Tuesday, October 19, 2004

Footsteps right behind you

I walked swiftly down the path. Through the sunlight flickering off the rustling leaves of the guava trees I could see the kids slinking up. I felt the adrenaline surge. This was my time. The kids always stole our guavas. I knew how to stop them. All I had to do was catch one and beat him up like any good Nangjere man would do and the theft would stop. Unfortunately, for some reason beating up on small children has been something I‚ve never been able to do. Now, if it was the pigs that came scrounging for worms every morning. I could beat them up without a qualm. The only problem is they're too fast. You'd never think it to see them, but they're fast.

The kid in the tree saw me. Two things happened simultaneously: one, I kicked off my flip flops and began to lope towards the tree while, two, the boy almost fell out of the tree in his hurry to get down. His watchman took off and quickly veered left. I was hot on the tail of the second, the one who'd actually been in the tree.

A few days before I thought I'd found a solution. We watched from our screen window as a 12 or 13 year old took off one shoe, leaving the other shoe and both socks on, and climbed up the tree while his watchman stood casually by. Nathan went out the side door and ran up. Amazingly, for the first time ever, they didn't run. Everyone runs when Nasara comes anywhere close to where they are stealing guavas. They must've been new and didn't know the rules. So Nathan casually grabs his shoe. I follow close behind. I ask the boy how many guavas he's stolen. He looks confused. I explain that taking things that don't belong to you is called stealing. He nods and seems to understand. I notice two green guavas in his hand. I say, we'll keep your shoe here, you come back tomorrow to pay for the guavas and we'll give the shoe back.

He hangs around all afternoon with a small crowd of boys eager to see how the drama will unfold.

Nathan and I are on my side later that afternoon and see another boy up a tree. We pounce easily and take his hat. He follows us to the porch where we are soon surrounded by boys of all ages and a ritual dance of bargaining begins. He claims its not stealing. He claims it is only one guava and since when we caught him he dropped it to the ground he didn't really take it. I ask how much guavas go for. The boys say 10 francs (about 2 pennies). Finally, we bargain down to 5 francs and he pays for the two guavas of the other boy, they get their hat and shoe back respectively, and I explain how we don't like stealing so if they want our guavas all they have to do is ask for them.

This boy I'm chasing obviously hasn't been informed of that. He just knows someone is chasing him and he needs to get away. He's in too much of a hurry. I pace myself. I keep up with him easily with a measured stride. He cuts down a pit where mud bricks have been harvested and falls getting up in almost the same motion as I circle the rim. He ascends the other side with me know hotly on his heels. We enter an opening in a mud brick wall and circle around a hut into a courtyard. Â I can smell his fear. I know he's mine. He realizes he's in a dead end. He finds a narrow break behind a pile of reed mats. I cut him off. He stops behind the mats. Only the mats protects him from what he is sure is a severe beating. He begs for forgiveness then makes a break for it. I'm only a few feet behind. The pigs are his ruin.

You see, everywhere a small patch of water gathers, there the pigs will gather as well wallowing deep in with silly grins plastered on their snouts. When our outside faucet leaked last spring the melodious sounds of contentedly snorting pigs never ceased to freshen the airwaves as they kept it boggy. The pig's snuggling down keeps the wallow wet and slick even when all around has dried out.

Our friend met his wallow. With a look of surprise and terror he went down fast and hard skidding along the slime for a good 5 feet on his belly. I was on him in a second. I grabbed his wrist and pulled him up out of the bog. Come with me. He couldn't do anything but comply because of his fear even though I barely had his wrist with one hand. I had no idea what I was going to do with him but it had been good sport by the powers. He finally realized my weak grip and broke free only to trip and fall within 10 feet. By then the crowd has gathered and I explained again that while we don't like stealing we don't mind if they eat our guavas if they ask. I release him.

Between chasing them from our guava trees, playing basketball on our leaning tower of hoop and playing guitar and drums on the porch, we have gained quite a following among the local kids who never cease to tirelessly yell out "jay-mmm-suh, jay-mmm-suh, lalé, lapia, lalé" as they wave joyously anytime we pass or hang out. They are dirty, naked, barefoot, ragged, cheery, playful, mischievous, tireless, incorrigible and about the cutest to be found anywhere.

Since that day, one tiny little 6 year old boy never fails to come up every day and with a big grin ask in broken French, "Je mange les guyabes??" We of course say, "Oui, eat all you want"

James

Calloused Hearts or Just Feet?

