Freelance-a-rama

Back to Africa, the trip that’s been talked about, debated, mulled and otherwise decided for months now. Seems like I just got back, seems like I’ve been home for a long time. Seems like I didn’t get enough time to say good-bye, seems like with some people and some places, there wasn’t as much need to say good-bye as I thought there would be.

It’s been a struggle for the past few days to remind myself about why I’m really going. I’m excited to go, I’m anxious to go, I want to go. I’m scared to go. I’m nervous about what awaits, I’m afraid that I’ll be lonely or bored or broke or worse. I have no idea what awaits, I’m not really sure what I’ll be doing when I get there, other than scrambling for a few days. I know that it will be much different from Ghana. I’m just hoping it goes as well as I’ve been envisioning – which is pretty well.

These are the first words I wrote in my journal when I landed in Africa for the fourth time. Almost six months later, I can say with absolute certainty that journalism, Africa-style, has ruined me.

Last week I saw three movies. I had five naps, some of them for two hours. I read two books. I did three interviews, wrote two stories, planned an excursion to the slums and lined up an out-of-town trip. I spent an entire afternoon walking up and down the streets of downtown Nairobi looking to replace a pair of pants. (Without success. One shopkeeper, bless her, told me that she didn’t carry a single thing in my size. “You’re too small. I don’t even have anything for you in Italian sizes. If you fatten up you can come back.”)

How could I do all this with an office job? Bleech.

Until last week, I was $60 shy of having my earnings meet my expenses, including the $2,000 ticket over here. Then last week I spent nearly $400 on hotels, books, movies, postage, paintings, transport, a safari, food and phone cards.

It has indeed been very lonely, which I attribute 100 per cent to traveling. I meet people, but it seems like every one of my friendships right now is sustained via email. There have been definite periods of boredom. (Hence the three movies and two books – “The White Masai” and “Gorillas in the Mist.” Both excellent.)

There is a constant worry about running out of money. And as my parents can attest after a 4 a.m. phone call this week, there is a very real panic when I can’t access my money.

There is an intense longing for Kraft Dinner. And Doritos. And chicken peanut stew.

Of course, there are so many great moments. In Kibera, a slum of epic proportions, a little kid came running up and slapped me high five. He was so intensely adorable, I thought about snatching him. He thought I was Drew Barrymore, which, as you can imagine, happens all the time. Apparently when she was on a goody-goody tour at some point, she came with the World Food Program along the same goody-goody route I was following and had her picture taken with him. Several, in fact, until he accidentally scratched her and she dropped him like a hot potato, afraid that she’d contracted HIV.

Watching Rotarian Doug Cunningham do the hokey pokey for a bunch of kids at Mkuki, while they looked on stunned, mesmerized even, will likely stay with me forever. So will watching as the kids at the Kilema hospital got into the spirit of a game called “Doggie, Doggie Where’s your Bone?”

The kids here are really unbelievable, I mean, they sort of defy description. They have endless imagination, seem to take pleasure in the smallest of things, can turn almost anything into a toy. They’re well-behaved in an almost militant way. They seem to love cameras, break out into the most darling smiles at the smallest provocation, behave like little diplomats. (Kids at Kibera’s Kikoshep primary class sang “We welcome you!” when I stopped in, until they got a little too into the song and jolted one of the desks, sending a sleeping child tumbling to the floor, where she put her tooth through her lip. Then I had my own Drew Barrymore moment of alarm. Some 70 per cent of the kids in the school are HIV-infected orphans.)

It’s hard to watch what is happening to them. It’s hard to know that they are probably one of the biggest problem the world is facing: lonely, starving and parentless, with a loose moral grounding and a vulnerability that is almost shocking.

I suspect that if they continue to be ignored and neglected, in 10 years time, these sweet-faced children will have the street smarts to do something unspeakable about it.

Inured

Inure (verb): to make somebody used to something unpleasant over a period of time, so that he or she no longer is bothered or upset by it.

In attempting to set up a visit to drought-stricken areas around Nairobi, the World Food Program suggested I visit their school feeding program, which aims to feed school-aged children who would otherwise not eat. (SEE STORY BELOW)

Literally. Some would faint in class, others would be too weak to play during the break. Most would spend their lunch hour scavenging like goats for scraps of food tossed away by their neighbours. Some would return in the afternoon. Most would not.

