Bonjour,
Gueltir sets a brisk pace. We're walking side by side down the dusty streets of Béré. There are no street signs, no pavement, no sidewalks, no traffic lights, no signs, no evidence that we are in the 21st century. We walk past mud brick huts with people in front lying under mango trees on woven reed mats, pounding millet in crude wooden mortar-and-pestles, carrying big bundles of firewood on their heads, cooking over open fires, and a host of other activities that could place us anywhere from after the Flood to the present. In essence, Béré has managed to capture timelessness...at least until a motorcycle drives by or a man crosses the path with his world-band radio blaring.
We are headed to visit one of the junior high schools in Béré. There are two mixed junior highs, a Catholic girls only junior high and one full-fledged high school bursting at the seams with 1500 students meeting in crude mud buildings or in "hangars" constructed of woven reed walls and roof supported by crooked sticks stuck in the ground. The one we are going to visit is a private one built in 2001 which Gueltir says has been all but abandoned as the owner is occupied with other things in N'Djaména. Besides, for the moment, all the teachers are on strike everywhere except at Gueltir's school. None have been paid for three months. Fortunately, with some help from the US, our teachers are paid every month...a rare thing in Tchad.
We arrive at the Junior High. It's pathetic. The three mud brick buildings surround a courtyard with an open, empty well in the center. To the left and to the right, the buildings have three rooms each, side by side. Straight ahead is the administration building with two rooms. The doors are made from thin wood frames with green painted corrugated roofing nailed on. They hang haphazardly, "locked" precariously with tiny padlocks that come apart when unlocked. Inside, the uneven dirt floors support some rickety benches and tables leaning crazily at all different angles because of the floor. Most have been eaten by termites. Two walls have windows. The side facing the courtyard has windows made of the same material as the doors and they can be opened. The opposite side is made of mud bricks crisscrossed to leave openings in between for air circulation. The roofs are corrugated tin balanced on twisted sticks tied to the bricks with metal bands. One wall is painted black to serve as a chalkboard.
The ad building has one desk, a small bookshelf with a couple of empty chalk boxes on it, a locked trunk and a locked cabinet. A small chair leans precariously against the wall. I tell Gueltir I'm amazed at the conditions. He wonders what I mean saying this is great compared to how he learned sitting under mango trees and temporary shelters. In fact, on the way here, we passed a school and a church that were made entirely of mats. How can the Tchadians hope to become more educated when they have to learn without books, without good facilities and often without teachers (who are on strike half the year it seems)?
We finish and head across town, through the market as it closes up, and on to the house of one of the local "house doctors". He welcomes us into his courtyard, brings out chairs, and invites us to sit. One by one the members of the household come to greet us. The women bow to the ground and extend their hand to shake with the other hand supporting it at the elbow in a sign of deep respect. Our friend's wife brings us a metal bowl of water and a table is called for. We begin to discuss the local gossip. It appears everything is known about everyone. He wonders why I didn't leave to go to Koumra this morning with André. He thought I'd left. I just found out about it last night and decided it was too late to go. Apparently, he knew I was supposed to go before I did. We move on to the raising of ducks, how to plant fruit trees with bull horns buried beside, when the rain will come and a variety of other topics.
The pastor of the Evangelical Church #2 joins us. He is Dimanche's dad (Dimanche is one of our nurses provided by the state). We pass to another round of greetings and acknowledgements.
Finally, I get around to the purpose of our visit. I tactfully mention that we are all here for the health of the community and that one thing I've noticed is that kids often get referred late for treatment of malaria. In fact, we just finished rescuing a small, one-year-old girl that had been treated by him for several days before coming to the hospital. I say that it's something in general we see that kids just don't do well with malaria unless they're hospitalized. He seems to understand. In fact, he seems happy at the exchange. I don't bother to mention that I think he has no right to be treating patients at all since he is not trained except in basic CPR and first aid. He's still going to continue to treat patients at his home. In fact, in the middle of the conversation, someone comes up and greets him as "doctor." All we can do is try and help him to not hurt people.
