Navigating the mind

I lie on the couch. My arms stick to my bare chest. My eyelids are so heavy I can't keep them open. Hens cluck outside, their chicks tweeting alongside. Andr� shouts something in Moundan, which sounds like Chinese badly spoken. In the distance, thunder threatens to disrupt the heavy heat that hangs in the air like a cobweb stretching desperately to ensnare its next victim. The taste of M & M's rests in my mouth like a sticky, sweet film of scum on top of a stagnant pool where mosquitoes breed ready to spread their deadly curse of malaria across our small village.

Thoughts flit through my head hoping not to be caught by anything that might make my consciousness stay awake.

I glide through the wards in my mind as in a misty cave lit dimly by torchlight. There to the left is a smiling face of a well-looking woman with a cast on her right leg. She smiles, holds out her hand and says, "lapia". Three small children play some game with a plastic bag at her bedside.

To the right, Lona leads me to the new arrival. An elderly woman betraying her age by her silver hair rather than by her skin and body lies stretched on her back. I examine her abdomen and write prescriptions in her little health record which is carved out of a school notebook and called a carnet.

I enter the next room barely noticing the cracked blue dingy paint and ceiling panels hanging like moss from an ancient cave. Under a white mosquito net sits the Business Manager of the Mayor's office. His knee wound has become infected post-op leaking out pasty remnants of his gout deposits like toothpaste gone really, really bad. I unwrap and change the dressing.

I proceed to the next mosquito net cocoon hiding not a butterfly but a man lucky to be alive, yet very much so despite lying in his own stool which is leaking out of a poorly done colostomy on his left abdominal wall. Five days ago I was intimately acquainted with his abdominal contents from midnight until 6:00 am as I first unwrapped, then removed his dead sigmoid colon which had twisted on itself in a bizarre act of suicide called a volvulus. He is eating, has no pain, wound is clean, drains removed yesterday and colostomy functioning despite being done wrong (as learned by post op reading on the subject).

I move to the outside door passing our tall, thin friend with a left leg that I was sure he would lose when he first arrived. His thigh wound is still rather large but beefy red with no swelling or signs of infection. Of course, after two months at home and only our pitiful attempts at physical therapy, he is a long ways from bending his knee normally. But he has his leg...

I walk under the porch and across a surprisingly clear walkway lacking the normal proliferation of mats and bright colored Arabic rugs. I enter the dungeon of pediatrics.

Darkness and the smell of urine and old pus assault my senses. The smells soon disappear in the amazing adaptability of the body and the darkness by simply opening the sheet metal shutters. A row of red beds stretches in what seems like infinity interrupted by a smattering of mosquito nets and tubing hanging haphazardly from a varied assortment of poles, sticks and protuberances. I feel I should have a treasure map in my hand, a hat on my head, a whip by my side and a wry smile playing about my lips if I intend to navigate well this ancient tomb.

I notice that the second bed to the left has a new child. The one who'd occupied that bed the previous five days sticks out in my mind. A tiny 8-month-old with the typical fever, diarrhea, vomiting and anemia was admitted, diagnosed with malaria and severe anemia, and treated with IV Quinine and a blood transfusion. But despite all that, this tiny thing continued to hang on the edge of eternity. Each day brought no improvement. Her Arab father continually sought what to do and was quick to buy the necessary treatments. His love was contagious.

But the diarrhea continued. The refusal to breastfeed was discouraging. The fast heart rate and breathing was ominous. Finally, two days ago I noticed a change, but not the one I was expecting or hoping for. I noticed a small piece of white paper or animal hide folded many times and tied to her wrist. Then, I took note of the heavy bundle of leather pouches tied around her neck. I spoke to the father.

"Are you a Muslim?"

"Yes."

"Do you believe in the one true God?"

"Yes."

"Do you believe He is all powerful?"

"Yes."

"Then why do you put your confidence in these fetishes to save your child's life? If it is Allah's will she will die, if it is Allah's will she will live but you may give credit to the fetishes rather than Allah if she does. Why not take them off and put your trust in the all-powerful one God?"

"Doctor, you are right."

I pray with them. I walk away. I come back the next day and the child is well. The child has no pouches or things tied around her. They go home that same day.

I continue on pediatrics and remember what happened two weeks ago at the end of the cavern. A mother lying on the floor begins to writhe and twist and moan. I feel instantly this is something supernatural. Through a nursing student as translator we pray for her. She calms down. We speak with her.

She used to know God. Then, a catastrophe struck. She lost her husband and faith at the same time. She visited a witch doctor. The "seizures" started. We pray for her again, assuring her that our God is all powerful and she can be free. She is calm. Her child is still sick, though.

The next day, she is gone along with her child.