In Kenya alone, the WFP feeds some 1.1 million school-aged children in 3,800 schools across the country. Although they run similar programs in schools around the world, what makes the one I visited a little different is that it’s in an urban area. Traditionally, extreme poverty is thought to exist in the remote, rural areas, where the people are nomadic, without property except their cattle and their goats. But Nairobi has the largest concentration of slums anywhere in sub-Saharan Africa and the poverty defies description: it’s not just crippling, it’s not just abject. It’s unbelievable.

In 2004, WFP secured a huge grant from the International Paper organization – something I’ve never heard of and will have to Google – and they expanded the program in Kenya from two to six slums. Now, slum is an interesting word. In the Kenyan sense, it basically means high density housing without basic amenities, like running water, electricity or sanitation facilities. In practical terms, that means people living on top of one another in ramshackle buildings constructed from whatever is cheap and handy. Some “bathrooms” are plastic bags, tossed from the window or thrown on the pile in an alleyway when they’re full. At one point, near the railroad tracks that featured so prominently in “The Constant Gardener,” there was a little girl just pooping in the open.

The school we visited is the poorest of the 107 schools in the program. It is on the very edge of Kibera’s poorest district. Kibera itself is the largest slum in East Central Africa, home to more than a million people. Usually the WFP likes to have the schools that are part of the program equipped with a kitchen and pots and some basics that will help them run the program. St. Philips has none of these things.

The kitchen is merely a bunch of sticks nailed together. There are no walls and no roof. A giant pot provided by the WFP – large enough for a kindergarten student to bathe in – sits on top of three stones, which keep the pot up off firewood collected by parents or students. This is where, each day, a parent comes to cook maize and beans in oil. It’s hot work and there’s little praise for the menu. The mid-morning snack is corn-soya blend, a “high nutritious” supplement containing 43 vitamins. That is often all some kids have to eat: a mid morning snack and a margarine tub of maize and white beans. Some of them even snap a lid on their ration and take it home to share with their parents and siblings.

This school is being primed for a visit by the executive director of the World Food Program, Jim Morris. To get to the school, he will cross a river of sewage on a bridge that’s made of 16 sticks. Arrangements have been made so that he will be able to simply walk into the school, as opposed to walking around a partition made of junk that’s been fashioned for some unknown reason. Walking around the partition means jumping over the sewage river and then jumping back. The sewage actually smells quite nasty and is thick and black in colour, full of rotting vegetables, plastic bags, dirt and poop, both human and otherwise.

That smell wafts all through the school. (Lorna, the program assistant who is guiding this trip, tells me she has another school that is much worse off: it’s called Holy Unity but they’ve christened it “Holy Shit” because a river of human waste surrounds the school like a moat.)

Now, I’ve been around Africa, I’ve seen some pretty interesting schools, most memorable being the straw hut in the Dogon country in Mali. But St. Philips was a new and disturbing experience. A teacher gave me a tour, starting up a small hill where the kids and teachers gather for assemblies on Mondays and Fridays. It’s just a rocky piece of dry ground, with a tree off to one side. There’s a large, square, mud structure with gaping holes that’s now used for the nursery class. When I visited, the little tiny kids – nursery and pre-school aged – sat on a blanket in the middle of the bumpy floor. One of the older kids had a plastic red pointer and banged against the chalkboard, where there were five pictures hand-drawn with chalk. “What is theeeees?” she would scream. “Theeees is a cah-t,” the kids would answer. “Theeees is a geeraffe.” “Theeeees is a cow.” “Theeeees is a lie-on.” There were 31 children, most under the age of five.

The teacher, a born again Christian aptly named Hope, told me the kids were doing so well “through the blood of Jesus,” which is pretty gross. She had them stand up. (“We are standing up.”) Show me your head! “Theees is my head.” What are you doing? “I’m touching my head!”

This square of crumbling mud is where the entire school was once located. All nine classes were shoved into this one room, all the teachers talking on top of one another, all trying to hold onto the attention of their children.

In January, they moved into a new building, made of mud and sticks, a corrugated roof and, in some places, plaster. There’s no electricity. No water. No bathroom. The kids are called to school by a bell, rung by head boy or head girl. There are nine teachers and nine classes. Kids pay 100 shillings per month to attend, or 1,200 shillings per year, which is $20.