It's getting dark. We bid goodbye. Our friend accompanies Gueltir and I just till the main road. Without a guide, I'd be lost in the maze of paths and huts. He promises to come see me soon at the hospital. Gueltir and I head home. We pass an outdoor cabaret. The warm rumble of muffled conversation floats over the air along with the smell of local brew. Surrounding the cabaret are the small time vendors. Each has a small table with a kerosene lamp, small plastic sacs of tea and sugar and detergent and oil along with cigarettes, small crackers and various other items. Over head is a mat supported on four sticks poked into the ground. Business is booming. We continue on through the dark streets bereft of any artificial light until we see the fluorescent glow of the hospital through the trees and we know we are home.
James
Monday, May 30, 2005
Monday, May 23, 2005
From Sarah
I'm sitting in our living room with Djongjabe, the 5 year-old daughter of Pierre, the cassier. She's enjoying herself with paper and crayons. Last year she lived with me for almost two months. It all began when she would come and sit by me in church. Her family felt sorry for me that I slept alone (in this culture, being alone = by yourself is the worst possible thing that can happen to you.) They suggested "lending" me their daughter for company and help. I loved the idea. And apparently, so did Djongjabe! We would eat together, do the dishes together, shower together and she would sleep next to me. In the morning I would send her out the door to go to preschool, and she would come back late afternoon. We didn't speak the same language but got along just fine. I dare say she understood my Danish pretty well, and I usually figured out what she meant when she spoke her native language, which is Mundange. Besides, tickling never needed translation.
This idyllic evening makes me think of some of the extremes I have experimented here at the hospital. I have been in several situations, where if I had known about them, I probably would not have wanted to come. I have certainly done things I would NEVER have thought I would....
It was during one of my night shifts. A shift that begins at 2PM when everybody leaves and only the guard nurse is left to take care of all hospitalized patients, what comes in the ER and any deliveries.
A woman comes in for her delivery. She's alone. The husband is nowhere to be found, and for some reason she has no sister, mother, aunt cousin or neighbor with her. I recognize her - her little son was treated for tuberculosis some months earlier. I examine her. She still has a little ways to go. I check on the other hospitalized patients in between. Early morning comes and I expect the woman to deliver anytime soon. She's dilated and has a few good contractions. The head is right there.
After morning worship I give report about the night's events and hand over the woman to Rahama who is experienced in delivering babies. I go back to house and hope the goats and children will be quiet and keep away from my windows so I can get some rest.
I'm getting relaxed and ready to doze off, when the watch man calls me from outside the window "Sarah, you have to come up to the hospital. They have an emergency and need you to take care of the delivery". The delivery? That should have been over long ago? It's almost noon?! I worry if there had been any signs of complications I missed out on during the night?
On my way to the hospital I pass a group of people who have found a shady spot to sell their matches, spices and little plastic bags with sugar and salt. "Lapia" I say, knowing how not greeting people almost is taken as an insult. A teenage girl rises to follow me. She asks where I'm going, although everybody knows I mostly just walk the path between the house and the hospital. Often when I have bought something with her, she has kept the change and only by insisting and getting the help of onlooker have I got back the money she owed me. My thoughts are with the woman who has not yet delivered. What can be wrong? I'm no midwife! Just a plain RN.
Arriving at the hospital, I notice all the people gathered outside the OR. Some emergency has happened and someone is being operated. The other nurses are in there.
I arrive at the door to the delivery room. I notice the teenage girl is still behind me as I open the door. I turn and tell her to stay outside. I walk in to find the woman in great pain and to older women from the church are by her side. The husband has not showed up, neither have any relatives or friends. My mind is racing as I examine her again. Why hasn't she delivered yet? The contractions are good, there seem to be space enough for the baby to come out.... I get distracted by the sound of the door slamming. The teenage girl walks in. I widen my eyes in surprise and tell her this is not an entertainment show and she has to leave. I return to the woman. I wish I had someone to ask for help. Are there even sterile instruments around? Did anyone survey her or was she left alone when I went home?
