Rules of the Road

Friday, March 9, 2012

Day Twelve

At first, it sounded like we would enjoy a leisurely day today. In the morning we had the choice of visiting one of the bomas (houses) in the village or staying in camp to finish packing. I declined the boma tour having "been there, done that" when my daughter was in the Peace Corps in Zambia a few years back. Instead I opted for a quiet morning and an opportunity to breathe, stretch, and reflect on my experience these past two weeks...to commit it to memory. After lunch, we would be heading out to Tarangire National Park on safari.

packing up and moving out

It was a perfect morning... comfortably warm and dry, under a cloudless sky with a light breeze. A good day to see the sights.

Where ever I travel, I am amazed at how quickly we are able to connect with people of all ages from cultures of every description. Even in Lobosoit where tribal customs and traditions are still observed, where the mannerisms, dress, and language were so foreign to us, a fundamental and mutual bond existed even before we arrived. This is the connection I spoke about at the beginning of this blog...the willingness to help and to be helped. To teach and to be taught. To love and to be loved.

While we may have harbored some misgivings when we first arrived, they evaporated as we went about our work. And if the villagers were fearful of us at first, before long we were laughing together and embracing one another. By the time we left, we were talking about plans for the future...for building upon what we started here...for strengthening our partnership with one another. For giving and receiving...materially, intellectually, emotionally, and spiritually.

Admittedly, what we accomplished in our short time here may have been little more than a drop in the proverbial leaky bucket...but at least it's our drop to claim.

After lunch, we boarded the safari vehicles that would transport us to the game park. This is a three hour trek if you stick to the main roads...but our guides decided it would be okay (meaning the roads should be passable) for us to take the "back way"... through the bush. Don't ask me to describe the joys of following rough, rocky, rutted roads through the wilderness for SEVEN HOURS...except to say that I now know what popcorn must feel like!

RULES OF THE ROAD

1. If the bridge is out, use the river bed.
2. If the rocks are too big to get around, drive over them.
3. Don't worry about how deep the mud is. When in doubt, gun it.
4. Before you gun it...make sure the windows are closed.
5. Always carry food and water.

'Nuff said.

One advantage of taking the back roads was that we gained an appreciation for the vast African wilderness...vista upon vista as far as our imaginations could take us. Then, just when we started to think we'd never see civilization again, we would come across a boma...

...in the middle of absolutely nowhere...complete with children who ran out to the road waving and laughing...with livestock in the yard and dogs running loose. Nowhere!

We also saw a fair number of elephants, giraffes, and impala long before we entered the game park.

One of the most impressive sights, to me, were the ancient boabab trees.

You almost expect to see an elf peeking out of a door at the base of these huge trees.

In this part of Tanzania, the long, low hills resemble the drumlins of Central Pennsylvania except that they go on forever. The horizon is punctuated by mountains that rise as sharp and symmetrical as pyramids. From the ridge we drove along, the valley that led to the game park looked exactly like a never-ending championship golf course, studded with flowering bushes, acacia trees and baobabs that grew in perfusion.

We were so excited about seeing the animals in the wild that we had to hurry to make it to the game park gate before it closed for the night. It was still another hour or more until we pulled into the River Camp in Tarangire National Park http://mbalimbali.com/camps/tarangire_river_camp.php .

When we learned this is a "tent camp" our spirits fell...until we saw what kind of tents we were staying in:

Now we're talking! We enjoyed a wonderful meal, a hot shower, and an oh-so-comfy bed for a good night's sleep. We'll need it because we have a full day in store for us before we head to the airport tomorrow night.

*

"The danger of an adventure is worth a thousand days of ease and comfort."

--Paulo Coelho--

*

One more day of fun and adventure before...culture shock!

Be still,

Jan

No complaining. Ever. Again.

Thursday, March 8, 2012

Day Eleven

Daktari Boniface and me in his new pharmacy

Yesterday we closed the clinic and hung a sign on the door to that effect so that people wouldn't arrive expecting to be seen, only to be disappointed today. Still, we were up early so that we would have time to clean up and sort through all the meds and supplies we'll be leaving behind. Dr. Boniface wanted things done a certain way so that's what we did. By the end of the morning we had cleaned out his storage room, set up an exam room, and created a well-stocked and neatly organized pharmacy for him.

