One disease that men should avoid at all costs is filariasis. It can cause serious scrotal swelling.
It is caused by the infiltration of a small tropical worm which blocks the lymphatics which drain excess fluid away from different parts of the body. When filariasis blocks the lymphatics that drain the scrotum, the scrotum swells, often enormously. Sometimes to the extent that the sufferer may need a wheelbarrow to carry his affected organs.
The Nigerian Civil War* had moved on when Dr Dom Colbert flew back to Africa as a young volunteer at the Medical Missionaries of Mary hospital ‘Mile 4’, so called because it was four miles from the nearest town, Abakalik , in its eastern region. The area had been ‘liberated’ by the federal army, and was relatively peaceful. Dom was the only doctor in the hospital.
One of his first patients was Chief Joseph, a man, who believed he was about 50 years old, ‘with a fine face, lovely ebony skin, firm eyes and a noble head covered with a mass of black hair going grey.’ He had such presence that Dom felt honoured to be at his service. Chief Joseph, however, looked at the Irish doctor and wondered what this young mzungu could do for him. He pulled up his jellaba and revealed his huge scrotum. ‘It was so big that you could not see the penis which was presumably buried somewhere in its vastness. ‘You must operate on me doctor’, he said, ‘ you must get rid of this curse’. Dom argued that it really would not help matters at this stage. He told Chief Joseph that an operation would take away his ‘power’, his manhood, and would affect his ability to pee. But the chief was adamant. His ‘many wives’ and his children (between 20 or 30, he was not sure ) pleaded with him to see the doctor at the hospital.
Still unsure, Dom hesitated. One of the nurses took him aside. She said this was a serious matter. Chief Joseph cannot be buried underground if he dies with such a gross deformity. ‘He will be left in the bush for the wild animals, and his soul will wander around the land for ever more without finding rest.’
Dom did the best he could. He cut away ‘everything’, leaving him with just a sufficient penis to project his pee. Complications followed, but one month later, grateful and happy, Chief Joseph presented Dom with a pair of chickens, and left the hospital.
Writhing in pain
One Sunday morning, which was usually quiet with no operations scheduled, Dom was resting when he heard a great hullaballoo at the front gate. A group of young men were arguing with the gatekeeper to let them into the compound. Going to see what the fuss was all about, the men rushed towards Dom half carrying half dragging a boy of about 15 years of age. Despite all the shouting Dom got the message that the young man had not urinated for days despite having been forced to drink gallons of water. The poor lad was writhing with pain. His bladder was distended like a balloon right up to his umbilicus.
A learning curve
This was the first case of schistosomiasis that Dom saw, caused by the invasion of the urinary tract by parasitic flatworms. Inexperienced as he was it was obvious the boy had a stricture of the urethra, somewhere between the neck of the bladder and the tip of his penis. The boy’s cries were heart-rending, and, as Dom admits, panicked him into trying to force a plastic catheter through his penis past the impediment. It would not budge despite several attempts.
At this stage the boy was screaming, but, at the time, facilities and equipment at the hospital were poor. An injection of sodium amytal intravenously sent the boy into a deep sleep allowing a metal catheter to be pushed firmly through the blockage allowing the pent-up pee to flow freely. The boy woke at this point, and his relief was instantaneous.
Dealing with tropical diseases was a sharp learning curve. Dr Colbert admits his mistakes too many times, I think. Without him being in that hospital at that time, the boy would have suffered irreparable damage, while the chief faced humiliation at his funeral.
About a year later Chief Joseph died. Dom was sure he rested in peace with his people. ‘I had learned something about native customs from Chief Joseph, but had not learned enough as other cases continued to teach me…’
Next week: More lessons learned.
NOTES: *The Nigerian Civil War (1967 - 1970 ) was fought between government forces and the secessionist state of Biafra. Biafra did not come out of the bloody struggle well. Images of malnourished and starving children became a cause célebre in Ireland and elsewhere, made complicated by Britain and Russia who supported the Nigerian government; while France and Israel supported Biafra.
I am taking the above stories from No tears Left - Biafra to Bosnia, by Dom Colbert, published by Orpen Press and on sale €15.