As I turn to see if I have what I need nearby, I see the teenage girl, who has now found a comfortable place to sit down and watch! As I feel the stress of being thrown into a situation outside my competence, being tired and feeling alone, I raise my voice to make it even more clear to this girl that I meant what I said. I mobilized all my patience and explain again why she is not allowed to watch. I even tell her "PLEASE, go outside!" I know I can't concentrate on this delivery while she is sitting there.
She tilts her head, smiles subtly and says: "What if it doesn't PLEASES me to go outside?"
I'm beyond amazed! I need to get this girl out! I know I can't get violent...I look down on my gloved hand, covered with bloody vaginal secretion from examining the woman. I look sternly at the girl and walk towards her with my hand raised. As I get to her, she looks at me like she couldn't care less. I wipe my hand off on her cheek and neck, amazed at my self and she hadn't already left!!! She widens her eyes, turns and leaves. As I turn to the woman my eyes meet the two older women. They smile knowingly and nod. I think "WHAT did I just do???"
We tell the woman to PUSH and get this over with. The two older women have done this so many times before. They scold and slap her (why didn't I think of that...) and she starts to push better. Shortly after, a healthy baby comes out, I tie the cord and dry him off, extremely relieved. Everything goes well, the placenta comes out, the uterus goes hard and small, all bleeding stops.
The two women from church promise to look after the mom, and help her breastfeed. I walk to the OR. The head nurse has come out. I drag him aside and say I have something to confess. Somehow I'm sure they will not have anything to do with a nurse who smears bloody vaginal secretions over people. After telling him about the incident, he laughs hard and says "You did the right thing - she had it coming!" I can't believe my own ears.
After getting some sleep, I laugh too. And think of how much I'm learning about myself in this place, being driven beyond anything I've ever been before. Of course I have never had to things like this before, in Denmark I've never had strangers refuse to leave the delivery room.
Here, one has to be creative...
Sarah
This idyllic evening makes me think of some of the extremes I have experimented here at the hospital. I have been in several situations, where if I had known about them, I probably would not have wanted to come. I have certainly done things I would NEVER have thought I would....
It was during one of my night shifts. A shift that begins at 2PM when everybody leaves and only the guard nurse is left to take care of all hospitalized patients, what comes in the ER and any deliveries.
A woman comes in for her delivery. She's alone. The husband is nowhere to be found, and for some reason she has no sister, mother, aunt cousin or neighbor with her. I recognize her - her little son was treated for tuberculosis some months earlier. I examine her. She still has a little ways to go. I check on the other hospitalized patients in between. Early morning comes and I expect the woman to deliver anytime soon. She's dilated and has a few good contractions. The head is right there.
After morning worship I give report about the night's events and hand over the woman to Rahama who is experienced in delivering babies. I go back to house and hope the goats and children will be quiet and keep away from my windows so I can get some rest.
I'm getting relaxed and ready to doze off, when the watch man calls me from outside the window "Sarah, you have to come up to the hospital. They have an emergency and need you to take care of the delivery". The delivery? That should have been over long ago? It's almost noon?! I worry if there had been any signs of complications I missed out on during the night?
On my way to the hospital I pass a group of people who have found a shady spot to sell their matches, spices and little plastic bags with sugar and salt. "Lapia" I say, knowing how not greeting people almost is taken as an insult. A teenage girl rises to follow me. She asks where I'm going, although everybody knows I mostly just walk the path between the house and the hospital. Often when I have bought something with her, she has kept the change and only by insisting and getting the help of onlooker have I got back the money she owed me. My thoughts are with the woman who has not yet delivered. What can be wrong? I'm no midwife! Just a plain RN.
Arriving at the hospital, I notice all the people gathered outside the OR. Some emergency has happened and someone is being operated. The other nurses are in there.