The construction team was also successful in completing their goal of building and raising all of the trusses for the roof on the new school building...a monumental accomplishment considering there were no power lifts or cranes involved!

When our work was done, I took a tour of the village. On the way, I passed another group that was working to set up an irrigation project:

...which meant digging a very long ditch this way:

I also passed a woman who was milling maize using a contraption powered by a very loud, very toxic diesel engine:

Of course, I had to get into the act!

Then, it was on into the actual village, where the shopping district looked like this:

You can buy anything here, from flashlights to fabric to soda and candy.

and the road out of town seemed to go on forever:

After my little stroll around the village, I returned to the church where lunch was served...and then we said a tearful good-bye to our friends and staff from the clinic. Both the medical and construction teams felt that there was so much more we could do if only we had more time. Some of us were already planning our next trip to back to Lobosoit!

The afternoon was spent packing up...and enjoying our last few visits to the "cho" and showers. Diane and I decided we needed to track down the zebras nearby so (fearlessly) we took a little trek off the beaten path where we found them hidden among the trees.

After our last supper in camp, we were greeted and thanked again by the village leaders and members of their health committee, including Dr. (Daktari) Boniface. I spoke on behalf of the medical team to thank them for the work they do and for allowing us to be a part of the effort.

Our last night in camp was cold but quiet. I could only think of the children and how cold they must be with only cotton "blankets" for warmth...and of the older folks sleeping on skins on the hard ground with their aching hips and shoulders. While we had enjoyed a full meal of home-baked rolls, pasta, salad and, fruit, they had gone to bed with just milk and "ugali", the equivalent of stiff porridge.

Remind me never to complain again. Ever. About anything.

*

"Gratitude unlocks the fullness of life.

It turns what we have into enough, and more.

It turns denial into acceptance,

chaos to order,

confusion to clarity.

It can turn a meal into a feast,

a house into a home,

a stranger into a friend.

Gratitude makes sense of our past,

brings peace for today,

and creates a vision for tomorrow."

--Melodie Beattie--

*

Tomorrow, we break camp and head out to Tarangire National Park on safari.

Be still,

Jan

A Vague Sense of Relief

Wednesday, March 7, 2012

Day Ten

The night was quiet and the morning started off cloudy and cool, with a couple of passing showers during the day. Knowing that this was our last day to see patients in the clinic brought with it a vague sense of relief. This probably had something to do with the exhaustion we felt, and the inconveniences and minor discomforts we'd shrugged off for the sake of the mission...but it also coincided with the realization that we would soon be heading home to our loved ones...to our own soft beds...to toilets that flush...to everything that we used to take for granted, but never will again!

Today, Isaya translated for me. We treated a young man who was beaten in a fight the day before (not an uncommon occurence), sustaining multiple facial contusions and abrasions, as well as a large corneal abrasion that required antibiotic ointment and a patch. A two year-old presented with a fever of 103 degrees and MUMPS, something we rarely see in the States anymore.

I saw several men with symptoms of prostatism and gastric reflux, and a child who had fallen and sprained her knee.

As we reviewed the week our CRNP, Diane, reported caring for a child suffering the residual effects of polio,

a young woman with what appeared to be rheumatoid arthritis,

and a baby with a large abscess that had to be opened and drained. Except for parasitic infestations, tuberculosis, and malaria, the patients' needs were similar to what we see in our own practices. The difference is that we had less to offer in Lobosoit. And it broke our hearts to have to turn patients away without treatment.

By the end of the day, we had seen 138 patients. Reluctantly, we turned the few remaining hopefuls away. It was some consolation to know that Dr. Boniface and the three national nurses would carry on after our departure. It wasn't as though the clinic was shut down and boarded up. In fact, on Thursday we plan to spend the day cleaning the clinic, and sorting and organizing the medications and supplies we'll be leaving with them to carry on the work we started.

Back at camp, the staff sacrificed a goat so that we could share its meat in a traditional Maasai rite--a affirmation of our shared friendship. The animal was butchered and the meat was roasted on sticks by the fire.