The floor of the school was a minefield chipped rock; I had to clutch the mud walls just to maintain my balance. There were only enough desks and thin benches for seven of the classrooms, so form one and the nursery sit on the floor. The chalk boards are actually just smooth plywood that the teachers write on. That’s it for ambiance.

At one thirty, when lunch was finally served, kids came from all over, some in uniforms for other schools, some not in uniform at all. The head teacher, Jacinta, is a thin and nervous woman, a mother who cannot bear the thought of turning hungry children away from free food. So things have slid. But the executive director of the WFP is coming, so Lorna wants things ship shape for his visit. She wants grateful parents, smiling children. And no strays. No kids who only show up for food. She’ll put the fear of God into them herself if she has to.

We are expecting the culprits to be street boys who hustle or work, but stop in at the school for the free meal. But while I was taking pictures, a tiny girl with a baby on her back showed up with a black plate and a chipped black cup. Her name is Wambui. She is 10 and has five siblings, including the baby, who is smacking her lips at the sight of food. Wambui is registered at the school, in the nursery class, but she lives alone with her HIV-positive mother and has to rush home to feed the other kids and look after her sick mother. She has sticks for arms, knobby knees and elbows and a little line of snot drizzling from her nose.

I sometimes wonder whether I will continue to be surprised, shocked and saddened by Africa’s conditions or if I’ll just grow cynical and jaded and become inured to the misery around me.

WORLD
AIDS orphans struggle to survive ; Charity groups rush to supply children with proper care, food
Karen Palmer, THE WASHINGTON TIMES
1080 words
23 March 2006
The Washington Times
A15

Kilema, TANZANIA -- Poking out of Patrice Mavia's purple plastic sandals are toes dark and swollen with blood, ragged and infected as if chewed by jagged teeth.

His fingers seem to be in a similarly painful state.

Adella Kessy, a nurse at the Catholic hospital in the foothills of Tanzania's Mount Kilimanjaro, said tiny sand fleas are to blame. Left unchecked, the insects form painful pustules and lesions, destroy fingers and toes, and eventually leave a victim crippled.

They come from walking barefoot on ground infested with sand fleas, drying clothes on the ground or poor hygiene. They are a clear sign of neglect, said Ms. Kessy.

Patrice probably doesn't bathe with any regularity, nor is he likely to hand wash his thin clothes, or know that he has to destroy bugs and parasites with a heavy, charcoal-powered iron. He is, after all, only 8 years old.

Patrice was orphaned by AIDS maybe five years ago - he thinks he lost his parents in 2001 and 2003 - and he is the only one around to remind himself to wash behind his ears and scrub between his toes.

"No one is helping him care for himself," said Ms. Kessy, shaking her head.

As communities across Africa struggle to cope with the growing number of children left parentless by AIDS - a number expected to reach 18 million by 2010 - the United Nations Children's Fund (UNICEF) said recently that less than 10 percent of AIDS orphans receive any form of support.

"Most are in poor, poor, poor environments. They're in poor houses, poor environments and have poor food," said Anna Anselm, a clinical officer at the hospital's patient resource center.

"They can't afford everything that's needed for the essentials of life. They're so limited."

Once a month, Ms. Kessy and her colleagues at the hospital's HIV/ AIDS counseling center invite orphans like Patrice to the hospital for "tea" - giving health workers a chance to know who the children are, where they live and who takes care of them.

More important, it gives them a chance to see the children. Are they skinny? Scraggly? Sickly?

Worrisome cases are followed up with a home visit, where volunteers will also drop donated food staples like beans, oil or flour.

Problem spans Africa

The problem of starving, orphaned children is not limited to isolated pockets of Africa. In the decades since the spread of AIDS, more than 100,000 children at 107 schools in six of Nairobi's sprawling slums get their only meal - lunch - through the World Food Program.

At St. Philips School on the edge of Kibera slum, Wambui, 10, materializes at the clang of the lunch bell carrying a baby tied to her back with a brilliant pink scarf.

Skinny and stunted, with bony elbows and knees, Wambui carries a metal cup and a chipped black plate as she waits for her share of the mixture of corn and beans fried every day for the school's 345 hungry children.

The baby on her back smacks her lips waiting for food as school officials confront Wambui.

They want to know why she's not wearing her uniform, and whether she's showing up for classes or simply arriving for the free food and then disappearing back into Kibera's crowded, dirty alleys.