The sunset that evening sank into the dusty earth as if in a trance. Just a yellow orb leaving only a tiny trail of pink...it was like a sticky yellow ball flung onto a wall of light blue and slowly sliding into the night with no dying breath or comment. How jipped I felt!

In the early hours before dawn of that same day, Sarah, another nurse, and I had lost a small baby boy to death. His small body was already too weak to live when the parents had finally brought him to the hospital as a last resort. His small round belly had the markings of local healing. That is, he had scars on either side of his stomach where the parents had tried to bleed the evil out. It hadn't helped.

His bone thin extremities barely moved, and his eyes stared up at me in an empty gaze. I lead his parents down the dark hospital hallway, holding his infusion of quinine and glucose high as if it would light my step. I remember thinking I should put him in a bed where the least amount of kids had died. Maybe that would help. It hadn't.

Some people have made light of death of small children at Béré Hospital. It makes continuing with life easier if they laugh about it- saying the parents have eight other kids to worry about. They'll just have another kid to make up for that one. Some have even gone so far as to say that the villagers don't feel much human pain or loss. How unfair that is!

It you could only see the way a worried grandmother looked over her small granddaughter. I watched the shriveled brown fingers of the grandmother's hand gently caress the baby's forehead. Then the grandmother hunched forward as if in extreme pain. I thought she was going to let out a wail for a second, but she just put her head in her hands silently. And people have suggested they don't feel pain?

It is true that most of the dark eyed women here are forced into marriage at an absurd early age. Even before their breasts are fully developed, they are soon sagging after only five years. They are uneducated about sanitation and mud-hut keeping, and trained to cower beneath their old decrepit husbands who already have four other wives.

However, I believe their hearts are calloused (if I should apply such a term) out of necessity of survival...like their mud-soiled feet, yet their motherhood (or fatherhood) seems to bring about a softening of that guarded heart. I guess I can explain it as the kind of life that keeps their feet tough and their brown faces smiling.

Today, for example, I observed an old man squish his face like a contorted raisin with whiskers, (he had extreme pain from his toe amputation,) then in the next second, he stuck out his hand grinning from ear to ear to greet me. Amazing!

I think maybe they have naturally discovered this Buddha thought that "the secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live in the present moment wisely and earnestly." Or perhaps Buddha arrived at such a conclusion from watching civilizations similar to Béré?

With their loads piled high on their heads, (the women anyway), and life shooting out of every sandy crevice throughout the village, the people keep laughing. No time is spent on burial...for life is alive and kicking around the corner. It is not their heartlessness or lack of pain that keeps them going each day. It is wisdom!

Becky Jarnes

Saturday, October 9, 2004

Moonlight and Guavas

The Tchadian sky stretches out expanding beyond what seems possible to give the effect of being in some circus mirror show where everything is distorted to become larger than life. It's a brilliant light clear blue sky except for one huge bank of stacked puffy white clouds on the horizon. We are escaping Bere and the hospital. Becky, our second redhead nurse leads the way down the small path away from the back of the compound. Nathan, our 6'7" student missionary, strides casually beside her. Wendi, the third redhead in the group walks behind me with Jennie, the second newly arrived volunteer nurse. Sarah, the first and final redhead, brings up the rear. The sun beats down fiercely as we enter the rice fields where the path disappears under water for long stretches at a time. The water is hot to our bare feet alternating between a fresh sandy and a sticky mud bottom. We occasionally pass locals on their way to or from who knows where carrying flip flops and wading purposefully through the water much as we are. Friendly "lapia's" are exchanged and repeated as befits local custom. Occasionally, a "lapia aye" or "lalay" will be thrown in for variety. Of course, Sarah has to always show off by actually carrying on brief conversations in Nangjere not just giving generic greetings. I found it's not really necessary as "lapia" repeated often back and forth seems to keep everyone content.

At the river finally we are surrounded as usual by half naked children with fishing spears or poles who are more than happy to leave what their doing to watch "nasara" swim. What could be more entertaining than watching weird looking strange white foreigners jumping, swimming, mud wrestling and tossing mud at them? Getting them to hum the tune of "Indiana Jones" is also a big hit.

Coming back the moon is reflecting perfectly off the still waters of the rice paddies as the sky is still pinked from the recently setting sun.