After several hours, we were offered a bite to share. Traditionally, sharing the meat of the goat involves each person taking a piece and then passing in on to the next person until everyone has a piece, thereby feeding one another, a symbol of friendship.

The warriors returned to dance for us again and then night settled in, cold and quiet.

*

"The only true happiness

comes from squandering ourselves

for a purpose."

--William Cowper--

*

Tomorrow is our last day in Lobosoit. I'll give you a brief tour of the village before we leave.

Be still,

Jan

We Saw It All

Tuesday, March 6, 2012

Day Nine

The day dawned under a hazy sun, warmer than it has been. The construction team left camp early to take advantage of the cool morning air...and because they were worried that time would run out before they could raise all the trusses for the roof over the school building, their goal for this trip.

Making progress

That gave the medical team a few minutes to reflect on our experience and to share some of our thoughts about the work we have accomplished and the problems we have encountered...so breakfast ran a little long. Even so, we had to wait for the translators to arrive before we began seeing patients. And again, it was a joy to see the smiles on the villagers' faces when we arrived to open the clinic.

The first order of business was to dispose of a baby bat we found resting on one of the benches when we walked in.

Among the patients we saw today, several stood out. The first was an eleven-year old boy complaining of "leg pain" when what he had was mild cerebral palsy, with a spastic gait, ankle clonus, and joint contractures. We decided that the best management for him was a program of stretching exercises for his tight heel cords and hips. Our physical therapists worked patiently with him for almost an hour, and even drew pictures for him, until he was able to demonstrate the proper technique. He seemed frustrated at first, but left with his drawings in hand and a smile on his face.

We saw a baby with a large cystic mass overlying the anterior fontanel. Except for its appearance, it was causing no symptoms. There was nothing we could do but refer her to a specialist in Arusha.

I also saw a young man with a laceration on his forehead, sustained in a fight the day before. Dried blood still covered his face. I simply cleaned him up, dressed the wound, and gave him a tetanus booster. Boys will be boys.

Next was a developmentally delayed two year-old who was not yet walking or talking, presumably the result of a febrile illness at five months of age. When I suggested that he might have had encephalitis, his mother remembered the word. It turned out that she'd been to numerous doctors seeking help for her child to no avail...nor could we offer any hope to her.

Finally, there was a timid thirteen year-old girl with symptoms of a yeast infection, the result of having been treated with antibiotics a month earlier for G.C. and syphillis. I guess you could say, "We saw it all." Unfortunately.

It seemed as though the patients with the most serious problems were the ones we could help the least. This sounds counterintuitive given the superior medical care we take for granted in the West. In fact, it sounds downright counterproductive...until you realize that the vast majority of the patients we saw in Africa suffered from illnesses that were easily and effectively treated...if only the people had access to basic health care.

Back at camp, two surprises awaited us. First, we were treated to the performance of a traditional Maasai warrior dance, the "jumping dance", which can go on for hours. It is a male seduction dance challenging the strength and stamina of the young men to jump the highest in order to win the favor of a woman.

You can view a version of the dance on YouTube (type in "Maasai jumping dance").

After supper, we gathered around the fire and Elias, our host in Lobosoit, shared his story with the group. Elias was born with a birth defect. He is missing his right forearm and hand.



This is a problem in Africa because the right hand is considered to be the "clean" hand, used for eating and greeting. The left hand is considered to be "dirty"...and that is all Elias has. His story is that of a man struggling to prove himself capable of working and therefore, worthy of a wife. At an early age, he was somehow empowered to overcome his shame and refused to hide his deformity. He sought the humblest jobs and gradually worked his way up by demonstrating his ability and intellect. His family made sure he was educated in Arusha, and in church, his deep, resonating voice became a powerful tool as he turned to teaching.

Nevertheless, he was rejected over and over again by the women he wooed, until he abandonned the notion of marriage and family altogether. He was teaching a class when he met Happiness, the woman he would eventually marry. He wrote her a note inviting her to see him but then left to return to his assignment in his village...and simply dropped the idea of ever seeing her again. Then, one day, a note arrived from her asking where he had gone and why he'd forgotten her. So began an arduous courtship, requiring him to make the 40 km. bike ride in order to see her regularly...until they were married.