The feeding program is not simply about a free meal, they say. It's a way to keep children healthy and in school so they can break the cycle of poverty.

"Words cannot explain how much this food has done," said Louise Masese-Mwirigi, a monitoring officer from Feed the Children, which runs the program.

Before the program was in place, children were scavenging like goats, she said - looking for scraps in the garbage thrown out by their neighbors.

Adults could exploit them by luring some children with the promise of a piece of chicken or a plate of greasy chips.

"This is protecting them in a way you really can't quantify on paper," said Mrs. Masese-Mwirigi.

In soft Swahili, Wambui explains that she lives with her mother and helps care for five other children. Her father is dead, and her mother is dying of AIDS.

She was in class, she insisted. Teachers were simply looking for her in the wrong place: though she is 10 years old, she is still in the nursery class.

Taking food home

About 20 percent of St. Philip's students are orphans. Some come from single-parent families. Almost all are destitute.

A few children snap a lid on their ration - a scoop and a half - and take it home to share with desperate parents and siblings.

"They cannot even have a meal. They will feed here today and they will come tomorrow and feed again. There won't be anything to eat at home," said Joseph Ndungu, a representative of the city education department.

A report issued last year by Human Rights Watch found that AIDS orphans are more likely to drop out of school, more likely to fall behind in their studies and less likely to see meager family earnings go to their education.

Dropping out means children are more likely to become trapped in poverty, exposing them to greater risk of abuse, sexual exploitation and AIDS.

Teachers at St. Philips say the offer of free food has turned that trend around.

Before the feeding program began two years ago, there were 212 students enrolled in the school. Now there are 346, about a 50 percent increase.

"It's important for their academic work, and health-wise," said the school's head teacher, Jacinta Katheu. "The feeding program is helping their families very much. They are jobless - their guardians are often jobless - and at the end of the day, they won't even eat a meal. There's no food at home."

Caption: Every day in Nairobi, Kenya, students line up to receive a free lunch of a fried corn and beans mixture. Often, it is the only meal the children eat, and many take the food home to feed their families. [2 Photos by Karen Palmer/The Washington Times]; Nurse Adella Kessy gives donated used clothing to children orphaned by AIDS at a hospital in Kilema, Tanzania, located in the foothills of Mount Kilimanjaro. [Photo by Karen Palmer/The Washington Times]

All hail the Big Five

The Leopard, Lion, Rhino, Water Buffalo and Elephant. Went to the Ngorongoro crater on the weekend, a collapsed mountain top that usually has a huge lake that attracts migrating animals from all over east Africa. Now, with the drough, the lake is more like a muddy puddle. There were only a handful of flamingos and usually there are thousands. Commence worrying. When I crossed over from Tanzania to Kenya yesterday, even the cacti had wilted and withered. I can only imagine what the north looks like.





I don't know why hippos aren't included in the big five. They can weigh up to three tonnes, which is much, much more than those scrawny lions or leopards. I have a feeling it has to do with their public relations: people think of them as overgrown pigs. You don't see any Disney movies about them, although I guess they played a small supporting role in Fantasia.




"Mr. and Mrs. Thurmond J. Bewildered-Beest regret to inform you that due to unforeseen circumstances, their son, Billy, will not be attending the annual migration."

Jiggered

Once a month, the HIV/AIDS staff at the Kilema hospital in the foothills of Mt. Kilimanjaro host a "tea" for the orphans in the area. On Friday, 129 kids showed up looking for a slice of bread and a cup of hot, tea-like water. The hospital started this little tradition in the early 1990s, as a way to eyeball the kids. It not only draws them out of the bush, so they can at least be identified, it also gives health workers a chance to see whether they're too skinny or scraggly or sickly. (SEE STORY BELOW)

It took nurse Adela three solid hours to register the kids, which consisted of collecting their names, ages, schools, parents, grandparents and the Kilema version of assemblyman. Adela also asks the kids when their parents died (or if their parents died -- she shooed away one kid was not an orphan) and who's taking care of them. The assembly man is so that they can find them again when they do home visits to assess their living conditions and sometimes deliver food or clothing or whatever they can spare. Adela says most of the kids lie -- whether out of fear or pride or simply not knowing the answer to a question -- so they like to go and see for themselves how the kids are living.

