The health worker finishes the eye test and sits back down behind his desk. The girl is nervous.
“Mani, do you like animals?” he asks.
The question makes the young girl’s face relax a little. “Yes.” The man writes something, his pen scratching on paper like maize leaves rattling in the wind. He is nervous too. He has never taken part in a medical trial before.
“What kind of animals does your family keep?” he asks.
“We have a cow and a pig. And four chickens.”
“Your family has a milking cow? You fatten pigs and produce eggs?”
“Yes.”
He is being careful with his words. As happens so often, neither he nor his patient understands each other’s mother tongue, so they are sharing instead a third language to communicate. “Do you ever drink milk and eat meat? Do you eat eggs?”
“No. Father sells those things for clothes. He bought my shoes.” She proudly lifts her feet.
The man looks at her flat plastic shoes. He has seen shoes like that on the market. They are cheap. Scratch, scratch. Pause.
He studies the girl. In size she seems about six, but the birth date she has given shows she is twelve years old. Her black curly hair is dull, her brown skin looks wrinkled and she is thin. And of course, she has a swollen eye…
The man writes Kwashiorkor, and is about to add a thoughtful question mark when his attention is caught by the mobile phone. He stares at it, worried.Underneath the phone, the laminated instruction sheet lies stiff and white across the corner of his battered desk. He pulls it out and reads the words again.
“Prepare and email photographs via the mobile phone, using the attached schema: specialists will be on stand-by from 1200—1700 GMT.”
The man nods. The team in England is ready. They will reply soon. He pushes the sheet away.
“Let’s talk more about your animals Mani,” he says, “Which animals do you like best?”
“Ayah! I like the dog!” The girl smiles properly now.
“Do you play with the dog?” Mani frowns.
“No. He is a guard dog. He barks when someone comes to our compound.”
“How long has your family had a dog?”
“When I was a baby we had an old dog. He could catch rats in the maize store and guard the crops. No one stole from us when we had the old dog!”
“Do you still have that one?”
“No. No—one day he couldn’t kill snakes any more so the snake bit him. Father says everything dies.”
The man is sorry for her sadness. “Is there a new dog?”
She nods. “We call him Two Chickens.”
“I don’t understand. Why is your new dog called Two Chickens?”
The girl raises her chin, and uses it to point into the farmyard scene she remembers. “Mother went to the old man who is our neighbor. She paid him two chickens for the dog.”
Now it is the health worker’s turn to smile. “Do you like this new dog?” he asks.
“Ayah! His fur is thick like a blanket. He is a good dog.”
The man understands. The native dogs are clever. But before he can speak, a light on the beautiful phone throbs and he jumps. He lifts the handset and quickly checks the screen.
No. The light was not an email. Embarrassed, he lays the phone back down on his desk. Why does this small phone make him feel afraid? Why does it spark such emotions in his heart?
He knows the technology of this phone. It has the power to reach even patients living without roads and money. Unlike the eye clinic bus, which stays only for two weeks a year, this phone can remain with him, always ready to select people in need of urgent care so they can be flown to the City Hospital.
However, the health worker, sitting in the small clinic with the mud walls, has a poor man’s distrust of expensive tools. He has worked alone for so many years that he finds he is afraid of what the phone can see. Is it watching him? He has discovered that this trial needs him to carry ideas between two groups of people who do not fully understand each other. He must be a messenger between worlds. If he makes mistakes, he is unsure whose side the phone will take. Will it send evidence of his failure to England?
The health worker runs his fingers through his hair and goes back over his actions of the last hour.
The girl arrives. He registers her for the eye test, opening a new case file. He holds the mobile phone in front of her face, raising her eyelids with his thumb, right then left. For each eye he takes photographs of her lenses, her retinas, her overall eye-shape. He attaches the girl’s name, age and GPS details to each photograph then emails them to the surgeons in England, as instructed.
Good.
Like talking in the confessional, this list of actions allows the man to step back from his feelings of guilt. He relaxes, focuses, quickly asking his patient another question to fill the silence.
“Your new dog? Where does it sleep?”
The girl sits up. “Ayah! That dog! Sometimes he finds the warm earth in the yard, or sleeps in the hut with me. He likes the cow pen, and the maize store, but Mother beats him when he goes near the cooking pots.”
“Do your parents ever tie Two Chickens with a rope?”
“No. Father says a dog must earn his food. He says Two Chickens needs to guard the compound while he is digging our field.”
“Does your mother work?”
“Mother cooks and washes and feeds the baby and tends the animals and collects water.”
“Do you have a tap for water?