I arrive at the door to the delivery room. I notice the teenage girl is still behind me as I open the door. I turn and tell her to stay outside. I walk in to find the woman in great pain and to older women from the church are by her side. The husband has not showed up, neither have any relatives or friends. My mind is racing as I examine her again. Why hasn't she delivered yet? The contractions are good, there seem to be space enough for the baby to come out.... I get distracted by the sound of the door slamming. The teenage girl walks in. I widen my eyes in surprise and tell her this is not an entertainment show and she has to leave. I return to the woman. I wish I had someone to ask for help. Are there even sterile instruments around? Did anyone survey her or was she left alone when I went home?
As I turn to see if I have what I need nearby, I see the teenage girl, who has now found a comfortable place to sit down and watch! As I feel the stress of being thrown into a situation outside my competence, being tired and feeling alone, I raise my voice to make it even more clear to this girl that I meant what I said. I mobilized all my patience and explain again why she is not allowed to watch. I even tell her "PLEASE, go outside!" I know I can't concentrate on this delivery while she is sitting there.
She tilts her head, smiles subtly and says: "What if it doesn't PLEASES me to go outside?"
I'm beyond amazed! I need to get this girl out! I know I can't get violent...I look down on my gloved hand, covered with bloody vaginal secretion from examining the woman. I look sternly at the girl and walk towards her with my hand raised. As I get to her, she looks at me like she couldn't care less. I wipe my hand off on her cheek and neck, amazed at my self and she hadn't already left!!! She widens her eyes, turns and leaves. As I turn to the woman my eyes meet the two older women. They smile knowingly and nod. I think "WHAT did I just do???"
We tell the woman to PUSH and get this over with. The two older women have done this so many times before. They scold and slap her (why didn't I think of that...) and she starts to push better. Shortly after, a healthy baby comes out, I tie the cord and dry him off, extremely relieved. Everything goes well, the placenta comes out, the uterus goes hard and small, all bleeding stops.
The two women from church promise to look after the mom, and help her breastfeed. I walk to the OR. The head nurse has come out. I drag him aside and say I have something to confess. Somehow I'm sure they will not have anything to do with a nurse who smears bloody vaginal secretions over people. After telling him about the incident, he laughs hard and says "You did the right thing - she had it coming!" I can't believe my own ears.
After getting some sleep, I laugh too. And think of how much I'm learning about myself in this place, being driven beyond anything I've ever been before. Of course I have never had to things like this before, in Denmark I've never had strangers refuse to leave the delivery room.
Here, one has to be creative...
Sarah
Thursday, May 5, 2005
A tale
I feel lost in a story that seems to fly by. It's moving, intense, captivating, exhausting...and each page is turned so fast I can only catch enough glimpses to get the general idea of the what's going on...yet, each page once turned is permanently turned...you can't go back.
A woman in labor for 2 days. Seen last night by a retired health care worker. Sent to us this morning. Her baby's too big. The head is all molded and almost sticking out...but it's just skin on his head that has been squeezed out...the skull won't fit through.
I have been called from my egg and rice breakfast. I run to the OR. I grab a syringe, anesthetic, an instrument box, a scalpel, a urinary catheter and some gauze and gloves. I rush back. I shave, prep, and slice down to her pubic bone. I start to cut through the cartilage. The scalpel breaks inside. I can't find it. I yell for a flashlight and another scalpel. I mop up the blood with the gauze. I call for Lona and Rachel. They each grab a leg. I cut deeper, going by feel. I tell Lona and Rachel to pull her legs apart. I hear a crack and feel her pelvis widen at the front.
The baby slides out in a slippery bath of brownish green fluid. He's huge, has a slow heartbeat and a little muscle tone. He never breaths. Despite CPR and resuscitation for 10 minutes he never cries. He's dead.
Meanwhile Lona has delivered the placenta and casually says she's bleeding. As I'm pressing the baby's chest between my fingers and two thumbs to pump his blood I look and see that Lona has draped a gauze over the perineum which is soaked with strings of coagulated blood dripping down into the green basin as the entire area is bright red. I leave the baby. I pull off the gauze...the entire birth canal is filled with blood and a piece of tissue hanging out. I yell for more gauze...they run to get it. I cram gauze inside and pull them out so I can see what's going on. Nathan holds a flashlight over my shoulder.