Elias is now a strong advocate for the church and community, a liason between the village and international visitors, because of his fluent command of several languages. He overcame not only a personal disability, but a cultural handicap, in order to become a successful community leader, husband and father.

Our closing devotions that night included recitation of our favorite lines from scripture. I offered mine, "Be still and know that I am God," which launched the group into a hymn by that title. And then...one of the team members spoke in tongues. At first I thought he was reciting a prayer in Swahili...until it occurred to me what was happening. This is a gift I do not fully understand...except to say that the words were fluent and beautiful as they came forth.

Settling down for the night was difficult. We had just one more day of clinic and then we would be finished! On Thursday we planned to clean up, and to sort out and organize all the meds and supplies we were leaving behind for Dr. Boniface. On Friday, we planned to break camp and move on into the Tarangire National Park for a day on Safari before heading home...even though there is so much more we could do here...so much left undone.

This is when the count down began and mixed emotions emerged--the desire to get home to friends and family mingled with reluctance to leave...tempered with the hope...the promise, actually...of returning again one day.

*

"A man who becomes conscious of the responsibility he bears toward

a human being who affectionately waits for him,

or to an unfinished work,

will never be able to throw away his life.

  He knows the "why" for his existence,

and will be able to bear almost any "how."

--Viktor Frankl--
*

In my next post I'll tell you about our last day of clinic and the ritual goat slaying.

Be still,

Jan

Why God Created Sunshine

Monday, March 5, 2012

Day Eight

Monday morning rush hour in Lobosoit meant that we were tied up forever--waiting for herds of goats and cattle to amble across the road before we could get on with our business. By the second week we had our routine down pretty well--and so did the villagers who came to see us. They were neatly lined up, single file, outside the clinic when we arrived, instead of crowded together at the door for fear they would be overlooked. After yesterday's welcoming ceremonies, we were greeted with bashful smiles instead of solemn stares...and we started the week with a clean floor!

My fluent translator for the day was Julieth, a villager who was educated in Arusha and returned to the village with the goal of improving the lot of women there.

Julieth and me

She is organizing a women's group in hope of reversing the cultural taboo that prevents women from earning a living and supporting their children. The Masai consider their cattle to be a sign of status and wealth...so they grow their herds without reaping any benefit from them. She wants to teach the women to sell the milk, a "renewable resource", to a dairy affording them the opportunity to generate profit without endangering the herd. But...change comes slowly.

As the day went on, we were gratified to observe the relief and trust the patients felt about discussing their problems with three women...Julieth, Liz (one of our nurses) and me. We saw two women with infertility...one of them with heavy bleeding and two with pelvic pain. We taught them about STD's, their menstrual cycle, normal vs. worrisome pelvic pain, and how difficult it is to treat infertility. They were eager to talk and eager to learn. 

Other patients included a woman with ringworm with a secondary infection whose baby was also infected, and a ten-month old with vomiting, diarrhea, and dehydration. This time, though, it just took a matter of minutes to mix up a container of electrolyte solution, and to teach the baby's mother how to administer it before they were on their way. The rest of the line-up included innumerable patients with coughs, chronic pain, rashes, and worms. No one complained of anxiety. No one presented with depression. None of the children had ADHD. Go figure.

Just as we finished up for the day, a tremendous storm struck...alerting us to the leaks in the roof! Our return to camp was delayed for over an hour.

The group from the music ministry arrived in camp having spent their first week traveling and performing in schools and churches in and around Arusha. Their arrival was also delayed when their van was mired in two feet of mud for over two hours along the way. Around the fire, they treated us to a spiritual that they sang in Swahili.

After a warm shower and supper, another storm moved through and then it rained gently all night long...so good for the crops, but so hard on campers! Everything was damp again. This, I think, is why God created sunshine.

*

"No one cares how much you know

until they know how much you care."

--unknown--

*

In my next post, I'll share Elias's story with you.

