Wednesday, June 10, 2015

Ambositra, Madagascar Week 5

June 1, 2015

This week we moved. It is kind of strange that I have already moved into 4 different houses during my 5 months in country. I can confess that it has not been fun cleaning up years of crap from other missionaries though. I live in a house for half a week and then have to clean 5 years of dirt. Missionaries really do not know how to clean. The mop had been sitting idle for so long that a 5 foot long weed was growing out of it, that is pretty messed up. But I am now moved into my new house, we just need to wait for it to get finished now. The new house still doesn't have power or filtered water or hot water or a gate or doors that work and lock properly. But, it did have some bonuses waiting for us. It has a surplus of cockroaches and spiders. We were forced to move into this house early because our old contract ended on the 31 of may. So it was either move into the unfinished house (that the landlord promised would be finished in time mind) or live on the streets of Madagascar. I figure that there are already too many Malagasies living on the streets, there wouldn't be any room on the road open for two big vazahas. Our new house should be fairly decent when it is done, though. We shall see. I still don't like taking freezing showers though, not fun at all. I remember my old shower back home, nice, clean, relaxing, the perfect temperature. But at least for now I am going to have to shower in ice-water.

Yesterday I gave my first talk in Malagasy in Sacrament meeting. And, as always, I procrastinated until Sunday morning to write it. On Saturday night, I had hoped that it would write itself while I was getting some sleep, but, to my utter dismay, it was not so. So I wrote it on Sunday morning from like 7 to 8:30. I wrote a 3 page script that I was going to read in order to give my talk, but I ended up not really using it at all. I used it as a guideline for my talk and for my scripture references. While I was speaking I was shocked at my ability to speak in Malagasy, I wasn't really thinking of the words nor translating from English to Malagasy in my head, so it was good. It ended up being about 10 minutes in length, so not bad. My longest talk yet. Afterwards my Branch President told me that my talk was good and that I was really good at the language, so that's gotta count for something, maybe he was just being polite though. Oh, by the way, the topic of the talk was the keys of the priesthood. That was what the Branch President wanted me to talk about.

This last week I have also developed some sort of strange blisterish sort of infected thing that has a black ring on my foot (Mom note: It turns out that Benjamin actually had a chigoe flea in his foot. It had embedded itself and laid eggs in his foot). It has been growing for quite some time but hasn't starting really hurting or bugging me before this past week. So I sent some pictures to our Missionary Doctor-of-sorts, and she told me to pop it and depusify it to stop the infection or something. So I did just that, I depusified the thing and I was shocked at what came out, there were like 4 different colors and types of fluids that exited the thing. Pretty strange. I will probably send some pictures so you can enjoy the beauty for yourselves. But right now it is looking a lot better, it has lost its pale green color and has gotten smaller I think, and the infection covering my entire heel doesn't hurt really that bad anymore. Earlier this week though, it was hurting so bad that it woke me up at 2 am in the morning. It felt like my skin was decomposing off of my foot, but when I looked at it it just looked normalish. I was convinced that I had gotten the Bubonic Plague or something and downed some drugs from my special cache. After I operated on it though the pain lessened.

The investigators here are still pretty solid, but there is one minor problem, they never come to church. Every week everyone promises that they will come, but when Sunday comes we have our eternigators here and that is about it, though, this week we had one more than usual. So 4 came in total to church. The people here just don't like coming to church I guess, they think it is hard moving from church to church, and it is. But yeah, people never come, so it is sad. It is all about the FJKM. Ny Fiangonan' i Jesoa Kristy eto Madagasikara. We didn't catch too many lessons this week though, we spent a lot of time cleaning our joke of a house and then we spent the rest of our time moving into the unfinished house. Hopefully we get a new washer soon, because my clothes are getting pretty dirty.

My memory isn't the best so that is all I can think of to write about right now. Have a good week.

Not for the faint of heart. A chigoe flea (tungiasis) that embedded in Benjamin's foot and laid eggs.

A few days after the self extraction and the infection (redness around his heal) has started to diminish. He is taking antibiotics his dad sent with him and watching it closely. Hopefully he got all the eggs out. Benjamin says not to worry, it's fine and he seems to be a lot less concerned than his parents :)


 These last pics were taken by Elder Snell. Benjamin's New house in Ambositra.

Malagasy pharmacy.

Malagasy clothing shop.

Duck cage.

Talk on the keys of the Priestood.

Information about the Chigoe flea from the online journal of dermatology.

Tungiasis is caused by penetration of the flea through an intact epidermis by the pregnant female T. penetrans. The tiny (1 mm in greatest dimension) flea then burrows deep to the epidermal-dermal junction to feed on blood from dermal capillaries. As the parasite becomes engorged, it can enlarge up to 1000-3000 times its original volume, up to a diameter of 1 cm. Subsequently, the invaded local tissues become inflamed and the characteristic pain, tenderness, and swelling ensue. Within 1-3 weeks the flea extrudes hundreds of eggs that disseminate from the wound and into the environment. The exact biohabitat of the early stages of the flea are unknown. Following release of eggs, the adult dies shortly thereafter.

Patients with this condition most commonly present with a lesion on the plantar, interdigital or periungual regions of the foot, but infestations of the leg, buttocks, hand, and elbow have also been recorded. It is likely that the foot is most often affected, in part, because the flea is a poor jumper. Handheld dermoscopy may aid in visualizing the insect's dark exoskeleton and multiple eggs within the hyperkeratotic nodule. The gross appearance of the lesion varies according to the progression of the infestation process. This progression is described by the Fortaleza Classification system. In stage I (early infestation; 30-120 minutes), the flea that penetrated the epidermis is visible as a reddish spot. In stage II (1-2 days), the hypertrophied flea is visible as a 1-2+ mm opalescent spot with a central dark punctum. Stage III (2-21 days) is characterized by an indurated white halo, 3-10 mm in diameter, circumscribed around a central dark punctum. Hyperkeratosis is apparent, pain is common, and extruded eggs may be visible. In stage IV (3-5 weeks), a crusty dark ring of necrotic epidermis forms around the lesion, which now contains a dead parasite. Lesional involution with small scar formation characterizes stage V at six weeks to several months following infestation. More severe cases may also present with dystrophy or loss of the toenail, and/or permanently deformed toes.

Treatment involves extraction of the flea from the wound with a sterile needle followed by a sterile saline wash. With Stage III or later lesions, excision by deep shave followed by curettage with hyfrecation will suffice. Topical antibiotics should be applied to the area postoperatively. To date, no uniformly effective anti-parasitic drug has been identified to treat this particular entity. Although often effective against a broad range of ectoparasites, ivermectin did not show better efficacy than a placebo in a randomized, double-blind, controlled trial utilizing a relatively high dosage (2 x 300ug/kg). When secondary infections occur, culture most commonly reveals Staphylococcus aureus or various enterobacteriaceae. If secondary infection is suspected, appropriate oral antibiotics should be administered. Other rare infectious complications of this disease may include gas gangrene, tetanus, and septicemia. Generally however, prognosis is very good if sterile methods are employed during flea extraction and there is no pre-existing secondary infection.