in recent years. But it had been a last-minute addition to her suitcase.
As Evan turned the pages, one fell out in his hands. “Sorry,” she muttered. “I’m sure I’ve got some sticky tape somewhere.”
Jaja walked over to them. “The mother has no idea what the bites are. Her son was playing out near the fields a few days ago. He came home with the bites. She hasn’t seen them before and Dumkata just said they were bee stings.”
Evan’s head shot up. It was almost as if a little light had just gone on in his head. He started muttering and flicking through Violet’s book, “Fields...flies...” His eyes met hers.
“What about tsetse flies? What about the first signs of sleeping sickness?”
“Really? I thought that had almost disappeared?”
Evan pulled out his PDA and looked up some files. He frowned. “Only two cases reported in Nigeria last year. Could it really be something like that?”
Violet shook her head. “You’ll have to remind me about it. I can’t remember that much.”
His eyes scanned between the screen and the book he held in his hands. “African trypanosomiasis is a vector-borne parasitic disease, known as sleeping sickness. The parasites are transmitted to humans by the bite of the tsetse fly. Most common in areas of fishing, animal husbandry or—” he lifted his eyes to meet hers “—agriculture.”
“What do the flies look like?”
He shook his head. “There aren’t any pictures. It just says they are about the same s
ize as bees and quite aggressive.”
Violet looked over at the mother. Jaja was doing his best to relay their conversation to her and the distress on her face was visible. She rushed over and put her arm around her child.
“Help my baby.”