Be still,

Jan

Sunday--NOT a day of rest

Sunday, March 4, 2012

Day Seven

This morning we rolled out of our tents a little later that usual, just in time to eat and get to the church (which is next door to the clinic) in time for the worship service. When we pulled in, the countryside was already rocking with African spirituals, beautifully harmonized by a small group of women and children who were accompanied by two guitars and a keyboard...operating off a generator!

Assembly of God Church
Lobosoit, Tanzania

...in her Sunday finest

The music ministry

For forty-five minutes we were treated to rollicking music that invited us to clap along...to stand up and sway to the rhythm. The pastor, Peter, than delivered a meaningful sermon based on the story of Lazarus...insisting that God's plan is perfect, that He is never late...even when we lose hope. There's that word again...hope.

I noticed that the gentleman with the open fracture of his leg had somehow made his way to church. The children were perfectly well-behaved. From what I could gather, they do not spare the rod in this culture. The children learn to do as they're told. The elders and warriors dressed in traditional robes, while the women sported beautiful Western dresses. The men were particularly animated during the service. They held their children with such pride and joy.

After the service, we each received a set of traditional beaded earrings and we presented the Masai women with colorful scarves and sewing kits. We headed back to camp for lunch before returning to the village for the official welcoming ceremony in the afternoon, although a sudden downpour delayed everything for a couple of hours.

 

Each of was introduced at the ceremony and each of us received a traditional Masai "blanket" that was draped and tied for us.

Several of the men, including Vince who you see in this picture, were proclaimed "warriors" and received spears or clubs. The people all sang and danced for us...and we all laughed at our antics. How quickly and eagerly friendships were forged!

After the ceremony, the villagers set out a few traditional crafts for us to buy--beaded bracelets and necklaces, knives and clubs, and other trinkets. I was enchanted with the gourds they use as baby bottles, so I chose two of them.

We spent a typical evening around the fire after supper and enjoyed a quiet night so we would be rested and eager to get back to work in the morning.

*

"Blessed is the man who has the gift of making friends;

for it is one of God's best gifts.

It involves many things,

but above all the power of going out of one's self

and seeing and appreciating whatever is noble and loving in another."

--Thomas Hughes--

*

In my next post, I'll tell you a little more about the clinic and the camp.

Be still--

Jan





Victory

Saturday, March 6, 2012

Day Six

 

When I started to journal this week I had no idea how difficult it would be...for lack of words as much as lack of time and energy by the end of the day. Which is why I was running a day behind in my journal by Saturday. It took a while to process this experience from day to day...it took time and, for me--solitude, both of which were hard to come by.

I can honestly say that I witnessed suffering this week...and in my own way, endured it--emotionally, intellectually, and spiritually. To begin with, the lifestyle of this tribe is difficult...from the harsh, though breath-taking landscape to the cruel weather that challenges the survival of traditionally nomadic cultures--hunger during the dry season, impassable mud during the rainy season, extremes of heat and cold, the wear and tear of hard physical labor--the daily plight of the Masai. There are the rites of birth, puberty, and marriage--and attendant pain that is borne with determination, pride, and courage. And then there is illness that is borne quietly, with a pervasive sense of surrender and resignation...even among the children.

Some of our patient patients

The people came to us full of hope, bursting with gratitude, making it all the more difficult to acknowledge the fact that, in many cases, we could not help them at all. In some cases we lacked the necessary services or medications that might have helped. In others, the condition was untreatable even under the best of circumstances (mental retardation resulting from encephalitis, blindness from remote injuries or infections, traumatic amputations, to name a few).

Mumps

A cystic mass overlying the anterior fontanelle

And so, we shared the same sense of helplessness and hopelessness that drew the patients to us in the first place.