A few days later a baby comes in with a severe infection in her groin and legs and lower abdomen. Antibiotics help but then large black dead skin patches remain with yellow pus filled edges. They need to be debrided (taken off). I do. That afternoon Sarah comes to me to say she's unconscious. I come and find her recently dead. I desperately refuse to believe. She's pale. The bandages are red with blood. She's bled out and no one noticed. I do CPR furiously unable to let go and accept that I should have checked back on her several times before going home. I would've noticed. No one else did or seemed to be concerned about her at all. A waste. We have no post operative recovery room or any real post operative care. I see death all the time but this one gets to me. I should've checked more carefully to make sure all bleeding was stopped. Sarah is also devastated when I see her later. She feels it's her fault. I hug her and let her know it's not. I feel sick to my stomach.

Dimanche's sister comes in the next morning with abdominal pain. I first hear from the nurse that it's probably a urinary infection. I go to see her and I at first think it's appendicitis. She gives a good story and has peritoneal signs consistent with appendicitis. I decide I should do a pelvic exam first. Then I think it's probably an infection of the uterus or tubes. The pain has switched sides to the left. Then, her story changes too. I wish I had an ultrasound or other tests. I check a blood count which is normal. I put her on antibiotics and continue my work. I don't feel quite comfortable with the diagnosis. After work, the gang wants to go to the river. Right before leaving I decide to check on the patient again. She's worse. I look some stuff up in books and ask some more questions. I wish I had an ultrasound again. After reading I remember I should have checked to see if she was pregnant even if she hasn't missed a period. Matthieu comes in from home to do the test but says it probably won't work because it's not a morning urine sample. We do it anyway. The faintest of lines appears telling us it's positive. I feel relief. God has helped us come to the probable diagnosis even with our lack of equipment--ectopic pregnancy (out of the uterus). I know I need to operate but I'm always more nervous when it's a friend or a relative someone I work with everyday in this case. What if I'm wrong and I operate for nothing and something goes wrong? I'd operated a woman a few months ago who I'd thought had an ectopic pregancy and it turned out to be a simple pelvic infection treatable with antibiotics. Was I making the same mistake? I open up her belly in a low pelvic (Pfannensteil) incision and dark blood comes out of the abdomen. Sure enough there's a swollen mass in the left Eustachian tube. It was about to rupture. Despite some delays due to lack of equipment and my not having anyone to consult eventually with the help of books God led me to do the right thing in time to save her. What if I'd just gone to the river like I really wanted to? It's so hard to find that balance between doing what's right and needs to be done and not getting so overwhelmed and sucked in that you lose yourself and who you are in the incredible, never ending needs of a place like Béré.

Today, I'm finishing up lunch and look out the window at our guava trees. I see three kids staring up. There must be another kid up them again stealing our guavas. If they'd just ask I'd give it to them but kids here have no sense of right and wrong or respect for what belongs to others (like privacy for example). It's not their fault. They have no boundaries. They are outside naked and barefoot with other kids with no regular meals, often dependent on what they find in order to be able to eat. Then at night they can be out until 2-3 in the morning dancing and singing and pounding on drums without any set bedtime. I'm talking about 3 and 4 and 5 year olds as well as the pre-teens and teens. So they get the idea they shouldn't be doing something but not because it's wrong; because they might get beat if they're caught.

So I sneak out the front door to the edge of the house. The three kids are absorbed in whatever's happening in the branches above them. I start running. About 15 feet away they see me and start to run. I arrive at the tree and look up. Sure enough, a kid is caught there. She's about 8-9 years old dressed in a rag wrapped around her waist with bare feet and chest. I look at her with an expressionless face. Then I feel a shock course through me as she lets out a blood curdling yell that doesn't stop as her eyes go wild with fear and she's starts swaying on the branch while holding on tightly above her. I tell her to come down in a flat voice. I feel cut to the quick by her unreasonable fear. She starts to come down howls filling the air.

Other kids start gathering and laughing hysterically at her cries and fear and that she'll probably get the beating of her life now from the terrible "nasara." A couple adults who appear to be relatives approach. She comes down and when I reach to help her down she goes ballistic hanging onto the tree for all she's worth while her screams make my blood go cold. I pull her off the tree and let her down to the ground. She collapses and tries to wriggle away. I grab her wrist gently but firmly. She has wrapped herself around the legs of one of her relatives. Â I pull her free and if possible her cries intensify. I have a sick pit in my stomach half-loving and half-loathing the fear I cause in her. I explain to her relatives that this is our property and that taking stuff from someone else's property is called stealing. They agree. The surrounding kids continue to chortle gleefully at the young girl's distress.