It appears the cervix has completely torn itself off circumferentially and is literally hanging by a thread. I clamp the base. Then, I soak up the blood in the wound where I cut her pelvis and with the flashlight try to find the piece of broken off scalpel. No where to be seen. I fish around with a needle driver and bang against something. I dab up blood and look again. I see it and pull it out. Then I wash out and suture up. I then suture up a tear around her urethra and a small posterior perineal tear. I cut off the dangling strip of cervix, take off the clamps, see there's no bleeding and an hour and a half after starting head off for rounds.
What part do I have to play? Why am I even in this story called H�pital Adventiste de Béré? My character being in the tale, much less one of the protagonists, is as odd as Crush the turtle showing up in Blair Witch Project. I get this feeling sometimes of the other players whispering behind their backs, when they think I'm not looking, asking how did he get a part? And, doesn't he realize that his lines are totally out of place and poorly acted?
I'm called over to the TB ward. Someone's not doing well. I see one of our long-timers is in bad shape. He'd come from Kelo...had started to improve and put on weight. He has a congenitally deformed left arm where the hand faces the wrong way and the whole thing is too short. Yesterday, his cousin told me he had a fever...probably malaria. Sure enough the smear is positive. I write for Quinine and Fandsidar and forget about it.
Now, he's death warmed over. He's unconscious, gray, has a slow heart beat, his cheeks are sunken and his breathing is more like an occasional deep sigh out of reflex rather than a serious effort at obtaining oxygen. I expect him to die in front of me. I sit there and stare at him for ten minutes. If I'd only gone to see him yesterday maybe I'd have seen he was bad and been more aggressive with treatment. It's so easy to ignore the TB patients...there just there taking pills. I'm so busy, maybe I'll see them tomorrow...at least once a week...or now and then...
A little girl, also hospitalized with TB, is sitting at the foot of the bed weeping. She is the cutest, cheeriest, most helpful girl. She always yells, "James-uh", and waves as she passes by carrying laundry or water on her head. She's helped us this week trim the mango trees wanting to saw as much as she can even if it doesn't really do much. Now, as easily as she laughs, she cries for someone she wouldn't know except for their common disease...I feel useless...I want to cry too...I want to run home and hide...I want to be a little kid again...but I just stand and stare and then walk lamely off with a blank expression...
Yet, somehow, it works. Beyond all rational thought, the play goes on...the plot thickens...the suspense builds...the rivals grow to respect each other...love is found in the most unexpected of places...laughter pops up randomly...joy is found...
I see all three "James-uhs" today. I've had three kids born here since I've been here who are named for me. The first one is the Chaplain's grandson. He's also been treated for Malaria a couple times and just wandered in with his mom looking healthy. James-uh 2 was brought in when 3 days old with a strangulated umbilical hernia that we operated on urgently. He recovered, then developed a wound infection and came in daily for a while for antibiotic shots and dressing changes. He sees me today as one of the sutures has poked through the skin and is sticking out. He is a round, chubby, dark baby with a serious afro going on and a vigorous cry and kick as I cut the suture and pull it out.
James-uh 3 is weak and malnourished. He is the surviving twin of Yvonne, born of c-section to an HIV+ mom. David, his bro, died last week. He manages to barely hang on. We tried him on formula to protect him from mommy's HIV and almost killed him with the diarrhea and lactose-intolerance. He's somehow toughing it out and I see him stretch out his puny arms for mom's breast as I change her dressing. She pulls him close and he sucks vigorously as if his life depended on it...and it does...
Then, despite the time in the desert, thirsty, hot, baked, dried out, tongue sticking to the roof of the mouth, hot, unbearable...despite it coming to an end with refreshing rain and cool winds and pleasant evenings...the sleeplessness continues. The thoughts ramble. The feeling of hopelessness for change enters. The spirit isn't even willing and the flesh is very weak.
A well-groomed, stocky man walks into my office with jeans, a tucked-in flannel and alligator skin boots. He presents his dossier. He is the referring doctor for a patient I've just seen. I was surprised to get an official looking letter with a reference from a traditional healer that morning. He'd tried to treat her pelvic pain for 3 days without success and so now was referring to the hospital. How cool, I'd thought.