Our entire effort might have seemed a great defeat...except for a couple of indisputable victories:

In my medical practice, I rarely observed an infant with severe dehydration. It never got to that point. Children were seen early and treated intravenously without a second thought. I knew what to look for--elevated heart and respiratory rates, dry skin and tongue, a depressed fontanelle, and lethargy--but it wasn't until I saw a three-month old Masai infant with a 2 week history of vomiting and diarrhea that I observed all the classic signs. And it scared me...because we had no way of measuring sodium and potassium levels or monitoring urine output, information that is important in the care of these infants. And we had only oral rehydrating packets with us...packets that required clean water that could be measured and mixed. We had to brainstorm for a few minutes. Eventually we estimated what strength solution we should use and simply mixed it up in a couple of discarded containers for the mother to carry home with her. Then we taught her how to measure and deliver the solution to her baby through a syringe. To our delight, the child eagerly sucked it down without any trouble before we sent her on her way.

In another case, a young boy presented with a limp, the result of cellulitis (infection) involving both legs from festering sores. Both legs were red, hot, and swollen by the time we saw him and provided the antibiotics he needed. God knows what would have become of him otherwise. Sepsis? Osteomyelitis? Death?

Access to timely and competent medical care is considered an imperative in our culture

...though it remains an impossibility in many Third World countries, in remote villages like Lobosoit. Yet, sometimes the simplest intervention can be life-saving. Why would we want anything less for these children than we expect for our own? How can we endure their suffering when we can't bear our own? In places like Lobosoit, compassion is rewarded with heartache...and heartache compels us to care.

Today we joined the construction team for lunch which consisted of a traditional dish, "green banana stew." In case you were wondering, green bananas taste just like potatoes when prepared this way.

We saw almost one hundred patients again today--all of them stoic and solemn, hopeful, and appreciative. Oh, and playful. At the end of the day, while waiting for our ride back to camp, we engaged a few loitering children in games of jump rope and "follow-the-leader". First, work...then play.

Back at the camp, we showered, and took our nice dry laundry in off the lines we had hung. The hunt brought in a water buffalo today...with a 39 inch horn spread. It was butchered on site. You can imagine my reaction when one of the Masai took one of the kidneys, sliced it in half, and popped it into his mouth raw! Euwww! At least ours would be roasted before it appeared on our plates...like the marshmallows we enjoyed around the fire again before heading to bed.

All night long we were serenaded by the night sounds arising from the bush. We awoke during a passing thunderstorm and then slept until daybreak.

Tomorrow is Sunday--though NOT a day of rest--closing out Week One of our adventures in Lobosoit.

*

"Without suffering there is no compassion,

and without compassion, there is no hope..."

--author unknown--

*

In my next post, I'll tell you how to enjoy Sundays without access to professional sportscasting.

Be still,

Jan

Habari! Hujambo?

Friday, March 2, 2012

Day Five

Habari! Hujambo? Hello! How are you?

As you can see, I've learned a few words in Swahili. I've also mastered a couple of other survival skills:

• checking outside before stepping out of the tent to avoid the fresh droppings that were deposited on our doorstep over night
• brushing my teeth with Listerine (I was positive I'd packed toothpaste...somewhere.)
• applying make-up by the light of an LED flashlight

That accomplished, we gathered for breakfast, discussed plans for the day, and we were headed out to the worksite by 8:30. The "waiting room" was already crowded.

Today my translator was Isaya:

Isaya

Although he had no medical background he quickly learned to ask patients about their symptoms and, because he was familiar to the villagers, they felt comfortable around him. Among the problems we saw today were the unbiquitous coughs and back pain, as well as a few unfamiliar rashes, urinary tract infections, mastitis, conjunctivitis, and worms. A mother brought her daughter in, blind in one eye because of a thick corneal scar, probably the result of  an infection at birth. Sadly, we had nothing to offer her.

The case of the day though was something of a medical miracle, an older gentleman who, four months earlier, had suffered an "open fracture" of the tibia and fibula in his lower leg...meaning that the bones were so displaced they broke through the skin.

He arrived with a pair of crude crutches. The wound was wrapped in rags. I dreaded uncovering it, expecting to see gangrene by this time, but miraculously, there was no sign of infection. The injury had closed over with a thick scar...although whenever he attempted to bear weight on the leg, he felt the bones shifting...with excruciating pain. Glenn, one of our physical therapists, was so touched by the man's predicament...and survival...that he looked into the cost of an Xray, orthopedic referral in Arusha, and eventual surgery. Literally, a pittance! The team contributed the necessary funds and Glenn made certain the man would receive follow-up care after our departure. It's likely he'll end up with an amputation and a prosthesis which would enable him to walk again without pain.