I return to the present. I find my way through the maze of sick children and return home. I pass through whirlwind of email trying to get students ready to enter nursing school, sending the chauffeur to get IV fluids at Lai across the barge-less and bridge-less swollen Logone River, going to church, getting called out to see a woman with a likely kidney infection and going home to find some peace with George MacDonald's "The Princess and Curdie" and M & M's leads me to an exhausted flop on the couch where I drift back into an endless cycle of thoughts buzzing through my head like mosquitoes in search of Malaria-free victims to infect...

Speaking in Tongues the hard way...

Tout le monde,

Speaking in tongues would come in real handy right now. Apparently, in early post-Jesus days, His disciples were given the instantaneous ability to speak fluently languages they'd never known before. Here we just struggle along hoping to understand a few words of what's said around us.

Chad has 130 languages and dialects and two official languages: French and Chadian Arabic.

Before coming, I felt if I could just learn French I'd be fine. Who wants to learn some obscure language anyway? Wrong...

Most of our staff speak a minimum of 5 languages including French, Arabic and a smattering of local languages. The dialects heard commonly if not daily at the hospital are Nangjere, Moundan, Foulb� and Ngambai.

Without Rahama I'm lost. I call a patient in. It's a Fulani woman. She is dressed in bright colored frilly blouse and wide skirt. She has dreads, a nose ring, and multiple leather pouch fetishes hanging around her neck. She carries a baby strapped on her back with another bright cloth that completely clashes but somehow seems right. Her husband is wearing a tattered light blue arabic robe with a white turban wrapped amply around his neck. I begin.

"Al salaam alekum"

"Wa alekum al-salaam"

"Inti af�?"

And then she spouts off in Foulb�. Her husband translates into Chadian Arabic, Rahama translates into French and hopefully I understand. Rahama has a gift of translation because she's done it long enough that she knows what I want and so if the person doesn't answer the question right instead of just translating she'll continue to clarify with the person till the answer comes to the question asked. With other translators it often turns into a long, painfully slow process of back and forth translation.

I go on rounds. I've heard certain things translated enough that I have picked up some key Nangjer� phrases. I approach a one and a half year old with Malaria. I ask the mom...

"Ba ma balou ga?" (Has he vomited, upchucked, heaved, honked, ralphed, lost his lunch, tossed his cookies, puked, blown chunks, or spewed?)

"Balou di" (None of the above)

"Ba ma sua kouba?" (Does he breastfeed?)

She responds with a nod and a click in the throat.

"Ka kang" (Any more IV fluids left?)

"Kang di" (There's nothing)

"Xalas, ma ere 'ya ba" (He's done with his treatment, he's discharged)

But then grandma comes in and starts to greet me in the long drawn out African style and all I can do is smile and say "lapia" over and over without understanding a thing.

Gueltir knocks on the door. He's arrived to give me my first official Nangjer� lesson. We open the songbook. I can sing a ton of songs but not understand a word. I think it's time to change. We start with the blessing at the front. It's only 4 short lines, but one hour later we have exhausted ourselves trying to help me understand it. The problem is that Nangjer� is so simple and grammatically different from English or French that they are used to translating the meaning of phrases but not words so I never really know what a word means. I made him tell me even if it didn't make "sense" or wasn't good English (our exchange is that Gueltir gets to practice his English). Our other hang-up today is that kà, ka, ka' and 'ka all have different pronunciations and meanings (at least he says they sound different...it's all one and the same to me).

Sarah and I learn languages differently. She learns by ear. She listens, hears, talks and learns...the way we all learn our first language when we are kids...but she may not be able to tell you why a certain thing is said a certain way...just like not everyone who speaks English can teach it. She has an amazing gift and already speaks Danish, English, German, Spanish and French fluently as well as a little Croation, Hebrew, Chadian Arabic and Nangjer�.

I, on the other hand, need books. I need to understand the structure and grammar, the why. That's why Nangjer� is so difficult. There are no books and no dictionary.

With Chadian Arabic I'm having more success. I've bought a book of grammar, a dialogue book and a dictionary. Three nights ago I found myself in the throes of exhilarated language study the kind of which I hadn't enjoyed since my three months in France at the language institute of Collonges.

I had looked up a word in the dictionary. That had it in several phrases. I saw another word I'd wanted to know the meaning of. I looked that up which sent me off to find out the meaning of two other words...etc, etc. I stayed up late with just a candle feeling the thrill of search and discovery. That's why that ending is there. That's what that phrase is they say all the time..."Marra wahid" means completely or till the end...ah ha! Yeah, it's sounds geeky, but when you love languages...

So, I'm starting to feel better. Maybe this speaking in tongues will come even if it is the hard way.

I'm back at work rounding on peds again. I'm feeling pretty cocky after my night with the Chadian Arabic dictionary and my first Nangjer� lesson with Gueltir. I approach the first patient.

"Ba ma balou ga?" Blank stare. Ok, no Nangjer�.

"Hu gai giddif?" Arabic maybe? Blank stare...

"Docteur," a nursing student ventures, "She only speaks Ngambai..."

I give up...

James