The relatives start to yell viciously at the poor girl. I interrupt to continue trying to explain reasonably why she shouldn't be in our tree. I ask what they will do about it. The young man says they'll discipline her. I let her go as the giggles from the kids continue. The young man picks up a switch as she takes off. I turn away hoping that they won't beat her if I'm not there--that they would only do it because they think I want it and that when I leave they'll all just laugh but somehow I just think the whole situation was sick. If the kids would just ask for the guavas I'd give them to them. But their parents have never taught them how to behave so they have no clue. They learn from their fellow children and that is the basis for the society and social structure and attitudes that leads them later in life to prefer to let their kid die than pay $5 for a complete treatment.

I return home subdued--life is hard here in so many ways.

James

Friday, October 1, 2004

Nose Peanuts

Warning: no bloody, gory or otherwise crazy-nuts stories available at this time.

So I'm hauling sand what was left after construction of the wall. I decided to landscape a little around the house which is really ridiculous because now there's this one tiny patch of niceness replete with cactus, volcanic rock and a brick piece border on one corner of a tin roof house with peeling paint, cracked windows and moth eaten rafters harboring bats and rats. So anyway, the boys start gathering as they usually do anytime "Nasara" starts doing anything. Soon they have insisted on grabbing the shovels and hauling the sand in the wheel barrows as well--but you already know the story--this is really a tale about a boy--Fambe (think Thumper and Bambi crossed and you have an idea of the pronunciation). He starts dancing on the sand pile. He's only three, runs around naked most of the time and dances as if he was born to it. He's Lona's second youngest son. He loves to stare at "Nasara" with a blank look on his face. He won't smile, talk or do anything accept come up to you in church and want to sit on your lap until he rips your Arab robes. Then he'll run off to sweep up peanut shells off the floor. Occasionally, you'll be walking to work in the early morning fog and you'll see someone sitting in the dirt waving with a huge grin saying "lalé, lalé" but other than that it's all just serious, expressionless staring. I'm not sure if Fambe still likes me now after I circumcised him and he then got infected because, well he runs around naked and rolls in the dirt at every opportunity. Not to mention that he was quite proud of his new look and would show off to anyone. Oh, and there was the time I was tossing the football and accidently pegged him right on the head causing him to tumble off the porch railing he was perched on 4 feet to the ground. I got there quickly to find him screaming like a hyena with blood pouring off a tiny slit in his scalp. Lona just laughed and shook his head when I told him. As mentioned, Fambe has natural rhythm and likes to take one of my small drums, lay it between his legs as he sprawls on the ground and pound it--sometimes in rhythm with what we are playing.

Fambe's brother Henri on the other hand just stands around looking at you with the cheesiest grin all the time. I've never seen a kid so happy and with a bigger smile. Even when he was deadly sick with Malaria his smile never diminished--his eyes just looked a little droopy.

A boy with a huge Burkitt's Lymphoma on his right cheek (bigger than two huge grapefruits) who I've searched to world over to find treatment for comes into see me when I say I've found it. I first saw him walking down the street to market months ago and stopped the car to yell at him to come see me which he always has done everytime I've called for him. Now when I have the meds finally I set up an appointment to start chemo and he never shows up. I see him by the basketball court we've rigged up in a field the other day and he says he's coming tomorrow then never shows up. I don't get it--maybe he's afraid of getting his hopes up or what--I often can't figure out how people think here.

So, finally--nose peanuts. Never say never. You can teach an old dog new tricks. I never cease to be amazed. Sarah calls me to come see a baby with a peanut stuck up it's nose. I hurry over and see the baby comfortably in mom's arms. I walk down the hall to my office and gather my arsenal: Otoscope, nasal speculum, forceps, clamps, spray anesthetic. I'm armed to the teeth. I walk back balancing all my goodies in both hands. I turn the corner and see a strange man bending over the child. One of the other patients' fathers. I don't get it until I hear loud sucking noises. I'm frozen. He then lifts his lips off the baby's nostrils and there is the slimy peanut sitting right there. He nimbly picks it off and tosses it aside. I'm flabbergasted feeling a little foolish with my "modern" medecine. I tell Sarah to give them their money back and return home laughing and shaking my head. It's brilliant!

James