Our therapists also took an extended period of time with a boy who presented with "leg pain" but actually had mild cerebral palsy with a spastic gait. They taught him some stretching exercises for his tight heel cords and hips. Many thanks to Glenn and Kim for their patience and dedication!

Today we saw over 100 patients in the clinic...and we tended to a couple of team members as well...one of whom tripped on a vine and took a bad tumble, one with an eye infection, a couple of rashes, and one of our builders who suffered with a cervical radiculopathy...meaning severe pain in his neck running all the way down his left arm, not conducive to hammering, sawing, and heavy lifting...which he insisted upon doing against medical advice--mine! You know who you are...

Back at the camp in the afternoon, I sorted and washed dirty clothes (in a bucket), and hung them out to dry. Finally the sun came out and the we were able to enjoy the warmth.

The game hunters brought in an Impala today. It appeared at supper and will grace various dishes over the next few days, including stews and sauces.

But before we gathered for supper one of the village elders was invited to share his story with us, a matter of great pride to him. It was the story of a lion attack he survived...and he had the scars on his leg to prove it. As he was describing the attack, he was laughing...about how the lion had been surrounded, how it paced and growled as it sought a way out of the circle of warriors, and finally made a break for it, attacking as it ran. It was as though he were amused by the lion's antics...even though he nearly lost his leg in the attack. It seems as though pain is borne as an inevitablilty here, something to be expected, tolerated, even celebrated. I wonder what ever became of PTSD among these people.

After supper, we gathered around the fire as usual. This time, though,we roasted marshmallows. Oh, the simple, sweet pleasures we take for granted!

The night sky was hazy but the moon was full, casting an eerie light over the landscape and whatever was lurking there...

I still haven't gotten a glimpse of the Milky Way...stretching in a bright arc from horizon to horizon, the way I remember it from my visit to Zambia a few years ago. Like Mt. Kilimanjaro, I'll be disappointed if I don't get to see it again on this trip. 

It stayed dry all night for the first time since our arrival. Instead, our sleep was interrupted by the night noises...animals baying in the distance, the rustle of branches behind the tent, the footsteps of the warrior checking for nocturnal predators. Even so, one woman was surprised by a hyena behind her tent when she stepped outside to relieve herself! The hunting team had reported cheetahs, giraffes, and water buffalo not far away. Still, I never sensed that we were any real danger. Life was simply carrying on as usual despite our arrival.

We enjoyed another (relatively) quiet night.

*

"There are only two ways to live your life.

One is as though nothing is a miracle.

The other is as though everything is a miracle."

--Albert Einstein--

*

Tomorrow we are promised entertainment by the Masai warriors.

Be still--

Jan

Hearts warmed, hearts broken

Thursday, March 1, 2012

Day Four

the thorns of the Acacia tree

After the overnight storms moved away, the day dawned cloudy, breezy, and cool. We hung things out, mopped up the puddles in our tents, and opened the flaps in hopes that they would dry during the day. Breakfast was served at 7 am--eggs and toast, sausage (think "hot dog"), fresh fruit, juice, and good strong coffee.

After breakfast we were introduced to our English speaking host, Elias, several of the local elders and officials,

as well as the young Masai (or Maasai) warrior who guarded the camp against nocturnal prowlers, hyenas among others.

Masai warriors are young men between the ages of around seventeen (when they are circumcised without any anesthesia) and thirty-five, when they become elders. While they are in training they live separately where they participate in initiation rites and learn to fight and hunt. Historically, the warriors fought to protect the village when tribal warfare was rampant. Now that peace reigns, at least around Lobosoit, they are charged with protecting the cattle herds against attacks by lions and other predators, and with guarding crops against herds of elephants that tramp through indiscriminately. As if the circumcision wasn't enough to prove their courage and strength, they were traditionally required to kill a lion with a spear before they earned the title "warrior". This, of course, is no longer permitted.  Warriors are identified by the head dress they wear and the long braids they sport. You can learn more about them at http://www.maasai-association.org .