Now he's presenting me papers telling how he's met with other traditional healers from Benin and other African countries for an exchange of ideas and how they're researching traditional pharmaceuticals. I'm impressed. I ask him how he was trained. That's when things suddenly turned bizarre.
I notice he's holding a carved horn as if it was a newborn baby...tenderly and pressed against his chest. He calmly tells me that he was drowned as a child, 5 spirits entered him and revived him, and they now tell him which plants to use for which problems. I don't know what to say. We continue otherwise to chat as colleagues. I tell him we've found Shistosomes in his patient's urine and have prescribed treatment. He is gracious, polite, refined and the last way I'd expected to see my first witch doctor.
This is just the latest to confirm my suspicions of the heaviness of spiritual forces here. A few weeks ago, after morning report we somehow got on the topic and all the staff started recounting tales of the supernatural.
Rahama told of taking her husband into the bush to see a healer. He boiled water, made him stand in the vapor and then threw something at his eyes. Animal bones immediately flew out of her husband's eyes and fell to the ground. She was shocked but had presence of mind to gather them up. She showed them to me the next day.
Samedi once saw two men who came by to show their powers. One took a sharp bush knife, suddenly turned, and whacked off the head of his companion. They all saw it fall to the ground. Then he picked it up and set it back on his friend's shoulders and he started talking and moving normally.
Andr� has seen people put curses on things that if you touch them you become frozen in place till the person comes back and sees it was you who was going to steal it. The others all confirmed that this is common.
Someone told the tale of our swimming hole by the bridge where Sarah and I like to jump off the cliffs. Apparently, a healthy young man was accused of adultery and was forced to swim across...which he did fine. But on swimming back he suddenly cried, lifted his arms out, and disappeared under the surface never to be seen again.
Then, there are the simple things like, when Pastor Job from N'Djam�na was here and said he's never heard goats and animals make so much noise or be so bothersome. He said they must be possessed. I'd thought the same thing but was afraid of sounding silly or paranoid if I mentioned it. Why else would they poop on our porch exclusively, pee right out side our windows, bleat uncontrollably for no reason just as we fall asleep and basically do as much as possible to assure we get no rest.
Spiritual forces are palpable here. I believe that God will protect me...but how to battle for the others? I've seen many patients I'm convinced should've lived except there was always some "sorcellerie" going on, or as the patients say, "he's been poisoned" meaning had a spell cast on him. What can I do? I feel helpless and inadequate...
I wonder like Sam Gamgee as he wanders the wilds near Mordor if they will write about me in the tales or am I way too insignificant...do I have an important part to play in this cosmic story? Will I have made a difference when the credits roll?
Somehow, I know that in the end, as I sit around the campfires of heaven, I will have stories to tell. People will say, tell me more about Samedi, and Lona, and Anatole and especially, about Sarah...did you really?...Are you serious?...No way!...That's what keeps me going...even though, or especially because, a place like this is beyond my wildest nightmares...it begins to take on a mythic quality. I feel detached at times, looking at myself, wondering if this is reality or just another movie, a story, a tale, something someone made up...and just maybe Someone did and the ending will be beyond my fondest dreams...
To be continued...
James
A woman in labor for 2 days. Seen last night by a retired health care worker. Sent to us this morning. Her baby's too big. The head is all molded and almost sticking out...but it's just skin on his head that has been squeezed out...the skull won't fit through.
I have been called from my egg and rice breakfast. I run to the OR. I grab a syringe, anesthetic, an instrument box, a scalpel, a urinary catheter and some gauze and gloves. I rush back. I shave, prep, and slice down to her pubic bone. I start to cut through the cartilage. The scalpel breaks inside. I can't find it. I yell for a flashlight and another scalpel. I mop up the blood with the gauze. I call for Lona and Rachel. They each grab a leg. I cut deeper, going by feel. I tell Lona and Rachel to pull her legs apart. I hear a crack and feel her pelvis widen at the front.
