Primitive?

I should have followed my instinct. Yesterday, Friday, was my first day back at work in Bere. Apparently, during my absence, the nurses have restarted their morning report. I walked in at the end of it. The nurse presenting was one of our sketchier government nurses named Desiré. He had just talked about a man who had constipation for four days. He was just on observation in the ER because he wasn't that sick. Deep down, I thought, I better go look at this patient now with Desiré. But then I thought, well, the nurses have been doing well during my absence, and I'm sure they can recognize and treat constipation. If they want me to see a patient, they usually tell me. So I went about my day and didn't see the patient.

This morning, Samedi comes to see me before 6 AM.

"The patient with constipation wasn't doing well, so the night nurse called me at 2 AM to see him. He was bloated and vomiting so I put in an NG tube but nothing came out."

"Let's go see him."

The middle aged man is sweating and in obvious discomfort, but able to converse normally. His abdomen is swollen and filled with air. He jumps when I tap it with my finger and shake the bed. There is no stool in his rectum but he is quite tender. He obviously needs an operation.

As the abdominal wall splits open under my knife a dark purple mass pops into view. I enlarge the incision and slide out an edematous, necrotic sigmoid colon that has twisted around itself effectively committing suicide. I clamp across where the colon is still healthy on both sides and remove the necrotic bowel. I free up the upper part of the descending colon so it is more mobile and suture it painstakingly to what's left of the rectum. After three hours, a lot of sutures and irrigation, I close the fascia and leave the skin open. As I pull off the surgical drape I discover his bowels are already moving as he's deposited quite the pile between his legs.

After a brief lunch and rest, Sarah and I saddle up the horses who haven't been out in three months. They are eager, yet controllable. I enjoy the thrill of power beneath me as we race to the river.

There's no relief like soaking in cool water on a hot sub-saharan day. Because of the massive rains yesterday, it is also quite humid and my shirt and pants are soaked with sweat after the five kilometer ride. I unsaddle Libby and lead her into the water where she kicks up a whirlpool playfully with her front hoof before wandering back and forth in the cool stream.

Some of the neighborhood kids have finally arrived, brought two by two on Cory's motorcycle taxi. I put them all through the same initiation. If they want to swim out in the middle they have to survive being attacked by me as I throw, spin, toss and tackle them for several minutes to their screams and cries of joy!

As Sarah and I relax a while later, up to our necks in the swift moving water, we spot an Arab crossing the river on his pregnant horse, following his herd of cows back to his village.

"Lalé!" Sarah shouts. No reply.

"As salaam aleikum!" I attempt but no response. This is quite unusual as most people will respond to a salutation.

"Kikef?" I try again. Finally, the man looks at us and seeing us looking at him wonderingly, he sheepishly reaches up to his ears and removes his tiny earpieces from his MP3 player and greets us back!

By now Sarah and I are laughing at the shear ridiculousness of the contrast between primitive and modern. The man laughs back and greets us many times.

Returning to the hospital on horseback we go cross country relishing in the green grass everywhere in between the broad leaved bushes and freshly plowed fields. We get slightly lost but are reoriented when we see the cell phone tower which is right behind the hospital.

That night, Sarah and I walk through a completely dark village, trying to avoid the mud puddles in the path until we get to a hut that has a single fluorescent bulb out front. We turn into a narrow alley and duck under a hangar made with straw mats. There are mud brick benches arranged between the twisted sticks holding up the roof and in the front is a mat in front of a small television. We have come to see the World Cup. Denmark is playing Cameroon and everyone is surprised to see a woman, much less one fanatically cheering and whistling every time Denmark scores a goal. The rest of the room is silent as we lift our arms and shout as Denmark comes back from 1 to 0 to win the game 2 to 1.

Chad, as usual, a country of contrasts, stuck in the past yet in some ways, just as modern as anywhere else in the world.