Once the introductions and welcomes were finished, we headed out to the clinic. I'd seen pictures of it before--a small, spare concrete building--but it wasn't until I saw it for the first time myself, with a long line Masai villagers already waiting for us, that I knew what we were up against.

the "waiting room"

my examination room

Right next door, the construction team got to work on the school building with a few simple tools and alot of muscle power!

The school before...

and after!

The clinic is staffed by three national nurses and a national doctor. Despite the inadequacies of the physical layout, the absence of any professional support system, and a shortage of medication, Dr. Boniface arrived every day with a broad smile and willingness to help and to be helped. It took several hours to organize and set up the clinic, meet our translators, and begin registering patients. The medical record consisted of the chief complaint, a brief (1-2 lines) history, the diagnosis (or as close as we come to one), and the treatment plan. Follow-up, for the most part, was impossible. Nevertheless, we saw over 50 patients before we had to close the doors and get back to camp. 

Our medical team

With all due respect for HIPAA (which thankfully doesn't exist in Lobosoit), this is some of what we saw on just the first day:

                    --Almost every man, woman, and child complained of chronic conjuctivitis and cough, the result of daily exposure to wood smoke and dust.
                    --Almost every patient complained of headache, neck and shoulder pain, and low back and leg pain. I have to admit that I was under the impression that African women were somehow uniquely suited to carrying heavy loads, that they were strong and resilient from years of physical labor, so that carrying five-gallon jugs of water on their heads, cultivating gardens by hand with a baby strapped to their backs, and sleeping on the hard floor with just a simple mat came naturally to them. I learned otherwise. Chronic, unrelenting pain is as much a problem for them as it would be for us under similar circumstances.
                    --I saw a child with a stiff, swollen, painful knee following an attack by a bull some three months earlier.
                    --There were many women with STD's, urinary tract infections, menstrual problems, and infertility.
                    --I saw a woman with anemia and rectal bleeding by history whose problems had been attributed to an hormonal imbalance for reasons I will never comprehend.
                    --And I learned to diagnose a belly full of worms by feeling them in there!

For me, making an accurate diagnosis was "iffy" at best. The language barrier made it difficult to obtain an accurate history. We lacked adequate facilities to examine patients (there was no place for them to lie down to be examined). We lacked even the simplest lab tests, and despite everything we brought with us, we still lacked the medication we needed to treat many conditions. This was a problem because unless the patient could be treated in the clinic...there simply was no treatment for them at all. Most of the villagers could neither find transportation to the hospital in Arusha nor afford the cost of care there. Therefore, people with the most serious illnesses or injuries still had no access to definitive care. And even when we offered patients a small amount of medication for their chronic pain and coughs, it was only enough to last a week or two.

It was so hard having to turn patients away when there was nothing we could do for them...they came so full of hope.  From time to time I had to ask myself what we were doing there...other than breaking our own hearts.

At three o'clock we had to close the clinic doors and send people away so we could finish up and make it back to camp before dark. There were no protests...no indignant outcries for immediate attention, no grumbling or head wagging. The people simply picked up their belongings and headed back home across the fields. They would be back in the morning.

When we got back to camp, we were just in time for a photo-op with the wildebeest they killed that day.

This little fellow appeared on our plates that night and in various other forms for several days. What we didn't eat (some 500 pounds of meat) was donated to the village. Let me just say that chewing wildbeest is alot like chewing rope...or what I imagine chewing rope to be like. I gave up on it after the first bite...otherwise I'd still be chewing on it today!

To our delight, the staff had a roaring fire going when we got back to camp and they actually heated water for us so we could enjoy a brief but warm shower. It's amazing how little water you can make do with when the supply is limited!

After supper we gathered around the fire again until it started to rain. The rain continued gently all night long but I slept soundly with a just few brief awakenings, still warm and dry. It was a better night in anticipation of another busy day.

*

"Doctors prescribe medicine of which they know little,

to cure diseases of which they know less,

in human beings of which they know nothing."

--Voltaire--

* 

In my next post, I'll tell you about an amazing man and how the team stepped up to assure him the medical care he needed.

Be still--

Jan