After the registration, the tea began. Plastic feed buckets were brought out and about 20 plastic cups. One bucket contained fried donuts, which two girls handed out. A bucket of tea was dished out by two more girls. The kids ate 20 by 20, while Adela and a Canadian CIDA intern named Sue handed out some banana cake and some treats brought over by a group of Rotarians. The kids should have been bouncing off the ceiling, but they were relatively well behaved. Out of 129 kids, there were only two who ended up in tears. Adela only lost her cool once, when she was handing out used clothing to some of the kids. When it came to the shoes, pandemonium broke out and we all thought Adela might get swallowed up by the kids. Instead, she started striking whoever was in arm's reach with the shoes and that seemed to bring things under control pretty quickly.

The needies of the needy orphans had a special Christmas dinner last Tuesday, even though it was the end of January. (Pole pole, as they say here, meaning slowly slowly!) The first child to arrive came around 10.30, even though the food wouldn't be served until well after 2 p.m. (That's Eric looking at the camera in the first photo.) He came charging through the blue gates and made a beeline for the HIV/AIDS resource centre, where he waited on the bench just singing and giggling to himself like all 6-year-olds who are left alone with their imagination. No one seems to know much about him. They think he lives with a grandmother but they're not too sure where and he never arrives with any other kids, so they're not entirely sure which direction he even comes from. He behaved a little like a small dog -- he seemed unaware of how little he was and kept taking on the big kids, giving them punches or just annoying them in that small yappy-dog kind of way. But he had dimples, so we all thought he was adorable.

On Friday, both Sue (the CIDA intern) and myself noticed this one child who had raggedy feet. They looked like they'd been chewed by something with jagged teeth and had been left to rot. He said nothing the entire time he was there, didn't seem to know the other kids and it took him about 15 minutes to start actually eating his donut. Adela called him aside at the end and told him to come back on Monday.

"Jiggers!" she pronounced to us in English, as the little boy stood there uncomprehending. An infection caused by a flea laying eggs in his feet. It's endemic in poverty-stricken areas and the biggest preventative is wearing shoes. Adela told us he lives with his grannie somewhere; they've never visited him so she's not entirely sure where. But he was obviously being neglected. Adela figures he's being left to clean his own clothes and take his own baths, and in the way of 8-year-olds, he's doing neither.

This is from a parasitic disease webpage on the treatment for jiggers. Like I said, she asked him to come back on Monday, but he never showed. I wonder if they'll ever see him again. He seemed pretty afraid when he left.

"Treatment consists of the physical removal of the flea by a sharp instrument. The residual cavity should then be surgically cleaned to remove its entire contents. Afterwards, an antibiotic ointment may be applied to prevent secondary infections. Certain chemicals have also proven to be effective, including 4 percent formaldyhyde solution, chlorophenothane (DDT), chloroform, turpentine, and niridazole. These treatments do not physically remove the flea from the skin, however, and therefore don't result in quick relief. They also carry their own risk of morbidity. Physical removal followed by antibiotic ointment and an anti-tetanus prophylaxis to prevent secondary infection (especially that of tetanus) is most effective."

So basically, they were going to take off all his nails -- fingers and toes -- and rub them down with turbo antiseptic wash then dig into them with sharp instruments to dig out the jiggers. They have to get them whole, Adela said, or they simply regrow.

If he doesn't get treatment, they will eventually burst, replicate (each one produces up to 2,000 babies) and eventually cripple him.

Imagine. All because he's eight and he's all alone.

News
So little money . . . so many orphans; TANZANIAGrassroots group must struggle with meagre funds to help AIDS orphans, writes Karen Palmer TANZANIA
Karen Palmer
Special to the Star
1099 words
12 February 2006
The Toronto Star
A12

Kilema, TANZANIA -- Poking out of Patrice Mavia's purple plastic sandals were toes as dark and swollen as blood sausages - ragged and infected as though a small animal with jagged teeth had chewed them.

The tips of his fingers seemed to be in a similar state of painful rot.

"Chiggers," declared nurse Adella Kessy after a hasty consultation at the Catholic hospital in the foothills of Kilimanjaro. Left unchecked, chiggers replicate by the thousands, form painful pustules and lesions, then burrow further and further into infected skin until they reach bone.

The parasite can destroy fingers and toes - its preferred harbour - and can leave its host crippled.