The baby slides out in a slippery bath of brownish green fluid. He's huge, has a slow heartbeat and a little muscle tone. He never breaths. Despite CPR and resuscitation for 10 minutes he never cries. He's dead.
Meanwhile Lona has delivered the placenta and casually says she's bleeding. As I'm pressing the baby's chest between my fingers and two thumbs to pump his blood I look and see that Lona has draped a gauze over the perineum which is soaked with strings of coagulated blood dripping down into the green basin as the entire area is bright red. I leave the baby. I pull off the gauze...the entire birth canal is filled with blood and a piece of tissue hanging out. I yell for more gauze...they run to get it. I cram gauze inside and pull them out so I can see what's going on. Nathan holds a flashlight over my shoulder.
It appears the cervix has completely torn itself off circumferentially and is literally hanging by a thread. I clamp the base. Then, I soak up the blood in the wound where I cut her pelvis and with the flashlight try to find the piece of broken off scalpel. No where to be seen. I fish around with a needle driver and bang against something. I dab up blood and look again. I see it and pull it out. Then I wash out and suture up. I then suture up a tear around her urethra and a small posterior perineal tear. I cut off the dangling strip of cervix, take off the clamps, see there's no bleeding and an hour and a half after starting head off for rounds.
What part do I have to play? Why am I even in this story called H�pital Adventiste de Béré? My character being in the tale, much less one of the protagonists, is as odd as Crush the turtle showing up in Blair Witch Project. I get this feeling sometimes of the other players whispering behind their backs, when they think I'm not looking, asking how did he get a part? And, doesn't he realize that his lines are totally out of place and poorly acted?
I'm called over to the TB ward. Someone's not doing well. I see one of our long-timers is in bad shape. He'd come from Kelo...had started to improve and put on weight. He has a congenitally deformed left arm where the hand faces the wrong way and the whole thing is too short. Yesterday, his cousin told me he had a fever...probably malaria. Sure enough the smear is positive. I write for Quinine and Fandsidar and forget about it.
Now, he's death warmed over. He's unconscious, gray, has a slow heart beat, his cheeks are sunken and his breathing is more like an occasional deep sigh out of reflex rather than a serious effort at obtaining oxygen. I expect him to die in front of me. I sit there and stare at him for ten minutes. If I'd only gone to see him yesterday maybe I'd have seen he was bad and been more aggressive with treatment. It's so easy to ignore the TB patients...there just there taking pills. I'm so busy, maybe I'll see them tomorrow...at least once a week...or now and then...
A little girl, also hospitalized with TB, is sitting at the foot of the bed weeping. She is the cutest, cheeriest, most helpful girl. She always yells, "James-uh", and waves as she passes by carrying laundry or water on her head. She's helped us this week trim the mango trees wanting to saw as much as she can even if it doesn't really do much. Now, as easily as she laughs, she cries for someone she wouldn't know except for their common disease...I feel useless...I want to cry too...I want to run home and hide...I want to be a little kid again...but I just stand and stare and then walk lamely off with a blank expression...
Yet, somehow, it works. Beyond all rational thought, the play goes on...the plot thickens...the suspense builds...the rivals grow to respect each other...love is found in the most unexpected of places...laughter pops up randomly...joy is found...
I see all three "James-uhs" today. I've had three kids born here since I've been here who are named for me. The first one is the Chaplain's grandson. He's also been treated for Malaria a couple times and just wandered in with his mom looking healthy. James-uh 2 was brought in when 3 days old with a strangulated umbilical hernia that we operated on urgently. He recovered, then developed a wound infection and came in daily for a while for antibiotic shots and dressing changes. He sees me today as one of the sutures has poked through the skin and is sticking out. He is a round, chubby, dark baby with a serious afro going on and a vigorous cry and kick as I cut the suture and pull it out.
James-uh 3 is weak and malnourished. He is the surviving twin of Yvonne, born of c-section to an HIV+ mom. David, his bro, died last week. He manages to barely hang on. We tried him on formula to protect him from mommy's HIV and almost killed him with the diarrhea and lactose-intolerance. He's somehow toughing it out and I see him stretch out his puny arms for mom's breast as I change her dressing. She pulls him close and he sucks vigorously as if his life depended on it...and it does...