“No. We use the river. Everyone in the village uses the river.”
“Do you have electricity?”
“No.”
The health worker shakes his head as he adds this information to the girl’s file. Like so many of his patients she has come to the health center saying she has eye problems, when really the issues are much bigger. In the past these stories have made him feel powerless, but to his surprise he now feels strong. He has the phone.
“This is how I should think about the phone,” he tells himself, “It is my friend. Together we can be part of the team in England. And if I discover many patients, perhaps my funding will improve…?”
The girl coughs, and the man shakes his head. Ayah! How can he think about his own income?
“Mani,” he says, “do you have friends to play with?”
The girl is thoughtful. “We all have chores. Each day I clean, I go with my brother to the school, I prepare vegetables, I look after the baby, I help my brother with homework. But when we have finished—then we meet and we sing.” She smiles. “I like to dance, and I like to sing.”
The man watches her smiling face. This girl comes from the hills. Her people are perhaps the poorest he knows. “Why do you like to sing?” he asks.
“Why?” Mani is surprised at the question and she struggles to find words. “All my cousins come —we are over 40. The oldest one teaches us new songs every day.”
“What do you sing about?”
Mani smiles, “Ayah! We sing about a handsome boy! And days when there is enough to eat. We sing about our beautiful land when the sun rises over the forest, and the crops are in the fields, and the warm rain smells like honey.” She speaks as if she is having a private conversation. “We sing about our people: the tiny babies, the pretty ones who marry, and the old wise people who die. We sing about the cow with the horns like the crescent moon. Our songs change.”
The man is humbled by the tenderness in her voice. He also envies her understanding about who she is. “Do you like the way you live?” he asks.
“Ayah! My family is good.”
The phone, quiet for so long, suddenly comes alive. The girl jumps as it rings, but the man covers his surprise by picking up the handset and studying the message.
Yes. There is an email from England.
“Though further tests are needed to verify the extent and cause of the condition,” he reads, “we recommend that the patient’s treatment includes immediate in-care at City Hospital Eye Centre.”
The email also confirms that an operation should mend much of the girl’s failing sight. The health worker is proud. He has already found a good patient. In addition, the prospect of being able to give good news to a sick person so quickly feels new and beautiful to him. Unable to stop himself, he smiles at the phone before turning to the girl.
“Mani.” He says, “I think I can help to make your eyesight better. Because of this message, we now have funds to send you to City Hospital.”
“How long will it take?” she asks.
“I’m not sure.” He doesn’t want to promise too much about the big City Hospital because he has never been there, so he guesses something that he hopes she will like. “It might take a few weeks?”
Mani is silent.
He begins again. “One reason for your blindness might be the dogs. You can catch worms from dogs. I can give medicine to improve this a little, but an operation will make your eyesight better.”
Mani frowns. “I don’t want to go to the City Hospital,” she says, ”I want to stay with my family. If I go to the hospital, who will help my parents?”
The health worker, guessing that the problem comes because he has used the wrong words, struggles to explain more clearly. “It might take two weeks Mani—it might be one week! Perhaps your parents can find someone else to help them for one week?”
“My parents have no money.”
“If you are not treated quickly, you might go blind in one eye.”
The girl is silent.
Now he doesn’t know what to do. He looks at the phone, but finds he has no words to explain this question to the far-away team. After a moment he turns back to the girl and says, “I must speak to your parents. When do they collect you?”
“I came with Two Chickens. He is outside.”
“You came with the dog? But you said your parents delivered you—when are they coming back?”
“They must work, but they know I will not have treatment if I say I am alone. The girl stands. “My walk is less than six hours—I will be home before dark.”
The health worker is suddenly washed over by a wave of helplessness. “What is your parents’ phone number? I must call them.”
“They do not have a phone.”
The man is deeply puzzled. Why isn’t the wonderful telephone making it easier to help people? “Don’t go…” he says.
The girl stops. “I cannot visit the City Hospital now. It is harvest time. If I go, Mother cannot work in the fields and we cannot collect our harvest. We will have no food.”
“So why did you come to the clinic today?”
“My parents told me to.”
Confronted by a patient who he is suddenly unable to treat, familiar words come to the health worker. “I can give you medicine now, and this leaflet will show how to keep healthy. But you will have to wait until spring for the Eye Bus.”
The girl nods. She accepts the pills. With her chin she points to an old plastic bag on his desk. “I put eggs here for you. They are chicken eggs, blue like the sky in springtime. Mother says you will like them.”
Clare Kemp is currently studying for an MSc in Science Media Production at Imperial College London.
Refractive Index 