The infection comes from walking barefoot on ground infested with sand fleas, drying clothes on the ground or poor hygiene.

Patrice probably doesn't willingly bathe with any regularity, nor is he likely to hand-wash his thin clothes in a stream.

He also doesn't know that he has to destroy bugs and pests with a heavy, charcoal-heated iron after the clothes come out of the stream.

He is, after all, only 8 years old.

But Patrice was orphaned by AIDS a few years ago - he thinks he lost his parents in 2001 and 2003 - and he is the only one around to remind himself to wash behind his ears and scrub between his toes.

He spoke Swahili in whispers when Kessy told him to come back to the hospital with an adult in three days for treatment.

"No one is helping him care for himself," she said with a shake of her head.

That's why, on the first Friday of every month, she and her colleagues at the hospital's HIV/AIDS counselling centre invite local orphans like Patrice to the hospital for "tea."

The program, funded by the Ottawa-based Canadian Africa Community Health Alliance, helps the aid workers identify orphaned children and sort out where they live and who takes care of them.

More importantly, it gives them an opportunity to see the children.

Are they skinny? Scraggly? Sickly?

At the hospital's resource centre, Anna Anselm says there are at least 265 orphans registered with the hospital.

There are probably just as many hidden in the dense banana fields that cover the region's lush peaks and valleys.

"It's going up, it's increasing," says Anselm.

At the most recent tea, 29 children turned up, some arriving as early as 9: 30 a.m.

Almost four hours later, two industrial-size buckets, a red one and a green one, emerged from the kitchen.

One contained fried balls of dough, the other dark, steaming tea. The children ate and drank in groups of 20, since there were only so many mugs to go around.

It took Kessy three solid hours to register the children, collecting their names, ages, schools and the names of their guardians.

Few remember exactly when they lost their mothers or fathers. Some have lost only one parent, but others were about to be left completely on their own.

Fifteen-year-old Emmanuel Deo's mother had been in the hospital for three weeks and Kessy expected the boy, his two brothers and a sister would be orphaned by the next month's tea.

The aid workers also arrange home visits, consulting community leaders to help them track down the children in the labyrinth of winding red dirt paths in a dense forest of banana trees.

"You see their food supplies and their caretakers and how they are managing," says Anselm.

But the visits are made only when there's something to give: a kilo of dry beans, three or four cups of coarse sugar, a bar of soap or a bottle of oil.

When the women visited 6-year-old Gifty Mosha at the mud-and-stick shack she shares with her grandmother, an uncle, a calf and three goats, she was barefoot wearing a cotton dress from the hospital's stash of second-hand donations.

There was not a scrap of food, other than some green bananas hanging in the surrounding trees.

Meeting her visitors on the rocky red path, the child with curly eyelashes and a nearly bald head offered her tiny hand first to Anselm, then to Kessy, then back again, as the women brought meagre supplies.

Her grandmother told the women that Gifty, who contracted HIV at birth, is coughing at night and is riddled with skin infections. Her mother died three years ago; within a week, AIDS took Gifty's father, too.

"They're missing out," says Anselm. "They're missing out psychologically, they're missing out emotionally and they're missing out physically."

"Most are in poor, poor, poor environments. They're in poor houses, poor environments and have poor food. They can't afford everything that's needed for the essentials of life. They're so limited."

Most of the children the hospital attempts to serve live with a grandparent or other elderly relative.

"These old people are beyond the age of caring for these little ones," says Anselm. "They'll be losing those old people soon, too, becoming orphans for a second time."

The local community can hardly afford to feed the orphaned children and the task falls not to big-name charities or United Nations' agencies like UNICEF or the World Food Program.

Rather, the job falls to small, grassroots groups that receive their funding in dribs and drabs from international donors.

It costs $1 to feed one orphan a balanced meal of rice, meat and cabbage - but the Canadian Africa Community Health Alliance has only enough funds to feed each child one such meal per year.

Back at the hospital, the appointed day for Patrice's chigger extraction has come and gone, but the boy has not turned up.

The treatment that awaits him sounds excruciating: first, all his fingernails and toenails would be removed and then his fingers and toes scrubbed with antiseptic bleach.

A nurse would have to dig into the fleabites and gingerly remove the parasitic larvae with a sharp instrument. The larvae must be removed with precision - even part of one left behind would simply regrow.

No one seems sure Patrice will be seen at the hospital again.