Then, despite the time in the desert, thirsty, hot, baked, dried out, tongue sticking to the roof of the mouth, hot, unbearable...despite it coming to an end with refreshing rain and cool winds and pleasant evenings...the sleeplessness continues. The thoughts ramble. The feeling of hopelessness for change enters. The spirit isn't even willing and the flesh is very weak.
A well-groomed, stocky man walks into my office with jeans, a tucked-in flannel and alligator skin boots. He presents his dossier. He is the referring doctor for a patient I've just seen. I was surprised to get an official looking letter with a reference from a traditional healer that morning. He'd tried to treat her pelvic pain for 3 days without success and so now was referring to the hospital. How cool, I'd thought.
Now he's presenting me papers telling how he's met with other traditional healers from Benin and other African countries for an exchange of ideas and how they're researching traditional pharmaceuticals. I'm impressed. I ask him how he was trained. That's when things suddenly turned bizarre.
I notice he's holding a carved horn as if it was a newborn baby...tenderly and pressed against his chest. He calmly tells me that he was drowned as a child, 5 spirits entered him and revived him, and they now tell him which plants to use for which problems. I don't know what to say. We continue otherwise to chat as colleagues. I tell him we've found Shistosomes in his patient's urine and have prescribed treatment. He is gracious, polite, refined and the last way I'd expected to see my first witch doctor.
This is just the latest to confirm my suspicions of the heaviness of spiritual forces here. A few weeks ago, after morning report we somehow got on the topic and all the staff started recounting tales of the supernatural.
Rahama told of taking her husband into the bush to see a healer. He boiled water, made him stand in the vapor and then threw something at his eyes. Animal bones immediately flew out of her husband's eyes and fell to the ground. She was shocked but had presence of mind to gather them up. She showed them to me the next day.
Samedi once saw two men who came by to show their powers. One took a sharp bush knife, suddenly turned, and whacked off the head of his companion. They all saw it fall to the ground. Then he picked it up and set it back on his friend's shoulders and he started talking and moving normally.
Andr� has seen people put curses on things that if you touch them you become frozen in place till the person comes back and sees it was you who was going to steal it. The others all confirmed that this is common.
Someone told the tale of our swimming hole by the bridge where Sarah and I like to jump off the cliffs. Apparently, a healthy young man was accused of adultery and was forced to swim across...which he did fine. But on swimming back he suddenly cried, lifted his arms out, and disappeared under the surface never to be seen again.
Then, there are the simple things like, when Pastor Job from N'Djam�na was here and said he's never heard goats and animals make so much noise or be so bothersome. He said they must be possessed. I'd thought the same thing but was afraid of sounding silly or paranoid if I mentioned it. Why else would they poop on our porch exclusively, pee right out side our windows, bleat uncontrollably for no reason just as we fall asleep and basically do as much as possible to assure we get no rest.
Spiritual forces are palpable here. I believe that God will protect me...but how to battle for the others? I've seen many patients I'm convinced should've lived except there was always some "sorcellerie" going on, or as the patients say, "he's been poisoned" meaning had a spell cast on him. What can I do? I feel helpless and inadequate...
I wonder like Sam Gamgee as he wanders the wilds near Mordor if they will write about me in the tales or am I way too insignificant...do I have an important part to play in this cosmic story? Will I have made a difference when the credits roll?
Somehow, I know that in the end, as I sit around the campfires of heaven, I will have stories to tell. People will say, tell me more about Samedi, and Lona, and Anatole and especially, about Sarah...did you really?...Are you serious?...No way!...That's what keeps me going...even though, or especially because, a place like this is beyond my wildest nightmares...it begins to take on a mythic quality. I feel detached at times, looking at myself, wondering if this is reality or just another movie, a story, a tale, something someone made up...and just maybe Someone did and the ending will be beyond my fondest dreams...
To be continued...
James
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